A Venous Reservoir Bag System
I’m doing some perfusion traveling as I am taking my show on the road. As such, every once in awhile I will be dropping a few notes and pictures of places visited, and observations made. In a sense, the beginning of a scrap book on Open Heart Surgery in America (and other places if possible).
To view the entire series- click here: A Locum’s ScrapBook.
A Paradigm Shift- The Venous Reservoir Bag
So it’s the 3rd day of being on call, and the phone rings…
Well of course, the first case to be- is an emergency. Challenges, challenges…
First you’ve got to navigate through the hospital maze of corridors, made a little hazier because you are already thinking 5 steps ahead to the pump setup, pyxis (perfusion access), meeting and working with the surgeon for the first time, meeting unfamiliar anesthesia teams, the OR teams, multiple new access codes, a new cardioplegia recipe, the natural progression of this heart team’s routine, the surgeon’s routine, anesthesia preferences, location of in-room cannulas and table supplies, and then there is your ECC- a closed system utilizing a bag and hardshell reservoir in tandem (see above red arrows).
To answer the obvious question, yes I had an orientation 3 days prior. A lot of stuff packed into a few hours. Being in an empty room, looking at a vacant circuit, and absorbing all of the tactical issues to be addressed for a live bypass run- is one thing. Walking into a room that is about to get a previously coded patient, and applying all of that new information into a workable timeline- is quite another. Not to mention that noone in that room has a clue as to who you are, or what your background is.
I guess the ID badge tells them I am a Perfusionist?
So into the fray it is, and the power works so that’s good. Two heater coolers, one for the ECC- the other is for cardioplegia (an old Sarns workhorse), Forane vaporizer is empty and has a leak (not good- but discussed with anesthesia and bypassed). So off to the lab to get a myriad of POC (Point Of Care) instruments in order to run blood gases, glucoses, and ACT’s. Run the controls, manual input of 3 data points, PT ID, Cartridge Lot numbers, and user ID, all of which can be scanned- but the scanner is kind of twitchy so it’s manual input time… for this case at least.
Ice is located, Pyxis emptied of prerequisite perfusion drugs, cardioplegia meds added for high and low dose K+ solutions, and all systems are primed and de-aired. CHECK!
About that Venous Bag System…
I am familiar with closed bag systems because I had trained on them and have roughly three years experience using them. They de-air via a line at the top that goes to a luer lock fitting on the inlet of the pump sucker line. Once de-aired, they are really a nicely closed system thus reducing dramatically, the O2-air interface. It gets it’s return from both the venous cannula AND a cardiotomy reservoir. The weakest-link-question of course is the hard shell open air reservoir that feeds into it, with extra volume as well as scavenged blood from the field (vents and suckers). The question of the day is whether in theory it is a closed system, and then in practice is it actually an open system?
The pundits can discuss that ad infinitum. Me, I have a patient to get on bypass.
An interesting nuance to the venous bag reservoir is that the top of it usually expands and contracts in tandem with fluctuations in the venous return. Movement on the circuit is to a perfsuionist- what a shiny object is to a Magpie, IT GETS YOUR ATTENTION.
Unlike the calm surface of the sea inside a hardshell reservoir, watching the venous bag is like watching a rough tide churn in and out from the beach, sucking sand (the other side of the bag) back into the deep (both sides of the bag getting sucked together like a collapsing jellyfish). Fascinating really, but it always makes you want to give volume to make it stop. Of course you don’t but the desire to do so is always right there.
A long story short? The case went well.
On to the next event 🙂