CONDUCT OF PERFUSION - cardiac anesthesia basics灌注心脏麻醉的基本行为.ppt

CONDUCT OF PERFUSION October 16, 2003 Brian Schwartz, CCP PURPOSE OF CPB PROVIDE SURGEONS WITH A MOTIONLESS AND BLOODLESS FIELD PROVIDE PROTECTION TO VITAL ORGAN SYSTEMS Your Objectives Understand the components of the CPB circuit Understand the sequence for assembly of the circuit Able to calculate the predicted hemoglobin and hematocrit Understand the determinants of oxygen consumption Conduct of Perfusion Purpose of CPB: support patient’s metabolic needs while providing a motionless, bloodless cardiac surgical field Parameters that must be met: Proper flow rate Oxygen delivery Carbon dioxide removal Anticoagulation Temperature Blood pressure Blood recovery Components of the CPB Circuit Oxygenator Heat exchanger Venous reservoir Gas flow meter Variety of pumps Tubing Cannulae Hemoconcentrator Alarms Drugs Assembly The set up is dependent upon: Procedure Patient size Surgeon’s preference Perfusionist’s preference CONDUCT OF PERFUSION WE ARE TALKING ABOUT OUR DUTIES AND RESPONSIBILTIES PRE-OP, INTRA-OP, AND POST-OPERATIVELY THE PERFUSIONIST’S TIME LINE GET A HANDLE ON THE SCHEDULE REVIEW PATIENT’S CHART SELECTION OF DISPOSABLE EQUIPMENT ASSEMBLE HLM PLUG IN POWER AND GAS LINES PLUG IN HEATER/COOLER (WATER TEST) Time Line (cont) CO2 flush the circuit Prime the circuit Test all occlusions Check list Perform all quality controls ALWAYS BE PROPARED TO GO ON CPB TIME LINE (CONTINUED) PRIME CIRCUIT PERFORM CHECK LIST ADMINISTRATION OF HEPARIN INITIATION OF CPB TERMINATION OF CPB ADMINISTRATION OF PROTAMINE BREAKDOWN AND CLEANUP OF HLM PRE-BYPASS CALCULATIONS PREDICTED HEMATOCRIT 70 X KG = TBV TBV X HCT = TRBC TBV + PRIME + ANES. DRIPS = TCBV TRBC/RCBV = DILUTIONAL HCT PRE-BYPASS CALCULATIONS HCT IF SEQUESTERING BLOOD TRBC – { 500 cc x HCT } / TCBV – 500 cc HEPARIN ADMINISTRATION DESCRIBED AS AN ANTICOAGULANT MUST FULLY ANTICOAGULATE PATIENT SITE OF ACTION: ATlll AND INHIBITS FACTORS IX AND XI OF THE CLOTTING CASCADE GIVE 300-400 UNITS/