Initiating Bypass; Terminating Bypass; Blood Recovery After Bypass; Oxygenator Replacement - Sorin Group D903 Avant Module Gebrauchsanweisung

l/min. Open the purging recirculation stopcock for some seconds in order to
prime the oxygenator recirculation line.
9) PURGE THE AIR FROM THE CIRCUIT
During this phase it is necessary to tap the entire circuit in order to facilitate
the removal of microbubbles from the tube walls.
After some minutes in which the flow is maintained at a high rate, all air will
be evacuated.
10) CLOSE THE PURGING/RECIRCULATION LINE
After 3-5 minutes of high flow recirculation/purge all the residual air will be
evacuated and the purging/recircualtion line can be clamped. Stop the
arterial pump.
11) CLOSE THE VENOUS AND ARTERIAL LINES
- During the priming and purge phases, the arterial/venous circuit
must be maintained at least 30 cm higher than the arterial outlet of
the oxygenator.
- Do not use pulsatile flow during priming. -Check the correct dosage
of anticoagulant in the system before starting the bypass.
- SORIN GROUP ITALIA recommends the use of the pump speed
control to reduce or stop the arterial flow slowly.
- Do not use the pump on/off switch until the pump speed is zero.
- If the reduction connector (D523C) and a cardioplegia circuit have
been connected to the coronary outlet port, check the priming of the
connected line.
- Clamp the line some centimetres away from the outlet.
- Do not create a negative pressure at the coronary outlet. Negative
pressure in the blood compartment could cause microbubbles
formation.
G. INITIATING BYPASS
1) OPEN THE ARTERIAL AND VENOUS LINES
Remove first the clamp from the arterial line, then remove the clamp on the
venous line. Start the bypass with a blood flow appropriate to patient size.
Check constantly the blood level in the venous reservoir.
2) CHECK THE CORRECT OPERATION OF THE HEAT
EXCHANGER
Check the temperature of the venous and arterial blood.
3) SELECTION OF THE APPROPRIATE GAS FLOW
The suggested gas/blood flow ratio in normothermia is 1:1 with a Fi0
80:100%.
- Always open the gas flow after the blood flow. The gas/blood flow
ratio must never exceed 2:1.
- The pressure in the blood compartment must always exceed that of
the gas compartment. This is to prevent gas emboli appearing in the
blood compartment.
4) BLOOD GAS MONITORING
After a few minutes of bypass operation, measure the gas content of the
blood. Depending on the values found, adjust the relevant parameters as
follows:
High pO
2
Low pO
2
High pCO
2
Low pCO
2
H. DURING BYPASS
1) CHECK THE VENOUS RETURN
If a higher venous return flow is necessary lower both the oxygenator and the
venous reservoir with respect to the patient position
- The venous reservoir attached to the oxygenator must always be
placed in a higher position than the oxygenator.
- The auxiliary cardiotomy must always be placed in a higher position
with respect to the soft venous reservoir (closed system).
- The ACT (Activated Coagulation Time) must always be longer than or
equal to 480 seconds in order to ensure adequate anticoagulation of
extracorporeal circuit.
- If it is necessary to give the patient additional anticoagulant, use the
following:
a filtered luer inlet of the rigid venous reservoir (open system);
decrease FiO
2
Increase FiO
2
Increase gas flow
Decrease gas flow
a female luer lock on the collapsable reservoir venous return
(closed system).
2) ARTERIAL SAMPLING
To perform arterial sampling use the female luer lock connector placed on
the arterial outlet. That luer is fitted with a one-way valve which allows
aspiration only.
3) VENOUS SAMPLING AND DRUG DELIVERY
The venous reservoir should provide both drug delivery and venous
sampling.
4) LOW FLOW RECIRCULATION
(Hypothermia associated with circulatory arrest).
a) Reduce the gas flow to less than 500 ml/min.
b) Open the purging/recirculation line and clamp the venous line.
c) Reduce the flow from the arterial pump to 2000 ml/min.
d) Clamp the oxygenator arterial line.
e) Recirculate at a maximum flow of 2000 ml/min. throughout the patient's
circulatory arrest.
f) To restart bypass after circulatory arrest, open the venous and arterial lines
and slowly increase the blood flow.
g) Close the recirculation line.
h) Adjust gas flow.
5) CONTINUOUS AIR PURGE
The purging/recirculation stopcock features the continuous purge line
diverting from the arterial line only a few mls/min even at full arterial blood
flow.
Always carefully check the level inside the venous reservoir. Greater
care should be taken during emptying over particularly low levels
and/or reduced flows.
I. TERMINATING BYPASS
Must be carried out after consideration of each individual patient's state. Act as
follows:
1) Turn the gas flow off.
2) Turn the thermocirculator off.
3) Slowly decrease the arterial flow to zero while closing the venous line.
4) Clamp the arterial line.
5) Open the purging/recircualtion line.
6) Increase pump flow until 2000 ml/min.
- If extracorporeal circulation has to be restarted subsequently, a minimum
blood flow inside the AVANT MODULE must be maintained (maximum 800
of
ml/min).
2
- Verify that the cardioplegia circuit connected to the coronary outlet port is
properly clamped.
To eliminate air from the oxygenator, proceed as follows:
1) Turn the gas flow off.
2) Turn the arterial pump off.
3) Clamp the arterial line.
4) Restore the venous return so that the required volume of liquid is in the
venous reservoir.
5) Clamp the venous line.
6) Open the purging/recircualtion line and recirculate at a rate of 2000 ml/min
until complete air removal from the system.
7) Restart bypass by opening the arterial and venous lines.
8) Clamp the purging/recircualtion line.
J. BLOOD RECOVERY AFTER BYPASS
1) Recover as much blood as possible from the venous line, as soon as the
surgeon has removed the cannulae from the patient's vena cava.
2) Deliver blood into the aortic cannulae as required by the patient's condition,
slowly decreasing the level in the Venous Reservoir.
3) When the reservoir is nearly empty stop the arterial pump and clamp the arterial
line.
K. OXYGENATOR REPLACEMENT
A spare oxygenator must always be available during perfusion. After 6 hours of use
with blood or if particular situations occur, which may lead the person responsible for
perfusion to determine that the safety of the patient may be compromised
(insufficient oxygenator performance, leaks, abnormal blood parameters etc.),
proceed as follows for oxygenator replacement:
Use a sterile procedure during the entire replacement phase.
1) Turn the gas flow off.
GB - ENGLISH 5