During Perfusion - Terumo Xcoating Capiox Rx Serie Bedienungsanleitung

1. If recirculation line is used to prime, clamp arterial and venous lines distal to recirculation line and make sure that recirculation line
is not clamped.
2. Introduce crystalloid priming solution through quick prime port or any of the luer ports leading to cardiotomy filter.
3. Make sure that recirculation circuit and the purge line are not clamped, then start pump at a low speed. After checking for leakage or
any other problem, gradually increase to full flow. Do not exceed 7 L/min flow rate for RX25, 5 L/min flow rate for RX15R40 or 4 L/min
flow rate for RX15R30. Vigorously recirculate the priming fluid through the entire circuit until all air bubbles are eliminated. Check
oxygenator and tubing for leakage or any other problems.
WARNINGS • Do not use an oxygenator and reservoir that leak. Replace it with another CAPIOX RX oxygenator and reservoir.
• Do not use a tubing with internal diameter less than 3/16" (4.8mm) as a recirculation line. Also do not use
a sampling line nor a purge line for recirculation. If used, the oxygenator module will be damaged as a result
of excessive positive pressure being generated inside itself.
CAUTIONS • Do not supply gas during priming.
• Recirculate the priming solution at a rate of 4 L/min or higher to facilitate air removal. Failure to remove air
from the oxygenator may result in serious injury to the patient.
• Maintain a minimum operating level of 200 mL in the RX25/RX15R40 reservoir at all times.
• Maintain a minimum operating level of 70 mL in the RX15R30 reservoir at all times.
• Returning the priming solution back to the cardiotomy filter when there is an insufficient level of solution
contained within the reservoir may generate gaseous emboli. Maintain an adequate level of solution in the
reservoir.
4. When appropriate after the debubbling, introduce blood or blood-derived products through quick prime port or any of the luer ports
leading to cardiotomy filter.
5. Set stopcocks as shown in Fig. 7, and close sampling line with arterial side stopcock to prevent arterial to venous shunting during
extracorporeal circulation. After closing the purge line, reduce blood flow rate gradually to zero; then close recirculation line.
WARNING
• During recirculation, do not use pulsatile flow or stop blood pump suddenly. Otherwise gaseous emboli may
enter the blood phase from the gas phase due to inertia force.
CAUTION • Close purge line prior to initiation of bypass.
INITIATION OF BYPASS
Check the following before initiating bypass.
CAUTION Ensure that the de-airing process is complete prior to initiating bypass. Repeat "priming procedure" to
dispel air.
Initiate extracorporeal circulation using normal procedure, taking note of the following warnings.
WARNINGS
• Before starting gas supply, confirm again that gas outlet port is not obstructed. Such obstruction may lead to
pressure build-up in the gas phase, allowing gaseous emboli to enter into the blood phase.
• Start gas supply only after blood circulation is initiated.
• Before initiating extracorporeal circulation, be sure to confirm that recirculation line and purge line are closed
and sampling line is also closed with arterial side stopcock. Otherwise, opening arterial line will cause the blood
to flow back into reservoir through sampling line because of the patient's blood pressure and the head height.
• Start gas supply with V/Q = 1 and FiO

DURING PERFUSION

1. In order to collect blood samples, withdraw at least 10 mL of blood, then collect blood through the sampling line. When sampling arterial
blood, blood can be collected after opening the stopcock for arterial-venous shunting through sampling line.
WARNING
Collect blood only while pump is running, or blood-side pressure will decrease and air bubbles may result.
NOTE : Sampling manifold holder (Code No: XX*XH051) can be used when the sampling system is separated from the
Hardshell Reservoir.
2. Measure blood gases and make necessary adjustments as follows.
a. Control PaO by changing concentration of oxygen in ventilating gas using gas blender.
2
– To decrease PaO , decrease FiO
2
– To increase PaO , increase FiO
2
b. Control PaCO by changing the total gas flow.
2
– To decrease PaCO , increase total gas flow.
2
– To increase PaCO , decrease total gas flow.
2
WARNING
A phenomenon called wet lung may occur when water condensation occurs inside fibers of microporous
membrane oxygenators with blood flowing exterior to the fibers. This may occur when oxygenators are used
for a longer period of time. If water condensation and/or a decrease in PaO
during extended oxygenator use, briefly increasing the gas flow rate may improve the performance. Increase gas
flow rate to 15 L/min for RX15 and 20 L/min for RX25 for 10 seconds. DO NOT repeat this flushing technique,
even if oxygenator performance is not improved.
CAUTIONS
• A minimum of 0.5 L/min oxygen gas flow is needed when blood is circulated. Less than 0.5 L/min oxygen
gas flow may result in inadequate gas exchange.
• Prior to resuming bypass, set FiO
PO in the patient's blood at the beginning of recirculation may not be able to be recovered without appropriate
2
gas supply.
= 100 %, then make adjustments based on blood gas measurements.
2
.
2
.
2
at 100% to ensure adequate oxygenation. Increased PCO
2
and/or an increase in PaCO is noted
2 2
and decreased
2
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