Terminating Bypass; Blood Recovery After Bypass; Use Of Cardiotomy For Post-Operative Drainage; Oxygenator Replacement - dideco D 901 LILLIPUT 1 Bedienungsanleitung

The suggested gas/blood flow ratio in normothermia is 1:1 with
a Fi0 of 80:100%.
2

WARNING

- 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 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) CHECKING THE VENOUS RETURN
If a higher venous return flow is necessary lower both the oxyge-
nator and the venous reservoir with respect to the patient position.
WARNING
- 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 administration of anticoagulant to the patient is envisaged,
use the "DRUGS PORT" of the sampling stopcock.
2) ARTERIAL SAMPLING
a) Turn the selector switch on the sampling stopcock (ref. 10) to
the "A-SAMPLE PURGE" position (the arterial line will then be
automatically purged).
b) Insert the syringe into the sampling female luer marked
SAMPLE PORT (ref. 16).
c) Aspirate at least 2 ml of blood (the automatic purge avoids the
need to repeat the operation). A self-closing valve will avoid
any blood leakage from the luer.
3) VENOUS SAMPLING
a) Turn the selector switch on the sampling stopcock to the
"V-SAMPLE PURGE" position.
b) Insert the syringe into the female luer marked "SAMPLE
PORT".
c) Aspirate and purge the blood sample a couple of times before
proceeding to the venous sampling analysis. This double
4
operation (aspiration and purge) can be done whilst maintai-
ning the selector switch in the same position.
4) DRUG DELIVERY
a) Turn the selector switch on the sampling stopcock to the
DRUGS INJECTION position.
b) Insert the syringe containing the drug into the female luer
marked DRUGS PORT (ref. 17) and inject the liquid.
c) Turn the switch to the A-V SHUNT position. The system will be
automatically flushed and the drug will flow into the venous
line.
5) LOW FLOW RECIRCULATION
(Hypothermia associated with circulatory arrest).
a) Reduce the gas flow to less than 200 ml/min.
b) Open the recirculation line and clamp the venous line.
c) Reduce the flow from the arterial pump to 200 ml/min.
d) Clamp the arterial line of the oxygenating module (ref. 13).
e) Recirculate at the flow of 200 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) Clamp the recirculation line.
h) Adjust gas flow.
6) VENOUS/CARDIOTOMY RESERVOIR MANAGEMENT
As reported in the Description (chapter A), the D901 LILLIPUT 1
OPEN SYSTEM enables the separation of the Cardiotomy
Decrease FiO
2
Increase FiO
2
Increase gas flow
Decrease gas flow
Reservoir from the Venous Reservoir. This separation is achieved
by closing the connection key ("CARDIOTOMY RESERVOIR
CLOSE" position) located on the top of the cardiotomy reservoir.
This option is suggested when the liquid from the suckers must
be separated from the venous blood in order to be:
1. rejected
2. processed apart.
If you wish mix the collected blood collected into the Cardiotomy
Reservoir and the venous blood, open the connection key ("CAR-
DIOTOMY RESERVOIR OPEN" position). With the connection key
in position "CARDIOTOMY RESERVOIR OPEN" the hardshell
reservoir acts as a standard Venous Reservoir.
If you need to add priming solution directly into the Venous
Reservoir, without using liquids collected into Cardiotomy
Reservoir, connect a priming line to 3/16" - 1/4" connector loca-
ted on the connection key (ref. 18).
The connection key must be kept in "CLOSE" position.
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) Open the recirculation line.
5) Clamp the arterial line.
6) Increase arterial flow to 200 ml/min.
CAUTION
- If extracorporeal circulation has to be restarted subsequently, a
minimum blood flow inside the D901 LILLIPUT 1 OPEN SYSTEM
must be maintained (maximum 200 ml/min).
- If the use of the haemofilter is necessary, refer to its specific
instructions for use.
WARNING
Absolutely avoid the emptying of the hardshell Venous Reservoir.
J. BLOOD RECOVERY AFTER BYPASS
1) Recover into the Venous Reservoir 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.
4) If necessary, empty the Cardiotomy Reservoir through pos lock
connector and dedicated adapter included in the LILLIPUT 1
OPEN SYSTEM packaging.
K. USE OF CARDIOTOMY RESERVOIR FOR POST-
OPERATIVE DRAINAGE
If the use of the Cardiotomy Reservoir for post-operative drainage
is envisaged, act as follows:
1. Clamp the purging/recirculation line.
2. Disconnect the purging/recirculation line and close the connec-
tion with a luer cap.
3. Separate the venous reservoir from the oxygenating module by
rotating the white hook .
4. Locate the Venous Reservoir on its own holder.
L. 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.
CAUTION
Use sterile methods during all replacement procedure.
1) Turn the gas flow off