Terminating Bypass; Blood Recovery After Bypass; Use Of Cardiotomy For Post-Operative Autotransfusion; Oxygenator Replacement - SORIN GROUP D905 EOS Mode D'emploi

"DRUGS PORT" 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 500 ml/min.
b) Open the recirculation line (lever of the purging/recirculation stopcock in
the "RECIRCULATION" position) and clamp the Venous Reservoir inlet
line (fig. 2, ref. 15).
c) Reduce the flow from the arterial pump to 2000 ml/min.
d) Clamp the oxygenator arterial line (fig. 2, ref. 7).
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 (lever in "CLOSE" position).
h) Adjust gas flow.
6) VENOUS/CARDIOTOMY RESERVOIR MANAGEMENT
As reported in the Description (chapter A), the D 905 EOS enables the
separation of the Cardiotomy Reservoir from the Venous Reservoir. This
separation is achieved by opening (up position) or closing (down position) the
connection lever 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 need to add priming solution directly into the
Venous Reservoir use the indicated port "Cardiotomy Bypass Port" (fig. 2,
ref. 16).
With the connection key in up position the hardshell reservoir acts as a
standard Venous Reservoir.
FOR DEVICES EQUIPPED WITH SELF-CLOSING SAFETY VALVE:
- The self-closing safety valve is a safety device to prevent massive air
transmission to the patient in case the venous reservoir suddenly
empties. The valve works with flows between 1 to 5 l/min.
However, the self-closing safety valve does not relieve the perfusionist
from carefully checking the level in the Venous Reservoir.
More attention has to be paid when emptying the reservoir with low
blood level and/or low flows.
- In the case of insufficient venous return flow the self-closing safety
valve might collapse. If this happens, consequent negative pressure
might cause gas extraction from the blood if the arterial pump is not
stopped immediately. To eliminate air from the oxygenating module,
proceed as follows:
1) Turn the gas flow off.
2) Turn the arterial pump off.
3) Clamp the arterial line.
4) Restore the required volume of liquid into the Venous Reservoir.
5) Clamp the venous line.
6) Open the purging/recirculation line and recirculate at a rate of 2000
ml/min until air removal from the system is completed.
7) Restart bypass by opening the arterial and venous lines.
8) Close the purging/recirculation line.
9) Open gas flow.
7) CONTINUOUS AIR PURGE
The purging/recirculation stopcock in "PURGE" position features the
continuous air purge diverting from the gas exchange module during bypass.
In this condition and at full arterial blood flow, the continuous purge diverts
from the arterial line only few mls/min.
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 recirculation line.
6) Increase arterial flow until 2000 ml/min.
7) In the case of separation of blood recovered by the aspirators:
a) remove the pos-lock on the connection key (fig. 2, ref. 5) and connect the
adapter D 523C (provided with the product)
b) recover the blood collected in the Cardiotomy Reservoir with an
autotransfusion machine connected to the adapter with a 1/4" line
c) wash the collected blood and reinfuse to the patient
6
- If extracorporeal circulation has to be subsequently restarted, a minimum
blood flow inside the D 905 EOS must be maintained (maximum 2000 ml/min).
- During recirculation do not turn the thermocirculator off. -Verify that the
cardioplegia circuit connected to the coronary outlet port is properly
clamped.
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 canulae 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. USE OF CARDIOTOMY RESERVOIR FOR POST-
OPERATIVE AUTOTRANSFUSION
If the use of the Cardiotomy Reservoir for post-operative autotransfusion is
envisaged, act as follows:
1. Disconnect the purging/recirculation line.
2. Separate the venous reservoir from the oxygenating module by removing the white hook.
3. Locate the venous reservoir on the "Post Operative Chest DrainageHolder code 05039" and
use one of the following optional kits referring to their respective instructions for use:
- D 540 AUTOTRANSFUSION CONVERSION KIT code 05053;
- D 540 W AUTOTRANSFUSION CONVERSION KIT with water seal, code
05062.
4. If wishing to use the full capacity of the reservoir, lock the connection key (fig. 2,
ref. 5) with the red clamp found in the convenience kit provided with the product.
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.
Use sterile methods during all replacement procedure.
Replacement of the oxygenator and the EOS DUALRESERVOIR
1) Turn the gas flow off.
2) Close, by means of a double clamp, the venous line (5 centimetres apart).
3) Turn the arterial pump off and close, by means of a double clamp, the arterial
line(5 centimetres apart) placed next to the oxygenator.
4) Turn the thermocirculator off, clamp and remove the water lines.
5) Disconnect the gas line, all monitoring and sampling lines.
6) Cut the venous return and the arterial lines in the section between the two
clamps, leaving a sufficient length of tubing to
7) Remove the D 905 EOS from the holder and remove the pump segment from the arterial
pump.
8) Place a new D 905 EOS on the holder. Connect all lines (i.e. venous to the Venous
Reservoir, arterial and gas to the oxygenator, pump line to Venous Reservoir and
oxygenator).
In this phase, keep the venous and arterial lines clamped.
9) Open the water lines on the holder, turn the thermocirculator on and check the
integrity of the new D 905 EOS.
10) Fill the cardiotomy reservoir of the new D 905 EOS with priming solution.
11) Prime the new D 905 EOS and evacuate the microbubbles, as described in the
priming and recirculation procedure.
12) Verify all connections and secure with ties.
13) Remove clamps from the venous and the arterial line, close the
purging/recirculation line and start the bypass again.
14) The blood remaining in the replaced Venous Reservoir may be recovered by
connecting its outlet port to one of the 3/8" inlet connectors of the new reservoir.
15) The blood contained in the oxygenator and heat exchanger may be poured into
the new Venous Reservoir by connecting the arterial line to one of the 3/8" inlet
connectors of the new reservoir.
Replacement of only the oxygenating module
1) Turn the gas flow off and disconnect the gas line.
2) Clamp the venous return.
3) Turn the arterial pump off and close, by means of a double clamp, the arterial
line (5 centimetres apart) next to the oxygenator.
4) Close, by means of a double clamp, the oxygenator inlet line near the
oxygenating module connector (5 centimetres apart).
5) Turn the thermocirculator off, clamp and remove the water lines.
6) Close the purging/recirculation stopcock and disconnect the purging/recirculation
line.
7) Clamp and disconnect the cardioplegia line, if connected.
8) Turn the sampling manifold selector switch to the "OFF" position.
9) Disconnect the arterial sampling avoiding any contamination of the sampling
stopcock luer lock (i.e. by connecting it to a female luer lock placed on the top of
GB - ENGLISH
allow re-connection.