Priming And Recirculation Procedure; Initiating Bypass; Terminating Bypass; Blood Recovery After Bypass - dideco D 902 LILLIPUT 2 ECMO Mode D'emploi

anticoagulant to the patient, use a female luer lock
connector on the venous line.
F. PRIMING AND RECIRCULATION
PROCEDURE
Do not use alcoholic priming solutions: such solutions could
compromise the proper functioning of the oxygenating module.
1) KEEP THE GAS FLOW OFF
2) KEEP THE OXYGENATOR RECIRCULATION LINE
CLOSED
3) ISOLATE THE OXYGENATING MODULE
Clamp the venous line and the arterial outlet of the oxygenator.
4) CIRCUIT PRIMING
The pressure level inside the blood compartment of the
–
oxygenating module shall not exceed 100 KPa (1 bar / 14
psi).
Gravity prime the oxy module keeping, when possible, the unit in
orizontal position. Switch the pump on, opening the clamp on the
recirculation line, keeping the flow at 200 ml/min. In this condition,
the blood recirculates between the oxygenator and the venous
line.
5) OPENING OF THE VENOUS AND ARTERIAL
LINES
Remove the venous and arterial line clamps and increase flow up
to 2000 ml/min.
6) CLOSING THE OXYGENATOR RECIRCULATION LINE
Close the recirculation line.
7) PURGING THE AIR CONTAINED IN 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.
8) OPENING THE RECIRCULATION LINE
After complete removal of air from the circuit, it is possible to
reduce the arterial flow to 200 ml/min opening the recirculation line
and performing recirculation.
9) CLOSING 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.
G. INITIATING BYPASS
1) OPENING OF 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.
2) CHECKING 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 of 80:100%.
2
• 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) 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.
d) Clamp the arterial line.
e) Recirculate at a maximum 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.
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 blood flow to 200 ml/min.
• If extracorporeal circulation has to be restarted subsequently, a
minimum blood flow inside the LILLIPUT must be maintained
(maximum 200 ml/min).
• If the use of the haemofilter is necessary, refer to its specific
instructions for use.
J. BLOOD RECOVERY AFTER BYPASS
1) Recover as much blood as possible from the venous line and deliver
it into the aorta by means of the arterial pump, as required by the
patient condition.
2) Once the venous cannulae have been removed:
a) Turn the arterial pump off.
GB - ENGLISH
Decrease FiO
2
Increase FiO
2
Increase gas flow
Decrease gas flow
5