Initiating Bypass - dideco D 902 LILLIPUT 2 Mode D'emploi

WARNING
- The pressure level inside the soft venous reservoir shall not
exceed 13 KPa (0.13 bar / 1.9 psi).
- The pressure level inside the blood compartment of the
oxygenating module shall not exceed 100 KPa (1 bar / 14 psi).
All versions
Switch the arterial pump on to prime the oxygenating module. In
this condition, the blood recirculates between the oxygenator and
the venous reservoir: maximum flow shall not exceed 200 ml/min.
8) OPENING OF THE VENOUS AND ARTERIAL LINES
Open the purge line of the oxygenator by means of the blue clamp
in order to purge the air which is contained in the line.
Close the clamp. Remove the venous and arterial line clamps and
increase flow up to 2000 ml/min.
9) CLOSING THE OXYGENATOR RECIRCULATION LINE
Close the white clamp placed on the recirculation line.
10) 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.
11) PRIMING OF THE 4-WAY SAMPLING MANIFOLD
Versions with the SOFT and RIGID VENOUS RESERVOIR
The removal of the air from the A/V sampling system is achieved
by selecting the yellow A/V SHUNT position.
If the arterial pressure is not sufficient to remove the microbub-
bles from the tube walls, squeeze gently the arterial line of the cir-
cuit so as to partially close it.
12) 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.
13) CLOSING THE VENOUS AND ARTERIAL LINES
WARNING
- 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
4
Remove first the clamp from the arterial line, then remove the
clamp on the venous line. Start the bypass with a blood flow appro-
priate to patient size.
Check constantly the blood level in the venous reservoir.
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
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 para-
meters as follows:
High pO
2
Low pO
2
High pCO
2
Low pCO
2
5) KEEP THE PURGE LINE OF THE SOFT VENOUS RESERVOIR OPEN
Decrease FiO
2
Increase FiO
2
Increase gas flow
Decrease gas flow
Versions with SOFT VENOUS RESERVOIR
Continuous air purge from the soft venous reservoir is recommended.
H. DURING BYPASS
1) CHECKING THE VENOUS RETURN
If a higher venous return flow is necessary act as follows:
Versions with SOFT VENOUS RESERVOIR
a) Open completely the soft reservoir squeezer in order to
increase the reservoir volume.
All versions
b) Lower both the oxygenator and the venous reservoir with
respect to the patient position.
WARNING
Versions with SOFT VENOUS RESERVOIR
- The cardiotomy must always be placed in a higher position
with respect to the soft venous reservoir.
- It is recommended to keep the line connecting cardiotomy
and soft venous reservoir clamped during the case, in order
to prevent massive air delivery to the patient in case the car-
diotomy and the soft venous reservoirs empty. In case blood
has to be moved from the cardiotomy to the soft venous reser-
voir, carefully open the clamp and avoid to empty the line
connecting cardiotomy and soft venous reservoir. Emptying
the cardiotomy and the soft venous reservoir might result in
air delivery to the oxygenator and, eventually, to the patient.
All versions
- The venous reservoir attached to the oxygenator must always
be placed in a higher position than the oxygenator.
- The ACT (Activated Coagulation Time) must always be longer
than or equal to 480 seconds in order to ensure adequate
anticoagulation of extracorporeal circuit.
2) ARTERIAL SAMPLING
Versions with SOFT and RIGID VENOUS RESERVOIR (fig. 1 and 2)
a) Turn the selector switch on the sampling stopcock (ref. 9) 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. 8).
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
Versions with SOFT and RIGID VENOUS RESERVOIR
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
operation (aspiration and purge) can be done whilst maintaining
the selector switch in the same position.
4) DRUG DELIVERY
Versions with SOFT and RIGID VENOUS RESERVOIR
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. 10) 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.
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.