Initiating Bypass; Terminating Bypass - SORIN GROUP D901 LILLIPUT 1 Mode D'emploi

3) ISOLATE THE RIGID VENOUS RESERVOIR FROM THE OXYGENATING
MODULE
Clamp the reservoir outlet "blood outlet" and the venous return.
Clamp the arterial line some centimetres from the oxygenator arterial outlet.
4) CHECKING THE HEAT EXCHANGER
Verify again the integrity of the heat exchanger, with particular attention to
possible water leaks.
5) VENOUS RESERVOIR PRIMING
Secure with ties all aspiration lines connected to the cardiotomy reservoir. Fill
the cardiotomy reservoir with sufficient liquid to ensure the intended
haematocrit is obtained, taking into account:
- the recovered priming volume of the oxygenator is 60 ml;
- the 3/16" tube capacity is 19 ml/m;
- the 1/4" tube capacity is 32 ml/m.
In order to fill the Venous Reservoir or if the Cardiotomy Reservoir capacity is
not enough (250 ml), open the connection to the Venous Reservoir by
rotating the connection key (ref. 3) on the top of the Cardiotomy Reservoir.
6) CIRCUIT PRIMING
- The pressure level inside the blood compartment of the oxygenating
module shall not exceed 100 KPa (1 bar / 14 psi).
Remove the clamp at the cardiotomy outlet.
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.
7) OPEN VENOUS AND ARTERIAL LINE
Remove the clamp from the venous and arterial line and increase flow up to
800 ml/min.
8) CLOSING THE OXYGENATOR RECIRCULATION LINE
Close the white clamp placed on the recirculation line.
9) 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.
10) PRIMING OF THE SAMPLING MANIFOLD
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 microbubbles from the tube walls, squeeze gently the arterial line
of the circuit so as to partially close it.
11) 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.
12) CLOSING THE VENOUS AND ARTERIAL LINES
- 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.
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
80:100%.
- 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 oxygenator and the
venous reservoir with respect to the patient position.
- 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 operation
(aspiration and purge) can be done whilst maintaining 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 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 ("CARDIOTOMY
RESERVOIR OPEN" position). With the connection key in position
"CARDIOTOMY RESERVOIR OPEN" the hardshell reservoir acts as a
standard Venous Reservoir.
of
If you need to add priming solution directly into the Venous Reservoir,
2
without using liquids collected into Cardiotomy Reservoir, connect a priming
line to 3/16" - 1/4" connector located 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.
GB - ENGLISH
decrease FiO
2
Increase FiO
2
Increase gas flow
Decrease gas flow
5