Initiating Bypass; Terminating Bypass - SORIN GROUP dideco D 905 AVANT Mode D'emploi

G. INITIATING BYPASS
1) OPEN THE ARTERIAL AND VENOUS LINES
Remove first the clamp from the arterial line, then remove the
clamp on the venous line. Start bypass with a blood flow
appropriate to patient size.
Check constantly the blood level in the Venous Reservoir.
2) CHECK 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 the 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) CHECK 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 manifold (fig. 2, 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.
c) Aspirate at least 2 ml of blood (the automatic purge avoids the
4
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) DRUGS INJECTION
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" 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).
Decrease FiO
2
Increase FiO
2
Increase gas flow
Decrease gas flow
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 D903 AVANT
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.
WARNING
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 7.5 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
CAUTION
- If extracorporeal circulation has to be subsequently restarted, a