Blood Recovery After Bypass; Use Of Active Venous Drainage With Vacuum; Use Of Cardiotomy For Post-Operative Autotransfusion; Oxygenator Replacement - SORIN GROUP dideco D 905 AVANT Mode D'emploi

minimum blood flow inside the D 903 AVANT 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 ACTIVE VENOUS DRAINAGE WITH VACUUM
This method may be applied at any time during extra-corporeal circu-
lation, provided that the steps below are followed. Using the kit code
086000, or equivalent supplied separately, and a vacuum regulation
device, AVANT can be used for active venous drainage using vacuum.
This technique constitutes an alternative to venous drainage by gra-
vity and allows the use of shorter venous lines with reduced diameter
and smaller-gauged cannulas.
L. 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.
M. 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.
CAUTION
Use sterile methods during all replacement procedure.
Replacement of the oxygenator and the AVANT 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 allow re-
connection.
7) Remove the D 903 AVANT from the holder and remove the pump
segment from the arterial pump.
8) Place a new D 903 AVANT 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).
WARNING
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 903 AVANT.
10) Fill the cardiotomy reservoir of the new D 903 AVANT with
priming solution through the 1/4" or 3/8" quick prime connectors
located on the head of the venous reservoir.
11) Prime the new D 903 AVANT 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 the reservoir).
10) Remove all other monitoring and sampling lines from the
oxygenating module.
11) Cut the oxygenator inlet line and the arterial line in the section
between the two clamps, leaving a sufficient length of tubing to
allow re-connection.
12) Move the water locking system to the "OPEN" position.
13) Lift the oxygenator and rotate the hook (fig. 1, ref. 2) on the upper
part of the holder.
14) Fit the slot of the reservoir into the hook of the holder.
15) Uncouple the reservoir from the oxygenating module by means of
the white interface (fig. 2, ref.19)
16) Remove the oxygenating module from the holder.
17) Place a new D 903 AVANT oxygenating module on the holder.
18) Fix it by moving the water connector locking system to the
"CLOSE" position.
19) Connect the oxygenator inlet line and the arterial line to the
oxygenating module
In this phase, keep the venous and arterial lines clamped.
20) Switch on the thermocirculator and check the heat exchanger.
21) Lift the reservoir and rotate the hook. Put the reservoir on the
oxygenating module. If possible couple the reservoir and the
oxygenating module by means of the white interface.
22) Connect the gas line, the arterial sampling line and all the
monitoring lines.
23) Remove the clamp from the venous line.
24) Keeping the recirculation line open (purging/ricirculation stopcock
in "RECIRCULATION" position) prime the oxygenating module
through the arterial pump. Purge the air contained in the module
at a maximum flow rate of 2000 ml/min
25) Close the recirculation line (purging/recirculation stopcock in
"CLOSE" position.
26) Remove the clamp from the arterial line and restart the bypass.
27) Connect, if necessary, the cardioplegia line and purge it.
N. MEDICAL DEVICES FOR USE WITH THE D 903 AVANT
For post-operative autotransfusion with the Venous Reservoir one of
the two following kits should be used:
- D 540 AUTOTRANSFUSION CONVERSION KIT code 05053.
- D 540 W AUTOTRANSFUSION CONVERSION KIT with water seal,
code 05062.
All tubing used to make the circuit connections must be of a diameter
5