Terumo CAPIOX FX 25 Mode D'emploi page 9

b. PRIMING PROCEDURE
CAUTION Perform priming using crystalloid solution which contains no blood, plasma and/or blood derived products. Using blood derived products will increase
the amount of time necessary to prime. Therefore, if blood derived products are used during priming, start bypass after performing air purge thoroughly.
NOTE: CAPIOX FX25 can be primed without CO
1. If recirculation line is used to prime, clamp arterial and venous lines distal to recirculation line, and make sure that recirculation line is not clamped.
2. Introduce crystalloid priming solution through quick prime port or any of the luer ports leading to cardiotomy filter.
3. Make sure the recirculation circuit and the purge line are not clamped, then start pump at a low speed. After checking for leakage or any other problem, gradually increase to full
flow. Do not exceed 7 L/min flow rate. Vigorously recirculate the priming fluid through the entire circuit until all air bubbles are eliminated. Check oxygenator and tubing for leakage
or any other problem. After all air bubbles are eliminated, circulate at full flow for 10 min to check oxygenator and tubing for leakage or any other problem.
WARNINGS
• Do not use an oxygenator and reservoir that leaks. Replace it with another CAPIOX FX25 oxygenator and reservoir.
• Do not use a tubing with internal diameter less than 3/16" (4.8 mm) as a recirculation line. Also do not use a sampling line nor a purge line for recirculation. If used, the
oxygenator module can be damaged as a result of excessive positive pressure being generated inside itself.
CAUTIONS
• Do not supply gas during priming.
• Recirculate the priming solution at a rate of 4 L/min or higher to facilitate air removal. Failure to remove air from the oxygenator may result in serious injury to the
patient.
• Maintain a minimum operating level of 200 mL in the reservoir at all times.
• Returning the priming solution back to the cardiotomy filter when there is an insufficient level of solution
contained within the reservoir may generate gaseous emboli. Maintain an adequate level of solution in the
reservoir.
4. When appropriate after the debubbling, introduce blood or blood-derived products through quick prime port or any of
the luer ports leading to cardiotomy filter.
5. Set stopcocks as shown in Fig. 7, and close sampling line with arterial side stopcock to prevent arterial to venous
shunting during extracorporeal circulation. After closing the purge line, reduce blood flow rate gradually to zero; then
close recirculation line.
6. After priming, if air bubbles continue to appear, identify the cause and make necessary corrections. Remove the air
while opening the purge line.
WARNING During recirculation, do not use pulsatile flow or stop blood pump suddenly. Otherwise gaseous
emboli may enter the blood phase from the gas phase due to inertia force.
CAUTION Close purge line before stopping bypass.
c. INITIATION OF BYPASS
Check the following before initiating bypass.
CAUTION Ensure that the de-airing process is complete prior to initiating bypass. Repeat b. "priming procedure" to dispel air.
Initiate extracorporeal circulation using normal procedure, taking note of the following warnings.
WARNINGS
• Start gas supply only after blood circulation is initiated.
• Before starting gas supply, confirm again that gas outlet port is not obstructed. Such obstruction may lead to pressure build-up in the gas phase, allowing gaseous
emboli to enter into the blood phase.
• Before initiating extracorporeal circulation, be sure to confirm that recirculation line and purge line are closed and sampling line is also closed with arterial side
stopcock. Otherwise, opening arterial line will cause the blood to flow back into reservoir through sampling line because of the patient's blood pressure and the head
height.
• Start gas supply with V/Q=1 and FiO
d. DURING PERFUSION
1. In order to collect proper blood samples, withdraw at least 10 mL of blood, then collect blood through sampling line. In the case of arterial blood sampling, blood can be collected
after opening the stopcock for arterial-venous shunting through sampling line.
WARNING Collect blood only while pump is running, or blood-side pressure will decrease and air bubbles may result.
NOTE: For the use of the sampling system separated from Hardshell Reservoir, sampling manifold holder (Code No: XX*XH051) is available.
2. Measure blood gases and make necessary adjustments as follows.
a. Control PaO by changing concentration of oxygen in ventilating gas using gas blender.
2
- To decrease PaO , decrease FiO
2
- To increase PaO , increase FiO
2
b. Control PaCO by changing the total gas flow.
2
- To decrease PaCO , increase total gas flow.
2
- To increase PaCO , decrease total gas flow.
2
WARNING A phenomenon called wet lung may occur when water condensation occurs inside fibers of microporous membrane oxygenators with blood flowing exterior
to the fibers. This may occur when oxygenators are used for a longer period of time. If water condensation and/or a decrease in PaO
PaCO is noted during extended oxygenator use, briefly increasing the gas flow rate may improve the performance. Increase gas flow rate, to 20 L/min for
2
10 seconds. DO NOT repeat this flushing technique, even if oxygenator performance is not improved.
CAUTIONS
• A minimum of 0.5 L/min oxygen gas flow is needed when blood is circulated. Less than 0.5 L/min oxygen gas flow may result in inadequate gas exchange.
• Prior to resuming bypass, set FiO
may not be able to be recovered without appropriate gas supply.
flush when crystalloid priming solution is used. Use of CO
2
=100%, then make adjustments based on blood gas measurements.
2
.
2
.
2
at 100% to ensure adequate oxygenation. Increased PCO
2
flush permits debubbling in a shorter time.
2
Fig. 7
and decreased PO in the patient's blood at the beginning of recirculation
2 2
Venous side stopcock
(blue spot)
Arterial side stopcock
(red spot)
and/or an increase in
2
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