Priming And Recirculation Procedure; Initiating Bypass - SORIN GROUP D 903 AVANT VAVD Mode D'emploi

3) Connect the 1/4" line with condensate chamber supplied with the
product to the adapter
4) Connect the other end of the line to the vacuum regulation system.
11) VAPOROUS ANAESTHESTICS
The oxygenator is suitable for use with volatile anaesthetic isoflurane and
sevoflurane, by mean of a suitable narcosis gas evaporator.
If these vaporous anaesthetics are used, some method of scavenging the
gas from the oxygenator should be considered.
The protocol, the concentration and the monitoring of the anaesthetic gases
administrated to the patient, is under the sole responsibility of the physician
in charge of the treatment.
The only volatile anaesthetics suitable for this use are isofluorane and
sevolfuorane
The methods adopted for vaporous anaesthetic gas scavenging should
not increase or reduce in any way the pressure level at the oxygenator
fibres.
F. PRIMING AND RECIRCULATION PROCEDURE
- Do not apply the vacuum during this procedure
- Do not use alcoholic priming solutions: such solutions could compromise
the proper function of the oxygenating module.
1) KEEP THE GAS FLOW OFF
2) KEEP THE OXYGENATOR PURGING/RECIRCULATION
LINE CLOSED
Check that the purging-recirculation stopcock is closed.
3) CLOSE VENOUS AND ARTERIAL LINES
Clamp the venous line. Clamp the arterial line some centimetres away from
arterial outlet connector of the oxygenator.
4) CHECK THE HEAT EXCHANGER
Verify again the integrity of the heat exchanger, paying 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 through the "Quick Priming Port" (fig. 2, Ref.
16) with sufficient liquid to ensure the intended haematocrit is obtained,
taking into account:
- the recovered priming volume of the oxygenator is 270 ml;
- the 3/8" tube capacity is 72 ml/m;
- the 1/2" tube capacity is 127 ml/m.
Clamp the Venous Reservoir outlet.
In order to fill the Venous Reservoir or if the Cardiotomy Reservoir capacity
(1200 mls) is not enough, open the connection to the Venous Reservoir by
raising the connection key (fig. 2, ref. 3) on the top of the Cardiotomy
Reservoir and keep it open during circulation.
6) CIRCUIT PRIMING
- The pressure level inside the blood compartment of the oxygenating
module shall not exceed 100 KPa (1 bar / 14 psi).
Clamp the venous reservoir outlet and remove the pump segment from the
arterial pump head. Fill the pump segment by keeping it at the same height
as the Venous Reservoir and slowly opening the clamp occluding it. By
slowly bending downward the tube segment to be filled, the air in the tube will
be routed to the oxygenator. The complete priming of the oxygenating
module is completed by gravity.
Once the D903 AVANT VAVD is filled, place the pump segment in the arterial
pump.
7) OPEN VENOUS AND ARTERIAL LINES
Remove the clamp from the venous and arterial lines and increase flow up to
2000 ml/min.
8) OPEN THE PURGING/RECIRCULATION LINE
Once the steps up to and including point 7 have been carried out, increase
the arterial pump speed until the flow reaches the maximum value of 8.0
l/min. Open the purging/recirculation stopcock for some seconds in order to
prime the oxygenator purging/recirculation line.
9) PURGE 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) CLOSE THE PURGING/RECIRCULATION LINE
After 3-5 minutes in which the flow is maintained at a high rate, all air will be
evacuated and it is possible to close the purging/recirculation line from the
dedicated stopcock.
11) CLOSE 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.
-I f the reduction connector (D523C) and a circuit have been connected
to the coronary outlet port, check the priming of the connected line.
- Clamp the line some centimetres away from the outlet.
- Do not create a negative pressure at the coronary outlet. Negative
pressure in the blood compartment could cause microbubble
formation.
G. INITIATING BYPASS
1) CLOSE THE CONNECTION KEY
Close the Cardiotomy/Venous Reservoir connection key (Fig. 2, Ref. 3). The
vacuum can now be applied to the Venous Reservoir.
- It is advisable not to exceed ñ80mmHg (10,4 KPa / 0,10 bar) negative
pressure applied to the reservoir
- Periodically check functioning of the vacuum regulating device and
the degree of vacuum.
2) 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.
3) CHECK THE CORRECT OPERATION OF THE HEAT
EXCHANGER
Check the temperature of the venous and arterial blood.
4) 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.
5) 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
Regulate the vacuum applied to the Venous Reservoir so that an adequate
venous return is obtained.
- 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) LOW FLOW RECIRCULATION
(Hypothermia associated with circulatory arrest).
- Suspend vacuum application during the entire circulatory arrest
procedure.
GB - ENGLISH
Decrease FiO
2
Increase FiO
2
Increase gas flow
Decrease gas flow
of
2
5