Terminating Bypass; Blood Recovery After Bypass; Use Of Cardiotomy Reservoir For Postoperative Autotransfusion; Oxygenator Replacement - SORIN GROUP D 903 AVANT VAVD Mode D'emploi

- Vent the vacuum line by pulling the vent tab on the adapter
connected to the "Vacuum Line Port" for a few seconds.
a) Reduce the gas flow to less than 500 ml/min.
b) Open the purging/recirculation line and clamp the Venous Reservoir inlet line
(fig. 2, ref. 13).
c) Reduce the flow from the arterial pump to 2000 ml/min.
d) Clamp the oxygenator arterial line (fig. 2, ref. 5).
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 purging/recirculation line (lever in "CLOSE" position).
h) Adjust gas flow.
i) Restart vacuum assisted drainage.
3) VENOUS/CARDIOTOMY RESERVOIR MANAGEMENT
As reported in the Description (chapter A), the D903 AVANT VAVD 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.
- During a vacuum assisted venous drainage procedure keep the
connection key (Fig. 2, Ref. 3) in the down position (closed). Open the
connection key only for the time necessary to send, when considered
appropriate, the blood collected in the cardiotomy reservoir to the
venous reservoir.
- If wishing to change from vacuum assisted venous drainage to
traditional venous drainage, suspend the vacuum application and
open the connection valve (Fig. 2, Ref. 3). The valve can be locked in
this position with the red clamp found in the convenience kit
provided with the product.
- If the venous reservoir is completely filled, a safety system intervenes,
suspending vacuum application (Fig. 2, Ref. 17). To restart vacuum
assisted venous drainage, pull the vent tab on the adapter (Fig. 2, Ref. 21)
connected to the "Vacuum Line Port" (Fig. 2, Ref. 18) for a few seconds.
If you need to add priming solution directly into the Venous Reservoir use the
"Cardiotomy Bypass Port" (fig. 2, Ref. 15).
Keep the "Venous Reservoir Port" connection closed during a vacuum
assisted venous drainage procedure. Open it when fluids need to be
sent to the Venous Reservoir and only for the time necessary for this
operation.
With the connection key in up position the hardshell reservoir acts as a
standard Venous Reservoir.
4) CONTINUOUS AIR PURGE
The purging/recirculation stopcock in "PURGE" position features the
continuous air purge evacuating 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
4) Clamp the arterial line.
5) Open the recirculation line.
6) Increase arterial flow until 2000 ml/min.
- If extracorporeal circulation has to be subsequently restarted, a minimum
blood flow inside the D903 AVANT VAVD 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 CARDIOTOMY RESERVOIR FOR
POSTOPERATIVE AUTOTRANSFUSION
6
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 Drainage Holder"
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. Close all the connections used during the bypass including the vent on the
cardiotomy reservoir (Fig. 2, Ref. 22).
5. Connect the vacuum regulator to the adapter provided with the product (Fig. 2,
Ref. 19)
6. Lock the connection key (Fig. 2, Ref. 3) with the red clamp found in the
convenience kit provided with the product.
- 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.
- In case negative pressure applied to the system makes pressure relief valve
operate, the collected blood is not suitable for retransfusion as
contaminated.
L. 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, clotting of the filter etc.), proceed as follows for

oxygenator replacement.

Use a sterile technique during the entire replacement procedure.
Oxygenator and AVANT VAVD DUAL RESERVOIR:
1) Suspend the vacuum application to the Venous Reservoir.
2) Turn the gas flow off
3) Close, by means of a double clamp, the venous line (5 centimetres apart).
4) Turn the arterial pump off and close, by means of a double clamp, the arterial
line (5 centimetres apart) placed next to the oxygenator.
5) Turn the thermocirculator off, clamp and remove the water lines.
6) Disconnect the gas line, all monitoring and sampling lines.
7) 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.
8) Remove the D903 AVANT VAVD from the holder (according to the appropriate
instructions for use) and remove the pump segment from the arterial pump.
9) Place a new D903 AVANT VAVD on the holder. Connect all the lines (i.e.
venous to the Venous Reservoir, arterial and gas to the oxygenator, pump
segment to the Venous Reservoir and oxygenator, vacuum to the Venous
Reservoir).
In this phase, keep the venous and arterial lines clamped.
10) Open the water lines on the holder turn the thermocirculator on and check the
integrity of the new D903 AVANT VAVD.
11) Fill the cardiotomy reservoir of the new D903 AVANT VAVD with priming
line.
solution through the 1/4" or 3/8" quick prime connectors located on the head of
the venous reservoir.
12) Prime the new D903 AVANT VAVD and evacuate the microbubbles, as
described in the priming and recirculation procedure.
13) Verify all connections and secure with ties.
14) Remove clamps from the venous and the arterial line, close the
purging/recirculation line and start the bypass again.
15) 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.
16) 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) Suspend vacuum application to the Venous Reservoir.
2) Turn the gas flow off and disconnect the gas line.
3) Clamp the venous return.
4) Turn the arterial pump off and close, by means of a double clamp, the arterial
line (5 centimetres apart) next to the oxygenator.
5) Close, by means of a double clamp, the oxygenator inlet line near the
oxygenating module connector (5 centimetres apart).
6) Turn the thermocirculator off, clamp and remove the water lines.
7) Close
purging/recirculation line.
GB - ENGLISH
the purging/recirculation stopcock and disconnect the