Priming And Recirculation Procedure; Initiating Bypass - SORIN GROUP D902 LILLIPUT 2 Mode D'emploi

All versions
Close the blue clamp on the oxygenator purge line.
10) CONNECTING THE GAS LINE
Connect the 1/4" gas line to the connector on the upper cover labelled "GAS
INLET". Ensure that the gas supply is from a suitable air/oxygen mixer such as
the Bird, code 9374 (available from SORIN GROUP ITALIA) or a system with
compatible technical features. A capnograph connector can be found in the centre
of the connector marked "GAS ESCAPE".
The "GAS ESCAPE" system is designed to avoid any possible risk of
blocking the gas outlet; such blockage could cause the immediate
passage of air to the blood compartment.
SORIN GROUP ITALIA recommends the use of a bubble trap or filter on
the arterial line to reduce the risk of emboli transmission to the patient.
Such risk could be due to:
1) collapse of the soft venous reservoir, caused by a reduced venous
return; arterial pump cavitation generates emboli; LILLIPUT purge not
being correctly operating, allowing air to enter artery via the pump.
2) the air which is delivered via the venous cannulae is not removed
promptly from the venous reservoir and is aspirated by the arterial
pump.
If there is to be continuous administration of anticoagulant to the patient:
Versions with SOFT VENOUS RESERVOIR
Use a female luer lock connector on the soft reservoir venous return
connector.
V
ersion with RIGID VENOUS RESERVOIR
Use one of the two filtered female luers lock positioned on the rotating head
of the rigid reservoir.
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 use alcoholic priming solutions: such solutions could compromise the
proper functioning of the oxygenating module.
1) KEEP THE GAS FLOW OFF
2) KEEP THE OXYGENATOR PURGE LINE CLOSED
Check that the blue clamp, placed on the oxygenator purge line, is in the closed
position. Keep the white clamp placed on the recirculation line open.
3) SET THE VOLUME OF THE VENOUS RESERVOIR (fig. 1)
Versions with the SOFT VENOUS RESERVOIR
Set the desired volume using the soft reservoir squeezer (ref. 7).
4) ISOLATE THE SOFT VENOUS RESERVOIR AND OXYGENATING
MODULE
Versions with the SOFT VENOUS RESERVOIR
Clamp the cardiotomy outlet, the venous return, the soft venous reservoir outlet
and the arterial outlet of the oxygenator.
Version with RIGID VENOUS RESERVOIR
Clamp the venous reservoir outlet, the oxygenator venous connector and arterial
outlet.
5) CHECKING THE HEAT EXCHANGER
Verify again the integrity of the heat exchanger, with particular attention to
possible water leaks.
6) CARDIOTOMY PRIMING
Secure with ties all aspiration lines connected to the cardiotomy. Fill the
cardiotomy with sufficient liquid to ensure the intended haematocrit is obtained,
taking into account:
- the recovered priming volume of the oxygenator is 105 ml;
- if it is present, soft venous reservoir capacity varies from minimum 40 to
maximum 190 ml;
- the 1/4" tube capacity is 32 ml/m.
7) CIRCUIT PRIMING
Remove the clamp at the cardiotomy outlet.
Versions with SOFT VENOUS RESERVOIR
The priming solution flows to the soft venous reservoir. The air contained inside
the soft venous reservoir will automatically be evacuated from the purge line
which is placed at the top of the reservoir by activating the suction pump. Remove
the clamp placed on the outlet of the soft venous reservoir.
The pressure level inside the soft venous reservoir shall not exceed 13
KPa (0.13 bar / 1.9 psi).
The pressure level inside the blood compartment of the oxygenating
module shall not exceed 100 KPa (1 bar / 14 psi).
All versions
Switch the arterial pump on to prime the oxygenating module. In this condition,
the blood recirculates between the oxygenator and the venous reservoir:
maximum flow shall not exceed 200 ml/min.
8) OPENING OF THE VENOUS AND ARTERIAL LINES
Open the purge line of the oxygenator by means of the blue clamp in order to
purge the air which is contained in the line. Close the clamp. Remove the venous
and arterial line clamps and increase flow up to 2000 ml/min.
9) CLOSING THE OXYGENATOR RECIRCULATION LINE
Close the white clamp placed on the recirculation line.
10) PURGING 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.
11) PRIMING OF THE 4-WAY SAMPLING MANIFOLD
Versions with the SOFT and RIGID VENOUS RESERVOIR
The removal of the air from the A/V sampling system is achieved by selecting the
yellow A/V SHUNT position. If the arterial pressure is not sufficient to remove the
microbubbles from the tube walls, squeeze gently the arterial line of the circuit so
as to partially close it.
12) OPENING THE RECIRCULATION LINE
After complete removal of air from the circuit, it is possible to reduce the arterial
flow to 200 ml/min opening the recirculation line and performing recirculation.
13) CLOSING THE VENOUS AND ARTERIAL LINES
During the priming and purge phases, the arterial/venous circuit must be
maintained at least 30 cm higher than the arterial outlet of the oxygenator.
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.
G. INITIATING BYPASS
1) OPENING OF THE ARTERIAL AND VENOUS LINES
Remove first the clamp from the arterial line, then remove the clamp on the
venous line. Start the bypass with a blood flow appropriate to patient size. Check
constantly the blood level in the venous reservoir.
2) CHECKING 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
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 gas content of the blood.
Depending on the values found, adjust the relevant parameters as follows:
High pO
2
GB - ENGLISH
decrease FiO
2
of 80:100%.
2
5