Terminating Bypass; Blood Recovery After Bypass; Oxygenator Replacement - SORIN GROUP D902 LILLIPUT 2 Mode D'emploi

Low pO
2
High pCO
2
Low pCO
2
5) KEEP THE PURGE LINE OF THE SOFT VENOUS RESERVOIR OPEN
Versions with SOFT VENOUS RESERVOIR
Continuous air purge from the soft venous reservoir is recommended.
H. DURING BYPASS
1) CHECKING THE VENOUS RETURN
If a higher venous return flow is necessary act as follows:
Versions with SOFT VENOUS RESERVOIR
a) Open completely the soft reservoir squeezer in order to increase the reservoir
volume.
All versions
b) Lower both the oxygenator and the venous reservoir with respect to the patient
position.
Versions with SOFT VENOUS RESERVOIR
The cardiotomy must always be placed in a higher position with respect to
the soft venous reservoir.
It is recommended to keep the line connecting cardiotomy and soft
venous reservoir clamped during the case, in order to prevent massive air
delivery to the patient in case the cardiotomy and the soft venous
reservoirs empty. In case blood has to be moved from the cardiotomy to
the soft venous reservoir, carefully open the clamp and avoid to empty the
line connecting cardiotomy and soft venous reservoir. Emptying the
cardiotomy and the soft venous reservoir might result in air delivery to the
oxygenator and, eventually, to the patient.
All versions
The venous reservoir attached to the oxygenator must always be placed
in a higher position than the oxygenator.
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) ARTERIAL SAMPLING
Versions with SOFT and RIGID VENOUS RESERVOIR (fig. 1 and 2)
a) Turn the selector switch on the sampling stopcock (ref. 9) to the "A-SAMPLE
PURGE" position (the arterial line will then be automatically purged).
b) Insert the syringe into the sampling female luer marked SAMPLE PORT (ref. 8).
c) Aspirate at least 2 ml of blood (the automatic purge avoids the need to repeat
the operation). A self-closing valve will avoid any blood leakage from the luer.
3) VENOUS SAMPLING
Versions with SOFT and RIGID VENOUS RESERVOIR
a) Turn the selector switch on the sampling stopcock to the "V-SAMPLE PURGE"
position.
b) Insert the syringe into the female luer marked "SAMPLE PORT".
c) Aspirate and purge the blood sample a couple of times before proceeding to the
venous sampling analysis. This double operation (aspiration and purge) can be
done whilst maintaining the selector switch in the same position.
4) DRUG DELIVERY
Versions with SOFT and RIGID VENOUS RESERVOIR
a) Turn the selector switch on the sampling stopcock to the DRUGS INJECTION
position.
b) Insert the syringe containing the drug into the female luer marked DRUGS
PORT (ref. 10) and inject the liquid.
c) Turn the switch to the A-V SHUNT position. The system will be automatically
flushed and the drug will flow into the venous line.
5) LOW FLOW RECIRCULATION
(Hypothermia associated with circulatory arrest).
a) Reduce the gas flow to less than 200 ml/min.
b) Open the recirculation line and clamp the venous line.
c) Reduce the flow from the arterial pump
d) Clamp the arterial line.
e) Recirculate at a maximum flow of 200 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) Clamp the recirculation line.
h) Adjust gas flow.
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.
6
Increase FiO
2
Increase gas flow
Decrease gas flow
3) Slowly decrease the arterial flow to zero while closing the venous line.
4) Open the recirculation line.
5) Clamp the arterial line.
6) Increase arterial blood flow to 200 ml/min.
If extracorporeal circulation has to be restarted subsequently, a minimum
blood flow inside the LILLIPUT must be maintained (maximum 200 ml/min).
If the use of the haemofilter is necessary, refer to its specific instructions for
use.
Versions with SOFT VENOUS RESERVOIR
In case of insufficient venous return flow the soft venous reservoir might
collapse. If this happens, consequent negative pressure might cause gas
extraction from the blood if the arterial pump is not stopped immediately. To
eliminate air from the soft venous reservoir, proceed as follows:
1) Turn the gas flow off.
2) Turn the arterial pump off.
3) Clamp the arterial line.
4) Restore the required volume of liquid in the soft venous reservoir (by
releasing the soft venous reservoir squeezer or by adding liquids).
5) Check for the absence of air bubbles in the soft venous reservoir.
6) Clamp the venous line.
7) Open the recirculation line and recirculate at a rate of 200 ml/min until
complete air removal from the system.
8) Restart bypass by opening the arterial and venous lines.
9) Clamp the recirculation line.
Version with RIGID VENOUS RESERVOIR
Do not absolutely empty the rigid venous reservoir.
J. BLOOD RECOVERY AFTER BYPASS
1) Recover as much blood as possible from the venous line and deliver it into the aorta
by means of the arterial pump, as required by the patient condition.
2) Once the venous reservoir is empty and the venous cannulae have been removed:
a) Turn the arterial pump off.
b) Clamp the venous line, the arterial line and the recirculation line.
c) Close the "ON-OFF" manifold (position OFF).
Versions with SOFT and RIGID VENOUS RESERVOIR
d) Disconnect the male luer lock of the recirculation line from the "ON-OFF"
manifold.
e) Connect an additional recovery bag (500 ml) to the male luer lock end of the
recirculation line to empty the oxygenator and the arterial line by gravity.
All versions
f) Open the recirculation line.
K. 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:
1) Turn the gas flow off.
2) Reduce arterial pump blood flow to 100 ml/min.
3) Empty the venous reservoir.
Versions with SOFT VENOUS RESERVOIR
4) Close, by means of a double clamp, the output line of the cardiotomy and add
appropriate liquids to the cardiotomy to prime the new oxygenator.
All versions
5) Turn the thermocirculator off, clamp the water lines.
6) Disconnect the gas line.
7) Close the venous lines by means of a double clamp and stop the arterial blood
pump. Close:
- the arterial line by means of a double clamp (placed next to the oxygenator
outlet).
- the pump line by means of a double clamp (placed next to the venous reserve
outlet).
- the oxygenator venous inlet by means of a double clamp
(placed next to the oxygenator venous inlet).
8) Disconnect all monitoring lines.
9) Cut all connector tubes in the section between the two clamps, leaving a sufficient
length of tubing to allow re-connection.
GB - ENGLISH