Role of Perfusionist
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What environment is needed for surgery?
What does the "oxygenator" act as?
What are the main components of the oxygenator?
- Temperature Control
- Filter Blood of clots and debris etc
There are 4 main pumps acting with the heart - What are their functions?
- Sucking of excess blood x 2
- Single chamber Pump
Circuit of equipment?
1 - Cannulate the right atrium - so blood entering the right atrium flows out of the heart and down tubes into the reservoir
2 - Blood flows to the main artificial heart pump where it is temperature controlled and passes through oxygenator for gaseous exchange
3 - This leaves via the aorta to the rest of the body
4 - Hand held suckers suck bleeding blood away from the surgery site and into the filter, where it rejoins and point 2
What is cardioplegia?
Flushing heart with cold potassium into the coronary arteries to stop its contractions
Why must the aorta be clamped proximal to the artificial pump that supplies the body with blood?
To prevent back flow of K into the body
Why is the patient cooled to around 15 degrees?
To slow down all metabolic activity as the patient does not lots of blood flow
Main roles of perfusionist include?
- Running heart and lung machine
- Maintaining physiological functions of the patient
10 Functions of the perfusionist:
- Going on bypass
- Maintaining adequate blood flow to patient
- Maintaining blood pressure
- Maintaining safe levels of blood in oxygenator
- Stopping the heart
- Controlling blood gases and electrolytes
- Monitoring ECG during cardioplegia
- Controlling temperature
- Observing Hb levels
- Manage clotting factors
Perfusionist and Bypass:
Turning on bypass whilst simultaneously draining blood from patient
Perfusionist and blood flow:
Surface area of patient should be measured and multifplied by 2.4
Perfusionist and BP:
Kept low because no cardiac output but some organs require minimal BP like kidneys so kept at 45-75mmHg
Perfusionist and Blood Level:
Must always have blood in reservoir or air will go to patient
Perfusionist and Stopping Heart:
Provide cardioplegia solution
Perfusionist and gases and electrolytes:
Control context of O2 and CO2 by sending samples regularly for analysis
Perfusionist and ECG:
Only interested in asytole
Perfusionist and Temp:
- Kept at 32 if heart is continue beating
- Dropped to 25-30 if heart is stopped
- Dropped to 15 for total circulatory arrest
Perfusionist and Hb:
- Maintain Hb above 7g/dl
- Done by removing excess water
Perfusionist and clotting:
- Clotted with heparin
- Accellerated clotting time measured every 30mins - takes roughly 8 mins
What reverses Heparin?
What would you like to do?
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