Postoperative Drainage - sorin SYNTHESIS 4D Instrucciones De Uso

recommended on all tubing connections. Ensure the cap on any
unused port is airtight prior to initiating vacuum assisted venous
return.
- It is advisable not to exceed -50 mmHg (-6.66kPa / -0.07 bar / -0.97
psi) negative pressure applied to the reservoir.
- Periodically check functioning of the vacuum regulating device
and the degree of vacuum.
- Utilization of vacuum assisted venous return can lead to
negative pressures in the oxygenator and the potential for air to
be pulled across the oxygenator membrane into the blood
pathway. The sample system, the arterial purge line, a
haemoconcentrator, and the centrifugal pump may also provide
a conduit for the vacuum to be applied to the arterial side of the
oxygenator.
- The use of the following is recommended in procedures utilizing
vacuum assisted venous return: reliable wall suction and
calibrated vacuum regulator, vapour trap in vacuum line, venous
line pressure monitor, vacuum relief valve in vacuum line, one-
way valves where necessary to prevent retrograde flow
M. POSTOPERATIVE DRAINAGE
The SYNTHESIS 4D reservoir is also intended to be used for
postoperative chest drainage collection and transfusion.
CONTRAINDICATIONS
The SYNTHESIS 4D reservoir is contraindicated for autotransfusion use
under the following circumstances:
- When pericardial mediastinal, pulmonary or system infection exists;
- When malignancy, gross contamination, lymphatic failure, or a
perforated intestine exists or is feared to exist;
- After a return to surgery for exploration (not contraindicated if massive
bleeding occurs); and
- When protamine is used before the reservoir is removed from the
extracorporeal circuit.
- Before use ensure that the SYNTHESIS 4D venous reservoir has
not been polluted as a result of handling which has compromised
sterility.
- The sterility of the system depends on the degree of asepsis
resulting from use of the venous reservoir and the care taken in
connecting the kit during the conversion to thoracic drainage.
- Ensure the cap on any unused port is airtight prior to initiating
chest drainage collection.
- Complications such as coagulopathies, particulate and air
embolism, and blood
postoperative autotransfusion. The physician is responsible for
determining the quality of the blood product before it is returned
to the patient.
- For postoperative use, never clamp the chest drainage tubes,
unless only momentarily to change out the device. Blockage of
air or fluid movement can lead to tension pneumothorax or
subcutaneous emphysema.
- Never autotransfuse blood that has resided in the reservoir for
more than six (6) hours. This will reduce the potential for
bacterial contamination.
stopped, the system can continue to be used for chest drainage
collection until the chest drainage tubes are removed from the
patient.
- If, during postoperative use, blood is ever observed in the filter
bypass line, the subsequent autotransfused blood should first
be passed through a microfilter to remove any clots that may be
present. Replacement of the reservoir in this situation is
recommended.
- Maintain a minimum of 50 ml of blood in the reservoir during
autotransfusion. If this is not done, gaseous bubbles could be
passed to the patient.
- During autotransfusion use an infusion pump with a bubble
detector to avoid the possibility of gaseous bubbles being
passed to the patient.
- Prepare the vacuum regulating device with integrated valve for
use, following the instructions of the manufacturer provided with
the device.
- Should negative pressure be applied to the system such that the
overpressure valve intervenes, the recovered blood will no
longer be suitable for transfusion.
- Periodically check functioning of the vacuum regulating device.
- if the recovered blood exceeds the amount established by
postoperative routine, immediately notify the physician.
- If the recovered blood is to be re-infused, an increase in vacuum
will be noted in the reservoir. A filtered venting system must
therefore be arranged in order to maintain the original negative
operating pressure.
- Check the degree of contamination of the blood collected related
to the time of use of the drainage system. The results of these
10
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coagulation may occur
After autotransfusion has
tests must be taken into account prior to blood transfusion.
- The recovered blood must be re-transfused with a suitable
volumetric infusion pump or with the syringe and three-way
stopcock technique used manually as an alternative to the pump.
- If the reservoir used does not have an integrated microfilter, fit
the re-infusion line with a 25-40 micron blood filter.
CONVERTING THE SYNTHESIS 4D RESERVOIR FROM
INTRAOPERATIVE TO POSTOPERATIVE USE
Supplies needed for conversion:
- One (1) reservoir holder
- One (1) sterile water manometer/seal
- One (1) sterile 1/4" (6.4 mm) water manometer line
- One (1) sterile 1/2" (12.7 mm) ID occluding plug
- One (1) sterile IV pump line adapter
- One (1) sterile 3/8" (9.5 mm) chest drain line
- One (1) foot (30 cm) of sterile 1/4" (6.4 mm) ID tubing
- Two (2) sterile 3/8" (9.5 mm) sealing caps
- Four (4) sterile 1/4" (6.4 mm) sealing caps
1. Ensure that the extracorporeal circuit will not be needed for an
emergency return to use for bypass support.
2. Remove the venous inlet tubing from the SYNTHESIS 4D reservoir.
Using aseptic technique, seal the venous inlet port with the 1/2" (12.7
mm) ID occluding plug.
3. Using aseptic technique, connect the 1/4" (6.4 mm) ID tubing from a
filtered to an unfiltered 1/4" (6.4 mm) port such that the tubing loops
vertically above the reservoir for maximum visibility. Blood in this
tubing will indicate the filter has become occluded and is being
bypassed.
4. One by one, using aseptic technique, carefully remove the tubing
from the remaining ports used intraoperatively and plug the ports with
sealing caps.
5. Ensure the SYNTHESIS 4D reservoir is completely empty. Remove
the 3/8" (9.5 mm) ID tubing from the reservoir outlet and replace with
the IV pump line adapter.
6. Mount the venous reservoir holder in a suitable location for patient
transport.
7. Remove the venous reservoir from the oxygenator using the
following steps:
8. Press the tab on the Reservoir Mount Locking Ring to unlock the ring
and rotate it clockwise until it stops.
9. Lift the reservoir away from the oxygenator.
during 10. Place the SYNTHESIS 4D reservoir in the dedicated reservoir
holder. Place the water manometer/seal on the holder. Attach the
1/4" (6.4 mm) water manometer line to the vent/vacuum port of
reservoir and the "liner lid tubing" port of the water seal.
11. Set up the water seal according to the manufacturer's instructions.
12. Using aseptic technique, connect the chest drain line(s) to the filtered
3/8" (9.5 mm) port(s) on the reservoir cover. If one of these ports is
not used, the cap provided with the reservoir will provide an
adequate seal.
13. The SYNTHESIS 4D reservoir is now ready for transport to the ICU.
been 14. SETUP
AUTOTRANSFUSION IN THE ICU
15. Once the unit has been moved to the ICU, connect the water
manometer/seal to a vacuum source according to the water
manometer/seal instructions.
16. After the initial drainage rate has been determined, and when there is
at least 75 ml of volume in the reservoir; reinfusion can begin if
indicated.
17. If blood is to be reinfused, prime an IV pump set by first clamping off
the vacuum source line. Connect the inlet of the IV pump line to the
outlet port of the IV pump line adapter. Prime the set as
recommended by the pump manufacturer following directions for
cellular fluids. Install the set into the pump. Remove the clamp from
the vacuum source. Connect the distal end of the IV set into a patient
IV access site used for volume administration.
18. Monitor and record the patient's chest drainage rate per your
institution's protocol. To minimize the potential for air embolism, a
minimum of 50 ml of blood should remain in the reservoir after
reinfusion.
19. If rapid bleeding occurs, the blood may clot and occlude the
reservoir's filter. If the filter is occluded, blood may back up and pass
through bypass loop and flow directly into the unfiltered section of the
reservoir, bypassing the filter. In this situation, use of a blood
transfusion filter in the IV line is required during reinfusion.
- Use of the SYNTHESIS venous reservoir as thoracic drainage is the
responsibility of the intensive care staff.
- Its preparation is the joint responsibility of the person performing
perfusion and the intensive care staff.
GB – ENGLISH
OF SYNTHESIS 4D RESERVOIR FOR