Priming And Recirculation Procedure; Initiating Bypass - SORIN GROUP Dideco KIDS D101 Instrucciones Para El Uso

7) CONNECT THE TEMPERATURE PROBES
- The arterial temperature probe site can be removed by unscrewing it.
- Check that the arterial temperature probe site is properly screwed on.
Use SORIN GROUP temperature probes or equivalent ones.
The connection for the arterial temperature probe (ref. 5) is located next to the
arterial outlet.
Version [A], OPEN SYSTEM:
The venous probe site (ref. 14) is located on the venous inlet connector of the
reservoir.
8) CLOSE THE PURGING/RECIRCULATION LINE
Close the clamp positioned on the purging/recirculation line (ref. 7) between
oxygenating module and venous reservoir prior to priming.
9) CONNECTING THE GAS LINE
Remove the green cap from the gas inlet connector indicated as "gas inlet" (ref.
3) and connect the 1/4" gas line. Ensure that the gas supply is from a suitable
air/oxygen mixer such as the Sechrist, (available from SORIN GROUP) or
a system with compatible technical features. A capnograph can be connected to
the "gas escape" connector (ref. 4).
10) 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
administered 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 within the oxygenator
fibres.
- 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.
- Do not for any reason occlude the external access holes of gas
compartment (ref. 4).
- 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.
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 RECIRCULATION/PURGE LINE
CLOSED
Check that the clamp, placed on the oxygenator recirculation/purge line, is
closed.
3) ISOLATE THE VENOUS RESERVOIR FROM THE
OXYGENATING MODULE
Clamp the venous return line, the venous reservoir outlet line, and the arterial
outlet line of the oxygenator.
4) CHECK THE HEAT EXCHANGER
Verify again the integrity of the heat exchanger, with particular attention to
possible water leaks.
5) VENOUS RESERVOIR PRIMING
Secure with safety ties all suction lines connected to the venous reservoir. Prime
the venous reservoir with sufficient fluid to ensure the intended haematocrit is
obtained, taking into account:
the static priming volume of the oxygenator is 87 ml;
-
the 1/4" tubing volume capacity is 32 ml/m;
-
the 3/8" tubing volume capacity is 72 ml/m.
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6) OXYGENATOR AND CIRCUIT PRIMING PROCEDURE
The pressure level inside the blood compartment of the oxygenating
module shall not exceed 100 Kpa (1 bar / 14 psi).
Remove the clamp at the venous reservoir outlet.
Switch the arterial pump on to prime the oxygenating module.Maximum flow
shall not exceed 200 ml/min.
7) OPEN THE PURGING/ RECIRCULATION LINE
When the oxygenator module is half primed open the clamp on the purging/
recirculation line, and complete the priming of the oxygenating module. In this
condition blood recirculates from the module to the venous reservoir.
8) OPEN VENOUS AND ARTERIAL LINE
Remove the clamp from venous and arterial line and increase flow up to
2500 ml/min.
9) OXYGENATOR AND CIRCUIT DEBUBBLING
During this phase it is necessary to tap the oxygenator and the entire circuit in
order to facilitate the removal of microbubbles from the whole extracorporeal
system.
Maximum blood flow must be maintained at least 5 minutes to assure that
all air will be removed.
10) PRIME OF THE SAMPLING SYSTEM
Priming of the A/V sampling system occurs automatically when the arterial,
venous and central stopcock handles are positioned towards the access ports of
the manifold to allow the prime to flow from the arterial outlet to the venous
reservoir.
11) REDUCE ARTERIAL FLOW
After complete removal of air from the circuit, it is possible to reduce the arterial
flow to 200 ml/min to recirculate through the opened purging/recirculation line.
12) CLAMP THE VENOUS AND ARTERIAL LINES
Clamp the venous and arterial lines.
- During the priming and debubbling 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 and debubbling.
- SORIN GROUP 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.
- Do not turn the heater-cooler off with the oxygenating module blood
inlet and outlet lines clamped.
- Check the correct dosage of anticoagulant in the system before
starting the bypass.
- The user should inspect the oxygenator and the circuit for air removal
prior bypass.
G. INITIATING BYPASS
1) OPEN 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) CHECK 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 FiO
100%.
- Always open the gas flow after the blood flow. In case of pump
stopping, turn off the gas before stopping the blood flow.
- During bypass, the gas/blood flow ratio must never exceed 2:1. A
phenomenon called "wet lung" may occur when microporous hollow
fibers oxygenators are used for a long period of time and when
temperature gradients occurs. If water condensation associated with
decrease of gas exchange performance is noted during extended
oxygenator use, increase the gas/blood flow ratio up to 4:1 for
10 minutes.
- 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.
- When the priming procedure is completed, make sure the gas flow is
kept off for the period of time before starting the procedure.
4) BLOOD GAS MONITORING
After a few minutes of bypass operation, measure gas content of the venous
GB - ENGLISH
of 80 to
2
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