Initiating Bypass; Terminating Bypass; Blood Recovery After Bypass; Use Of Active Venous Drainage With Vacuum - dideco COMPACTFLO EVOLUTION Istrucciones Para El Uso

- 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.
WARNING
- If the reduction connector (D523C) and a circuit have been
connected to the coronary outlet port, check the priming of
the connected line.
- Clamp the line some centimetres away from the outlet.
- Do not create a negative pressure at the coronary outlet.
Negative pressure in the blood compartment could cause
microbubble formation.
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 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 Fi0 of 80:100%.
2
WARNING
- 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 the gas con-
tent of the blood. Depending on the values found, adjust the rele-
vant parameters as follows:
High pO
2
Low pO
2
High pCO
2
Low pCO
2
H. DURING BYPASS
1) CHECK THE VENOUS RETURN
4
If a higher venous return flow is necessary lower both the
oxygenator and the venous reservoir with respect to the patient
position.
WARNING
- The ACT (Activated Coagulation Time) must always be longer
than or equal to 480 seconds in order to ensure adequate
anticoagulation of extracorporeal circuit.
- If administration of anticoagulant to the patient is envisaged,
use the "DRUGS PORT" of the sampling stopcock.
2) ARTERIAL SAMPLING
Use the arterial and venous stopcocks to mix the arterial and
venous sides. The pressure on the arterial side will allow
automatic purging; finally, take at least 10-15 ml of blood from
the arterial stopcock.
3) VENOUS SAMPLING
Ensure that the arterial stopcock is closed, open the venous stop-
cock and aspirate at least 10-15 ml of blood.
Purge it through one of the filtered Luer connectors positioned
on the top of the reservoir. Finally, take the sample of venous
blood from the venous stopcock.
4) DRUGS INJECTION
Insert the medication syringe into the Luer connector of the
Decrease FiO
2
Increase FiO
2
Increase gas flow
Decrease gas flow
central stopcock (purging site).
Open the central and venous stopcocks and inject into the vein.
Close the central stopcock to the flow of the medication syringe
and allow an arterial-venous "wash" through the stopcocks of the
ramp. Turn the stopcocks to the closed position when "washing"
has been completed.
CAUTION
Take the blood from the stopcocks only when the pump is run-
ning. If not, the pressure in the blood compartment would
decrease causing the formation of air bubbles.
5) LOW FLOW RECIRCULATION
(Hypothermia associated with circulatory arrest).
a) Reduce the gas flow to less than 500 ml/min.
b) Open the recirculation line (lever of the purging/recirculation
stopcock in the "RECIRCULATION" position) and clamp the
Venous Reservoir inlet line (fig. 2, ref. 2).
c) Reduce the flow from the arterial pump to 2000 ml/min.
d) Clamp the oxygenator arterial line (fig. 2, ref. 12).
e) Recirculate at a maximum flow of 2000 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) Close the recirculation line (lever in "CLOSE" position).
h) Adjust gas flow.
6) CONTINUOUS AIR PURGE
The purging/recirculation stopcock in "PURGE" position features
the continuous air purge diverting from the gas exchange
module during bypass.
In this condition and at full arterial blood flow, the continuous
purge diverts from the arterial line only few mls/min.
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.
3) Slowly decrease the arterial flow to zero while closing the venous
line.
4) Clamp the arterial line.
5) Open the recirculation line.
6) Increase arterial flow until 2000 ml/min.
CAUTION
- If extracorporeal circulation has to be subsequently restarted, a
minimum blood flow inside the COMPACTFLO EVOLUTION must
be maintained (maximum 2000 ml/min).
- During recirculation do not turn the thermocirculator off.
- Verify that the cardioplegia circuit connected to the coronary
outlet port is properly clamped.
J. BLOOD RECOVERY AFTER BYPASS
1) Recover into the Venous Reservoir as much blood as possible
from the venous line, as soon as the surgeon has removed the
cannulae from the patient's vena cava.
2) Deliver blood into the aortic canulae as required by the patientís
condition, slowly decreasing the level in the Venous Reservoir.
3) When the reservoir is nearly empty stop the arterial pump nd
clamp the arterial line.
K. USE OF ACTIVE VENOUS DRAINAGE WITH VACUUM
This method may be applied at any time during extra-corporeal
circulation, provided that the prescriptions below are respected.
Using the kit code 086000, or equivalent supplied separately, and a
vacuum regulation device, COMPACTFLO EVOLUTION can be used
with active venous drainage with vacuum.
This technique constitutes an alternative to venous drainage by
gravity and allows the use of shorter venous tubes with reduced
diameter, as well as smaller-gauged cannulas.