Terminating Bypass; Blood Recovery After Bypass; Use Of Active Venous Drainage With Vacuum; Use Of Cardiotomy For Post-Operative Autotransfusion - SORIN GROUP D905 EOS Instrucciones Para El Uso

As reported in the Description (chapter A), the D905 EOS enables the
separation of the Cardiotomy Reservoir from the Venous Reservoir. This
separation is achieved by opening (up position) or closing (down position) the
connection lever located on the top of the cardiotomy reservoir. This option is
suggested when the liquid from the suckers must be separated from the
venous blood in order to be:
1. rejected (i.c. cristalloid cardioplegia)
2. processed apart (i.c. blood cardioplegia with high potassium level, sucked
blood)
If you need to add priming solution directly into the Venous Reservoir use the
"Cardiotomy Bypass Port" (fig.2, Ref.15).
With the connection key in up position the hardshell reservoir acts as a
standard Venous Reservoir.
4) CONTINUOUS AIR PURGE
The purging/recirculation stopcock in "PURGE" position features the
continuous air purge evacuating 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.
7) In the case of separation of blood recovered by the aspirators:
a) remove the pos-lock on the connection key (fig.2, ref. 3) and connect the
adapter D 523C (provided with the product)
b) recover the blood collected in the Cardiotomy Reservoir with an
autotransfusion machine connected to the adapter with a 1/4" line
c) wash the collected blood and reinfuse to the patient
- If extracorporeal circulation has to be subsequently restarted, a minimum
blood flow inside the D 905 EOS 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 patient's condition, slowly
decreasing the level in the Venous Reservoir.
3) When the reservoir is nearly empty stop the arterial pump and clamp the arterial
line.
K. USE OF ACTIVE VENOUS DRAINAGE WITH
VACUUM
This method may be applied at any time of the extracorporeal circulation, provided
that the prescriptions below are respected. Through use of the kit - code 096834 or
equivalent supplied separately - and a vacuum regulation device, EOS may 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.
1. Open the kit for active venous drainage with vacuum, operating in such a way
that sterility of the system is not compromised.
2. Connect the end with the blue cap to the vent connector of the venous reservoir
(fig. 2, ref. 18) and the end with the red cap to the vacuum regulating device. The
latter must be connected to the line vacuum.
3. Close the clamp and the green cap on the line connected to the reservoir.
4. If necessary to interrupt or suspend this method, remove the yellow cap and
open the clamp on the line.
- It is advisable not to exceed –80 mmHg (10.4kPa / 0.10bar) negative pressure
applied to the reservoir.
- Periodically check functioning of the vacuum regulating device and the
degree of vacuum.
- Suspend vacuum application during the entire circulatory arrest procedure.
L. USE OF CARDIOTOMY RESERVOIR FOR POST-
OPERATIVE AUTOTRANSFUSION
If the use of the Cardiotomy Reservoir for post-operative autotransfusion is
envisaged, act as follows:
6
1. Disconnect the purging/recirculation line.
2. Separate the venous reservoir from the oxygenating module by removing the
white hook .
3. Locate the venous reservoir on the "Post Operative Chest Drainage Holder" code
05039 and use one of the following optional kits referring to their respective
instructions for use:
- D 540 AUTOTRANSFUSION CONVERSION KIT code 05053;
- D 540 W AUTOTRANSFUSION CONVERSION KIT with water seal, code
05062.
4. If wishing to use the full capacity of the reservoir, lock the connection key (fig.2,
ref. 3) with the red clamp found in the convenience kit provided with the product.
- In case negative pressure applied to the system makes pressure relief valve
operate, the collected blood is not suitable for retransfusion as
contaminated.
M. 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, clotting of the filter etc.),
proceed as follows for oxygenator replacement.
Use sterile methods during all replacement procedure.
1) Turn the gas flow off
2) Close, by means of a double clamp, the venous line (5 centimetres apart).
3) Turn the arterial pump off and close, by means of a double clamp, the arterial
line (5 centimetres apart) placed next to the oxygenator.
4) Turn the thermocirculator off, clamp and remove the water lines.
5) Disconnect the gas line, all monitoring and sampling lines.
6) Cut the venous return and the arterial lines in the section between the two
clamps, leaving a sufficient length of tubing to allow re-connection.
7) Remove the D 905 EOS from the holder (according to the appropriate
instructions for use) and remove the pump segment from the arterial pump.
8) Place a new D905 EOS on the holder. Connect all lines (i.e. venous to the
Venous Reservoir, arterial and gas to the oxygenator, pump line to Venous
Reservoir and oxygenator).
In this phase, keep the venous and arterial lines clamped.
9) Open the water lines on the holder turn the thermocirculator on and check the
integrity of the new D 905 EOS.
10) Fill the cardiotomy reservoir of the new D 905 EOS with priming solution through
the 1/4" or 3/8" quick prime connectors located on the head of the venous
reservoir.
11) Prime the new D 905 EOS and evacuate the microbubbles, as described in the
priming and recirculation procedure.
12) Verify all connections and secure with ties.
13) Remove clamps from the venous and the arterial line, close the
purging/recirculation line and start the bypass again.
14) The blood remaining in the replaced Venous Reservoir may be recovered by
connecting its outlet port to one of the 3/8" inlet connectors of the new reservoir.
15) The blood contained in the oxygenator and heat exchanger may be poured into
the new Venous Reservoir by connecting the arterial line to one of the 3/8" inlet
connectors of the new reservoir.
Replacement of only the oxygenating module
1) Turn the gas flow off and disconnect the gas line.
2) Clamp the venous return.
3) Turn the arterial pump off and close, by means of a double clamp, the arterial
line (5 centimetres apart) next to the oxygenator.
4) Close, by means of a double clamp, the oxygenator inlet line near the
oxygenating module connector (5 centimetres apart).
5) Turn the thermocirculator off, clamp and remove the water lines.
6) Close the purging/recirculation stopcock and disconnect the purging/recirculation
line.
7) Clamp and disconnect the cardioplegia line, if connected.
8) Turn the sampling manifold selector switch to the "OFF" position.
9) Disconnect the arterial sampling avoiding any contamination of the sampling
stopcock luer lock (i.e. by connecting it to a female luer lock placed on the top of
the reservoir).
10) Remove all other monitoring and sampling lines from the oxygenating module.
11) Cut the oxygenator inlet line and the arterial line in the section between the two
clamps, leaving a sufficient length of tubing to allow re-connection.
12) Move the water locking system to the "OPEN" position.
13) Lift the oxygenator and rotate the hook on the upper part of the holder.
14) Fit the slot of the reservoir into the hook of the holder.
15) Uncouple the reservoir from the oxygenating module by means of the white
interface (fig. 2, ref.19)
16) Remove the oxygenating module from the holder.
17) Place a new D 905 EOS oxygenating module on the holder.
GB - ENGLISH