Initiating Bypass; Check The Correct Operation Of The Heat Exchanger; During Bypass - SORIN GROUP D 905 E0S Instrucciones De Uso

Check for leakage from the heat exchanger, paying particular attention to
possible water leaks.
5) VENOUS RESERVOIR PRIMING
Secure with ties all suction lines connected to the Venous Reservoir. Fill the
Venous Reservoir with sufficient prime to ensure the intended haematocrit is
obtained, taking into account:
- the recovered priming volume of the oxygenator is 160 ml;
- the 3/8" tube capacity is 72 ml/m;
- the 1/2" tube capacity is 127 ml/m.
Clamp the Venous Reservoir outlet.
6) CIRCUIT PRIMING
- The pressure level inside the blood compartment of the oxygenating
module shall not exceed 725 mm Hg (100 KPa / 1 bar / 14 psi).
Remove the clamp from the venous line and start with the pump at a reasonably
high flow so that the pump loop tubing is primed. Reduce the flow rate to 500-
1000 cc/min and prime the oxygenator.
7) OPEN VENOUS AND ARTERIAL LINES
Remove the clamp from the venous and arterial lines and increase flow up to
1500 ml/min.
8) OPEN THE PURGING/RECIRCULATION LINE
Once the steps up to and including point 7 have been carried out, increase the
arterial pump speed until the flow reaches the maximum value of 5 l/min. Open
the purging/recirculation stopcock briefly until all air is removed from the line in
order to prime the oxygenator purging/recirculation line.
9) PURGE THE AIR CONTAINED IN THE CIRCUIT
During this phase it is necessary to tap the entire circuit tubing in order to
facilitate the removal of microbubbles from the tube walls. After some minutes in
which the flow is maintained at a high rate, 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 in such a way as to allow
the prime to flow from the arterial outlet to the venous reservoir.
11) CLOSE THE PURGING/ RECIRCULATION LINE
After 3-5 minutes in which the flow is maintained at a high rate, all air will be
removed and it is possible to close the purging/recirculation line stopcock.
12) CLAMP THE VENOUS AND ARTERIAL LINES
Clamp the venous and arterial lines.
- Do not use pulsatile flow during priming. Sudden changes in flow rate
during priming can pull air across the membrane in to the blood
pathway.
- 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.
- Do not turn off the heater-cooler.
- Check the correct dosage of anticoagulant in the system before starting
the bypass.
-The user should carry out a gross inspection for air removal.
- If the reduction connector (D523C) and a circuit have been connected to
the coronary outlet port, check the priming of the connected line.
- 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 rate appropriate to patient size.
Monitor 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
100%.
- Always open the gas flow after the blood flow. In case of pump
stopping, turn off the gas before stopping 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 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 the gas content of the blood.
Depending on the values found, adjust the relevant parameters as follows:
High pO
2
Low pO
2
High pCO
2
Low pCO
2
H. DURING BYPASS
During the procedure, when sequestering blood from the circuit
-
(hemofiltration, blood cardioplegia, sampling, ...) always make sure that
the flow generated by the main pump is higher that the blood flow
sequestered. If not, the pressure in the blood compartment would
decrease causing the formation of air bubbles.
Check the security of all luer connections. All accessory lines
-
connected to the device must be connected tightly and stopcocks must
be closed in order to prevent accidental introduction of air into the
device or blood loss.
1) CHECK THE VENOUS RETURN
If a higher venous return flow is necessary lower both the oxygenator and the
venous reservoir with respect to the patient position.
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 necessary, use the
-
luer connector of the central stopcock on the sampling manifold.
2) ARTERIAL SAMPLING
Insert a sample syringe into the arterial sample stopcock luer. Position all
stopcocks on the sample manifold to allow arterial blood to flow through the
manifold. The pressure on the arterial side will allow flow. Draw the sample of
blood from the arterial sample stopcock. Turn off the arterial stopcock before
removing the syringe.
3) VENOUS SAMPLING
Ensure that the arterial stopcock is closed. Insert a sample syringe into the
venous stopcock luer and a flush syringe into the center stopcock. Open the
center stopcock and draw at least 10-15 ml of blood prior to taking the venous
sample. Close the center stopcock. Return this blood through one of the filtered
luer connectors positioned on the top of the reservoir. Open the venous
stopcock and draw a sample of venous blood and close the stopcock before
removing the syringe.
4) DRUGS INJECTION
Insert the medication syringe into the luer connector of the central stopcock.
Open the central and venous stopcocks and inject into the drug into the manifold
and venous sample line.
Close the central stopcock to the medication syringe and allow an arterial-
venous "wash" through the stopcock manifold. Turn the stopcocks to the closed
position when the drug has been delivered to the venous line.
Draw blood samples from the stopcocks only when the pump is running. 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 1500 ml/min.
of 80 to d) Clamp the oxygenator arterial line (fig. 2, ref. 12).
2
e) Recirculate at a maximum flow of 1500 ml/min. throughout the patient's
circulatory arrest.
f) To initiate 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
GB — ENGLISH
Decrease FiO
2
Increase FiO
2
Increase gas flow
Decrease gas flow
7