11 unit 8 Foundations of Perfusion Technology and Techniques (1).pptx
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Perfusion Program Foundations of Perfusion Technology & Techniques What we will cover: Unit 8 - Describe the difference between a reservoir and a cardiotomy Describe different reservoir technologies and configurations Describe internal filtering systems found in cardiotomy systems Discuss safety...
Perfusion Program Foundations of Perfusion Technology & Techniques What we will cover: Unit 8 - Describe the difference between a reservoir and a cardiotomy Describe different reservoir technologies and configurations Describe internal filtering systems found in cardiotomy systems Discuss safety issues as they relate to the reservoir The Reservoir formerly known as “Venous” Venous Reservoir (Cardiotomy Reservoir) The venous reservoir serves as a buffer for fluctuations in venous drainage and is a source of fluid for rapid transfusion. - venous blood enters, filtered/de-aired - positioned pre-pump, and pre-oxygenator - Fluids administered to reservoir (crystaloid, blood, etc) The Reservoir formerly known as “Venous” Open Circuit: blood drained into the cardiotomy reservoir, which may be incorporated in the housing of an open (hard-shell) venous reservoir or may first flow into a separate freestanding cardiotomy reservoir before emptying into a separate venous reservoir. *Why is the neck of the venous drainage Polycarbonate so long inside the Depth and screen filtration reservoir? *blood exposed to air within the reservoir Question: **Which style of filtration is appropriate for venous drainage? How about pump suckers? Intracardiac vent? Why? Vortex effect The higher the volume level in the reservoir, the lower the vortex sits at the bottom of the reservoir, forced to exist at the outlet under the pressure of the volume. The Reservoir formerly known as “Venous” Closed Circuit blood is drained into venous reservoir “bag”, without direct exposure to air. - - no steps allow for direct exposure to air - hybrid form of “closed circuit” Why? - What is hybrid closed versus completely closed Ex. Venous bag reservoir with pump suckers filtered through hard shell cardiotomy into bag reservoir. Ex. ECMO circuit (completely closed) The Reservoir formerly known as “Venous” Open vs Closed • Features of Open • Multi-level Filtration • Use of VAVD • Use of level sensor • Large volume capacity (4000 mL) • Features of Closed (hybrid) • Reduced activation • Enhanced safety (from the poss. of draining reservoir) • Use of CAVD • Volume capacity (approx. 2000-2500 mL) • Use of separate Cardiotomy for suckers/vent – filtration prior to WYE into reservoir The Reservoir formerly known as “Venous” Filtration • Screen and Depth • We know that screens have pre-determine manufactured sizes (microns) • We know that depth filters have varying sizes of polyurethane fibers mats and/or dacron wool that make up a complex layering of filtration – they are also coated in Antifoam A (sometimes C) for enhanced defoaming capabilities. • With all the knowledge about filters we’ve learned, did we ever stop to wonder. . . . Why? • Which type of filter can take more direct and consistent air and why? • What happens when a filter becomes overwhelmed by air volume? A North Atlantic right whale showing its Baleen nature’s filtration The Reservoir formerly known as “Venous” Servoregulation ***Revisited*** • the control of speed (velocity) and position of a motor based on a feedback signal. (sciencedirect.com) • Translation: When the device we have assigned triggers the alarm we set. • Ex. Level sensor low level triggers alarm servoregulation functions causes autoclamp to shut on arterial tubing, preventing reservoir draining. • New cars/trucks: Lane assist – when vehicle senses it is touching established road marked outer lines (side of road or double yellow), it will make a small steering correction to try to maintain lane …… THAT is a form of servoregulation. The Reservoir formerly known as “Venous” Pressure Relief Valve • One way valve • Designed to relieve increasing internal POSITIVE pressure within the reservoir • Limited due to size and capabilities • Internal pressurization of reservoir – what happens? • Gravity drainage with open vented reservoir has less risk as there is a direct open vent communication with atmospheric pressure of the room • VAVD reservoir (risks: higher due to the sealed reservoir when vacuum is applied. • If Vacuum fails and positive pressure builds significantly, air embolus can occur - air emboli move retrograde up the venous drainage line into the The Reservoir formerly known as “Venous” An evaluation of hard-shell venous reservoir integrated pressure relie f valve pressure mitigation perfor mance Saczkowski, R., Zulauf, F., Spada, S. (2022) Perfusion. 37(1), 37-45. The Reservoir formerly known as “Venous” The Reservoir formerly known as “Venous” Relax. . . . Don’t let the pressure get to you
