Geographical placement of equipment on the Heart-Lung machine
Protocol of testing equipment on the heart-lung machine following
assembly
Protocols of inspection of disposables prior to assembly
Aseptic techniques of equipment assembly
1.
Oxygenator-Venous Reservoir
a)
Low
to ground
i)
to
maximise hydrostatic pressure
b)
Near
patient
i)
to
minimise length
c)
Easy
visibility to perfusionist
2.
Vaporiser
a)
Not
over oxygenator
i)
in
case of spills
ii)
in
case of dropping (heavy weight)
b)
Associated
with other gas delivery apparatus
3.
Main pump module
a)
Low
to ground
i)
minimise
cavitation when pumping from reservoir
b)
Close
to venous reservoir-oxygenator
i)
minimise
tubing length
4.
Other pump modules
a)
Close
proximity to Oxygenator & main pump module
i)
Minimise
tubing length (prime volume)
ii)
Minimise
movement of perfusionist
5.
Blender
a)
Associated
with other gas delivery apparatus
6.
Flow meter
a)
Associated
with other gas delivery apparatus
7.
In line O2
analyser
a)
Display
associated with other gas delivery apparatus
b)
Probe
inserted as close to gas line inlet into oxygenator
i)
For
detection of any breaks in gas delivery
8.
Level alarm
a)
Display/monitor
positioned within easy visual & physical reach while looking at venous
reservoir
i)
Enable
to override while watching reservoir blood level
b)
Probe
positioned according to:
i)
Institutions
& company guidelines
ii)
Performance
characteristics of venous reservoir (eg waterfall/vortex effect)
iii)
Predicted
flow rates for patient (higher flow rates would require a higher blood level)
9.
Bubble detector
a)
Probe
positioned according to:
i)
Institutions
guidelines
ii)
Venous
outlet
a)
Acts
as a 2° level detector
iii)
Arterial
line
a)
For
detection of any source of air emboli
iv)
Requires
1 cc air bubble
1.
Oxygenator
a)
Prime
gas ABG’s after running 100% O2 prior to CPB
2.
Heat exchanger
a)
Stress
heat exchanger tubes with full range of temperatures emanating from chiller
3.
Vaporiser
a)
Increase
fresh gas flow; open vaporiser & assess:
i)
Gas
analyser on anaesthetic machine
ii)
Smell
4.
Pump modules
a)
Assess
operation while assessing occlusion pressures
b)
Periodically
assess:
i)
rpm
vs lpm
ii)
‘run
away’ electronic detection
5.
Tubing
a)
Close
observation for leaks
b)
The
prime should be recirculated at a maximum calculated flow rate to test the
integrity of the circuit and for excessive line pressures
6.
Blender
a)
Assess
with in line O2 analyser
b)
Assess
reed alarm
i)
when
installing tubing to main gas supply ports
ii)
periodically
with a pressure gauge and O2 cylinder
7.
In line O2
analyser
a)
Assess
appropriate readings with room air & oxygen outlet (do not use blender)
8.
Level alarm
a)
Assess
while emptying reservoir during previous case
9.
Bubble detector
a)
Assess
while emptying reservoir during previous case
10.
Pressure alarm
a)
Assess
high pressure alarm noise and cut-off
b)
Periodically
assess with a anaerobe gauge or Hg manometer
11.
Flow meter
a)
Assess
with/by:
i)
Observing
rise of bobbins
ii)
In
line O2 analyser
iii)
Feel
of hot gas via gas outlet port on oxygenator
iv)
Smell
of expired gas with vaporiser open!
1)
Inspect
packaging of oxygenator and tubing for damage
·
Do
not use if packaging is opened
2)
Inspect
expiry date
3)
Open
packaging
4)
Inspect
oxygenator and tubing for damage
·
Do
not use if damage is evident or protective caps are not in place
5)
Inspect
for foreign/ loose material in oxygenator & tubing
6)
Document
serial number of oxygenator & batch number of tubing packs
1)
Prior
to assembly ensure:
·
Clean
hands
·
Clean
pump
·
Intact
packaging
·
Within
expiry dates
2)
Assemble
using no-touch technique
3)
Cutting
of circuitry & reassembly requires:
·
Sterile
scissors
·
Alcohol
swab
·
Sterile
gloves
4)
Unprimed
assembled circuitry may be kept for 24 hours provided:
·
Sterile
draped
·
All
capped
·
CO2
flushed
·
Kept
in operating theatre
5)
Primed
assemble circuitry may be kept for 12 hours
·
Sterile
environment
·
Circulating
·
22°C
prime