CP17 Standby and Backup Procedures
POLICY FOR PERFUSION SETUP FOR STANDBY CASES AND EMERGENCY BACKUP
The heart-lung machine and all disposable equipment needed are set up under sterile technique. The disposable setup is dry and not primed until needed by the perfusionist. The setup is moved to an area within the sterile confines of the operating room. The setup should remain ready for use within 72 hr. The setup is marked with time and date, as the same perfusionist may not be using this equipment.
Standby Procedures: OPCABs, Renal Tumor, Pericardectomy, Type III Aneurysms, etc.
The heart-lung machine and all disposable equipment needed are setup under sterile technique. The disposable setup is CO2 flushed and draped until needed by the perfusionist. The setup is moved into an operating room suite and draped to maintain sterility. If the pump is not primed and used, the setup is used for additional standby procedures and remains ready for use within 72h.
The surgeon may want to prime the heart-lung machine for the procedure and will proceed to cardiopulmonary bypass. In the event that the pump is then wet with prime, but not used, it must be used within 36h. The setup is marked with time and date, as the same perfusionist may not be using this equipment.
This policy is a guideline for use by the perfusionist. Tin the event that the pump setup is not clearly defined for a sterility time line, then the setup is disposed of and a new setup is required.
Off-Pump Coronary Artery Bypass (OPCAB)
The heart-lung machine and all disposable equipment needed are setup using strict aseptic technique. The disposable setup is CO2 flushed and primed according to the manufacturer’s instructions for use and departmental protocol. A CO2 blower assembly is setup for OPCAB procedures. Heparin is administered at the surgeon’s request at an initial dose of 150 U/kg. Activated clotting times (ACTs) are monitored 3 min after heparinization and subsequently, every 30 min, with a target ACT 0f 300s. After notification of the surgeon, additional heparin may be administered as needed to maintain a safe level of anticoagulation. Postprocedure heparin reversal may be accomplished by protamine administration using the Bull Curve heparin level technique. Heparin reversal should be confirmed by postprotamine ACT.