Initiating Bypass - sorin APEX HP M Instrucciones De Uso

perfusion circuit. Do not pulse, surge, or rapidly decrease flow
during priming and recirculation.
6. For easier circuit debubbling, it is suggested not to add non-
crystalloid solutions or blood products until priming and
debubbling steps are complete.
7. Clamp the arterial line near the oxygenator outlet port.
8. Start the arterial pump slowly at first and check that
connections are fluid tight.
9. Prime the oxygenator at 0.3 liters/min. until the purge line is filled.
10. Remove the clamp from the arterial line. Recirculate the priming
fluid through the arterial-venous loop at a maximum flow of 6
liters/min.
11. Continue to recirculate for 3-5 minutes. While recirculating, check
the system for air bubbles and tap the entire circuit to facilitate the
removal of air. Close the purge/recirculation valve.
12. If the sample system is used, it will prime itself during
recirculation when the stopcocks are positioned to allow flow
through the sample lines and the manifold. The handles point to
the OFF position. Flow through the sample system should be
stopped when there is no flow in the bypass circuit. This is to
prevent arterial to venous shunting.
13. Blood products, if used, may now be added to the circuit. When
the priming technique employs the use of blood products,
continue recirculation through the oxygenator at a minimum flow
rate of 500 ml/min to minimize potential thrombus formation.

INITIATING BYPASS

1. Ensure that the ventilating gas is flowing into the oxygenator.
2. Ensure that the sample system is off, if used.
3. Ensure that the purge/recirculation valve is closed.
4. Ensure that the line connected to the arterial blood access port is
properly clamped.
5. Initiate bypass according to normal procedure.
CONDUCTING BYPASS
1. If the sample system kit is used, open the system to permit
continuous flushing with arterial blood. This eliminates the
necessity of using a flush syringe when drawing an arterial
sample. Before taking a venous blood sample, shut off the arterial
side of the sample system and withdraw at least 10 ml from the
middle stopcock.
2. The blood gases may be controlled as follows:
Oxygen transfer is controlled by varying the concentration of
oxygen in the ventilating gas.
An oxygen/air blender will provide a controlled oxygen
concentration. To decrease arterial pO
concentration. To increase arterial pO
concentration.
Carbon dioxide transfer may be controlled by varying the total
ventilating gas flow rate.
To reduce arterial pCO , increase the gas flow rate. To increase
2
arterial pCO , reduce the gas flow rate.
2
3. The purge/recirculation valve in "PURGE" position allows
continuous air purge from the oxygenator module during bypass.
In this position and at full arterial blood flow, the continuous purge
diverts only a few ml blood/min from the arterial line.
CONCLUDING BYPASS
1. Stop flow through the sample system prior to concluding bypass.
2. Conclude bypass according to normal operating procedures.
3. Check that the line connected to the arterial blood access port is
properly clamped.
4. If desired, maximum blood return to the patient may be
accomplished by adding clear priming fluid to the venous
reservoir when the blood reaches minimum volume. Pump slowly
through the oxygenator to ensure
emptied.
PROCEDURE FOR CHANGING THE OXYGENATOR DURING
CARDIOPULMONARY BYPASS
The following procedure enables the user to change out the
all the
, decrease the oxygen
2
, increase the oxygen
2
that the reservoir is not
GB – ENGLISH
oxygenator during cardiopulmonary bypass.
Supplies needed for the change-out procedure:
One (1) Sterile tubing cutter
Eight (8) Tubing clamps
®
One (1) Sterile Apex HP M or Apex
One (1) Blood gas sample system accessory kit (catalog no.
050251003)
One (1) CMS oxygenator
050235000)
1. Connect a second CMS oxygenator mounting bracket (catalog
no. 050235000) to the pump console. Place the bracket as close
as possible to the first bracket and in such a way that the new
oxygenator will be oriented in the same orientation as the old
oxygenator.
2. Remove the new oxygenator from the shipping box and inspect
the sterile wrapper for damage. Do not use if the wrapper has
been compromised or damaged. Do not use if the oxygenator has
been compromised or damaged. Record the serial number
located on the oxygenator.
Place the new oxygenator in the second mounting bracket. The
inlet and outlet ports of the new oxygenator should be oriented in
the same direction as the ports of the old oxygenator. Stop the
flow through the sample system of the old device. Check to be
certain that the purge/ recirculation valve is closed and the
arterial blood access line is clamped.
3. Connect the water lines to the new oxygenator. Circulate water
through the heat exchanger and check for leaks.
4. Terminate bypass by following your normal procedures. This will
involve clamping of the venous line and the arterial line.
5. Turn off the ventilating gas. Remove the gas line from the old
oxygenator and place it on the new oxygenator.
6. Connect the arterial sample line of the new sample system kit to
the arterial sampling port of the new oxygenator. Remove the
existing venous sample line from the venous sampling port on the
venous reservoir; attach the venous sample line of the new
sample system. Make sure the stopcocks on the sample manifold
are positioned to allow flow through the sample lines and the
manifold and check that there is no leakage from the sample site
ports.
7. Connect the purge/recirculation line of the new oxygenator to the
venous reservoir.
8. Place two tubing clamps on the 3/8" (9.5 mm) oxygenator inlet
line. This is the line coming from the pump head to the inlet port
of the old oxygenator. Place these clamps close to the
oxygenator inlet port and approximately 1.5 inches (3.8 cm)
apart. Using an aseptic technique, cut the line between the
clamps. Cut near the clamp closest to the oxygenator.
9. Attach the 3/8" (9.5 mm) oxygenator inlet line (coming from the
pump head) to the new oxygenator inlet port.
10. Place two tubing clamps on the 3/8" (9.5 mm) oxygenator outlet
line. Place these clamps close to the oxygenator outlet port and
approximately 1.5 inches (3.8 cm) apart. Using an aseptic
technique, cut the line between the clamps. Cut near the clamp
closest to the oxygenator.
11. Attach the 3/8" (9.5 mm) oxygenator outlet line to the new
oxygenator outlet port.
12. Disconnect the arterial blood access line from the old oxygenator
and reconnect it to the arterial blood access port on the new
oxygenator.
13. Remove the clamp on the oxygenator inlet line of the new
oxygenator.
14. Open the purge/recirculation valve to the purge position.
15. Check that all the connections are secure. Ensure that there is
still a clamp on the arterial line to the patient.
16. Prime the new oxygenator and evacuate any air following the
priming and recirculation procedure.
17. Turn off the sample system. Turn off the arterial pump and close
the purge/recirculation valve.
®
HP M Ph.I.S.I.O. oxygenator
mounting bracket (catalog
7
no.