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not being correctly operating, allowing air to enter artery via the
pump.
2) the air which is delivered via the venous cannulae is not removed
promptly from the venous reservoir and is aspirated by the arterial
pump.
- If there is to be continuous administration of anticoagulant to the
patient, use a female luer lock connector on the soft reservoir venous
return connector.
F. PRIMING AND RECIRCULATION PROCEDURE
Do not use alcoholic priming solutions: such solutions could compromise the
proper functioning of the oxygenating module.
1) KEEP THE GAS FLOW OFF
2) KEEP THE OXYGENATOR PURGE LINE CLOSED
Check that the blue clamp, placed on the oxygenator purge line, is in the
closed position. Keep the white clamp, placed on the recirculation line, open.
3) SET THE VOLUME OF THE VENOUS RESERVOIR (fig. 4)
Versions with the SOFT VENOUS RESERVOIR
Set the desired volume using the soft reservoir squeezer (ref. 7).
4) ISOLATE THE SOFT VENOUS RESERVOIR AND
OXYGENATING MODULE
Versions with the SOFT VENOUS RESERVOIR
Clamp the cardiotomy outlet, the venous return, the soft venous reservoir
outlet and the arterial outlet of the oxygenator.
5) CHECKING THE HEAT EXCHANGER
Verify again the integrity of the heat exchanger, with particular attention to
possible water leaks.
6) CARDIOTOMY PRIMING
Secure with ties all aspiration lines connected to the cardiotomy. Fill the
cardiotomy with sufficient liquid to ensure the intended haematocrit is
obtained, taking into account:
-
the recovered priming volume of the oxygenator is 60 ml;
-
if it is present, soft venous reservoir capacity varies from minimum 25 to
maximum 90 ml;
-
the 3/16" tube capacity is 19 ml/m;
-
the 1/4" tube capacity is 32 ml/m.
7) CIRCUIT PRIMING
Remove the clamp at the cardiotomy outlet.
Versions with SOFT VENOUS RESERVOIR
The priming solution flows to the soft venous reservoir. The air contained
inside the soft venous reservoir will automatically be evacuated from the purge
line which is placed at the top of the reservoir by activating the suction pump.
remove the clamp placed on the outlet of the soft venous reservoir.
- The pressure level inside the soft venous reservoir shall not exceed 13
KPa (0.13 bar / 1.9 psi).
- The pressure level inside the blood compartment of the oxygenating
module shall not exceed 100 KPa (1 bar / 14 psi).
All versions
Switch the arterial pump on to prime the oxygenating module. In this condition,
the blood recirculates between the oxygenator and the venous reservoir:
maximum flow shall not exceed 200 ml/min.
8) OPENING OF THE VENOUS AND ARTERIAL LINES
Open the purge line of the oxygenator by means of the blue clamp in order to
purge the air which is contained in the line. Close the clamp. Remove the
venous and arterial line clamps and increase flow up to 800 ml/min.
9) CLOSING THE OXYGENATOR RECIRCULATION LINE
Close the white clamp placed on the recirculation line.
10) PURGING THE AIR CONTAINED IN THE CIRCUIT
During this phase it is necessary to tap the entire circuit 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 evacuated.
11) PRIMING OF THE 4-WAY SAMPLING MANIFOLD
Versions with the SOFT VENOUS RESERVOIR
The removal of the air from the A/V sampling system is achieved by selecting
the yellow A/V SHUNT position. If the arterial pressure is not sufficient to
remove the microbubbles from the tube walls, squeeze gently the arterial line
of the circuit so as to partially close it.
12) OPENING THE RECIRCULATION LINE
After complete removal of air from the circuit, it is possible to reduce the
arterial flow to 200 ml/min opening the recirculation line and performing
recirculation.
13) CLOSING THE VENOUS AND ARTERIAL LINES
- During the priming and purge phases, the arterial/venous circuit must
be maintained at least 30 cm higher than the arterial outlet of the
oxygenator.
- Do not use pulsatile flow during priming.
- Check the correct dosage of anticoagulant in the system before
starting the bypass. -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.
G. INITIATING BYPASS
1) OPENING OF THE ARTERIAL AND VENOUS LINES
Remove first the clamp from the arterial line, then remove the clamp on the
venous line. Start the bypass with a blood flow appropriate to patient size.
Check constantly the blood level in the venous reservoir.
2) CHECKING 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
80:100%.
-Always open the gas flow after 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. This is to prevent gas emboli appearing in the blood
compartment.
4) BLOOD GAS MONITORING
After a few minutes of bypass operation, measure 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
5) KEEP THE PURGE LINE OF THE SOFT VENOUS
RESERVOIR OPEN
Versions with SOFT VENOUS RESERVOIR
Continuous air purge from the soft venous reservoir is recommended.
H. DURING BYPASS
1) CHECKING THE VENOUS RETURN
If a higher venous return flow is necessary act as follows:
Versions with SOFT VENOUS RESERVOIR
a) Open completely the soft reservoir squeezer in order to increase the
reservoir volume.
All versions
b) Lower both the oxygenator and the venous reservoir with respect to the
patient position.
Versions with SOFT VENOUS RESERVOIR
- The cardiotomy must always be placed in a higher position with
respect to the soft venous reservoir.
- It is recommended to keep the line connecting cardiotomy and soft
venous reservoir clamped during the case, in order to prevent massive
air delivery to the patient in case the cardiotomy and the soft venous
reservoirs empty. In case blood has to be moved from the cardiotomy
to the soft venous reservoir, carefully open the clamp and avoid to
empty the line connecting cardiotomy and soft venous reservoir.
GB - ENGLISH
Decrease FiO
2
Increase FiO
2
Increase gas flow
Decrease gas flow
of
2
5
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