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Arterial Flow Control: Clamp vs Knob

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mjlperf View Drop Down

Joined: Feb 12 2009
Location: United States
Online Status: Offline
Posts: 1
  Quote mjlperf Quote  Post ReplyReply bullet Topic: Arterial Flow Control: Clamp vs Knob
    Posted: Feb 12 2009 at 3:06pm
Hello all,
As many of us work with centrifugal pumps we all know that our arterial flow can be controlled both with the pump control (i.e. knob) or clamping of the arterial line.  Also with centrifugal pumps there is a specific RPM threshold that must be maintained for forward-flow.
For small, acute decreases of flow such as when the surgeon is putting on or taking off the cross clamp I generally soft-clamp the arterial line to quickly decrease flow and return to the previous flow when I unclamp.  Ever since I started working with centrifugal pumps I have observed this to be pretty standard practice.  I have started working with a new group and this practice has come under scrutiny because it is new to them.  I am hoping to get a consensus of others' pros and cons of this practice.
I work in a center that uses the Terumo System 1 which utilizes a touch-screen control for all pumps but the one safety device this system does not have that systems such as the Biomedicus do have is an automatic limit on reduction of flow to prevent going beyond the forward-flow threshold.  This feature basically makes it so you must hit another button to be able to decrease your flow beyond that threshold.  The System 1 allows you to dip below the forward-flow threshold and possibly have a backflow situation if one is too aggressive in flow adjustment.  Thusly I am most comfortable soft-clamping my arterial line for short decreases of flow because it eliminates the possibility of backflow/exanguination.  My flow-probe is distal to the point at which I clamp so I always know my flows.  Another main reason I do this is that it is the closest way to decrease flow as it is immediately next to my reservoir so I am always able to see my level as I adjust.
If anyone knows of anything published on this subject I would appreciate feedback but I understand that's very unlikely.
The cons I can think of with this practice are:
Possible hemolysis in the short periods of jetting through the clamped line
Increased arterial line pressure proximal to the clamped portion
The pros I consider with this practice are:
No possible backflow
return to previous flow once unclamped
All variables (reservoir, arterial line, flow probe) are in front of you whereas System 1 control requires line of sight taken away from the pump itself  (ours is situated on opposite side of pump)
I use this as my practice because I feel it is the safest method for a (seemingly small) adjustment.  I would love any and all feedback regarding this.
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