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Pediatric prime control

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Kuzima View Drop Down
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Joined: Oct 10 2007
Location: Ukraine
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Posts: 4
  Quote Kuzima Quote  Post ReplyReply bullet Topic: Pediatric prime control
    Posted: Dec 03 2009 at 5:16am
Dear collegues,

please, let me to ask you a question:
do you use in your institution the pre-bypass prime monitoring? I mean: PCO2, PO2, pH, osmolarity, K+, Na+, Ca+, Ht and may be others in the prime volume before CPB starts.

If yes, what parameters do you check? Routinely? With what patients?
Big thanks!
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ggrist View Drop Down
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  Quote ggrist Quote  Post ReplyReply bullet Posted: Dec 22 2009 at 10:19am
Kumiza-
We do monitor our blood primes.  We prime the pump with PRBC and FFPand then ultrafiltrate it with 2 L of a specially mixed, buffered IV solution.  We try to keep the sodium under 145 and the glucose under 150.  We estimate the osmolarity with this formula:  (Na X 2) + (glucose/18) + 15 = estimated osmolarity.  For example, if the Na = 140 mEq/L and the glucose = 200 mg%, the estimated osmolarity will be:
 
(140 x 2) + (200/18) + 15 = 306 mosmols
 
The buffered IV solution also balances the pH.  We balance the pCO2 by recirculating the prime with a 21% O2 sweep gas with 5% CO2 added.
 
We have learned from past experience that a prime osmolarity over 320 mosmols can cause kidney and brain damage.  We do not add mannitol or tham to our prime because they are high osmolarity agents and we cannot directly assess the impact that they have on osmolarity with our test equipment in the OR. We would need to send a specimen to the lab for testing.
 
Gary Grist
Kansas City, Missouri
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tariq View Drop Down
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  Quote tariq Quote  Post ReplyReply bullet Posted: Oct 18 2010 at 12:39pm
Kumiza
We routinely perfoem prebypass ultrafiltration (PBUF) in all pediatric procedures where bank blood is used in prime. Pump is primed with Crystalloid Sol + Bank Blood + FFP + Albumin + Heparin and then we start PBUF, ultrafiltrate is removed @ 2-3ml  for each ml of bank blood added to prime. We ventilate the prime, gas flow @ 100 - 200 ml/min with FiO2, 21% for 2-3 minutes. When PBUF is complete ultrafiltrate line is clamped. NaHCO3 is added @  1 mEq for each 10 ml of bank blood added to prime. Drugs with smaller mol. wt and not bind blood proteins are not added untill PBUF is complete.
 
After performing above steps we do ACT , ABG's, and electrolyte test. If necessary we correct the results. We have found this combination of 3 strategies (PBUF + Ventilation + Drugs) with excellent results. 
 
We cannot afford cell saver. Blood  products are not leukodepleted. And so many other problems which are common for perfusionists working in economically weak countries or third world countries so with use of Ultrafilter we apply all the UF techniques i.e PBUF, CUF, ZBUF, and MUF.
 
If someone feels that we are doing something wrong or suggestion so that we can  improve our results will be appreciated.
Tariq Rao      
tikki
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