Circuit Surfers

Chase Crytsalloid out through Oxygenator ...

“I’ve put Femoral Art Lines in My Last 3 Patient’s…”

Editor’s Note: I heard this comment from a CV surgeon the other day- and reminded him that all 3 were very long pump runs (exceeding 180 minutes) and that based on anecdotal observation- I have always noticed a direct correlation to the increased amount of phenyephrine administered during the course of a long  pump run-…

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Bicarb Alternatives: Sodium Acetate & Balanced Crystalloids

Editor’s Note:   Authorization for the contributions below were obtained from each contributor via email.  Please see comments section… THAM A a Buffer Tham Description Tham Solution (tromeThamine injection) is a sterile, non-pyrogenic 0.3 M solution of tromeThamine, adjusted to a pH of approximately 8.6 with glacial acetic acid. It is administered by intravenous injection, by…

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Perfusion Policies 101: Angiomax

Editor’s Note: The use of alternatives to heparin in terms of managing anicoagulation doesn’t come up often.  It’s easy to get a bit rusty when it comes to using exotic agents such as Ancrod (Hirudin), Angiomax and similar agents. So here is a brief refresher, and as always- a disclaimer here:  Use this information with…

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Desmospressin: A Primer on DDAVP

<img class="alignnone size-full wp-image-32561" src="https://i2.wp.com/circuit.perfusion.com/wp-content/uploads/2016/07/1 20 mg prednisone.jpg?resize=529%2C167″ alt=”1″ srcset=”https://i2.wp.com/circuit.perfusion.com/wp-content/uploads/2016/07/1.jpg?w=787 787w, https://i2.wp.com/circuit.perfusion.com/wp-content/uploads/2016/07/1.jpg?resize=300%2C95 300w, https://i2.wp.com/circuit.perfusion.com/wp-content/uploads/2016/07/1.jpg?resize=768%2C243 768w” sizes=”(max-width: 529px) 100vw, 529px” data-recalc-dims=”1″ /> Click on image to view source article = Desmopressin Desmopressin acetate (DDAVP) is a synthetic analog of vasopressin and like ADH, epinephrine, and insulin, releases a variety of hemostatically active substances from vascular endothelium. …

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Angiomax: Use and Dosing Regimen

Editor’s Note: The use of alternatives to heparin in terms of managing anicoagulation doesn’t come up often.  So many of us get a bit rusty when it comes to using exotic agents such as Ancrod (Hirudin), Angiomax and similar agents. So here is a brief refresher, and as always- a disclaimer here:  Use this information…

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Protamine

Protamine Protamine, a polycationic protein derived from salmon milt, possess strong alkalinity because of an amino acid composition consisting of 67% arginine.  In its natural state, the numerous positive charges on the protamine molecule bind with the negatively charged phosphate groups of the nucleoprotein material of salmon sperm.  Heparin, a polyanion, binds ionically to protamine…

RoadMap

Adequacy of Perfusion:

Adequacy of Perfusion:  By Steve Sutton, LP, CCP Editor’s Note: Steve Sutton is well known and highly regarded into today’s Perfusion community.  He is a strong proponent for advancing Perfusion education and in pursuing that goal,  he has given numerous presentations at some of the most  premier Perfusion meetings held each year. Along with his…

Right Ventricle

Right Ventricular Function

Right Ventricle The right ventricle is one of four chambers (two atria and two ventricles) in the human heart. It receives deoxygenated blood from the right atrium via the tricuspid valve, and pumps it into the pulmonary artery via the pulmonary valve and pulmonary trunk. It is triangular in form, and extends from the right…

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Letters To ‘Surfers: From China: Pediatric Priming Solutions ?

(Click Image to Enlarge) Editor’s Note: I got this question regarding pediatric priming protocols from a perfusionist in China. My pediatric experience is limited to ECMO- so I defer to the more experienced pediatric perfusionists out there to help formulate an informed response 🙂 Leave your answers or suggestions in the “Comments” section plz? Frank…

FFP and Heparin

Heparin: Factors Affecting & it’s Effects [Reprint]

HEPARIN ONSET: Maximal at 1 minute past atrial delivery: Measured at radial artery.  Note:  10-20% reduction in svr without affecting c.o. and or h.r. LUNG VS MUCOSAL: Mucosal requires larger doses- but can be reversed with 25-30% less protamine:  greater postoperative blood loss associated with mucosal heparin- speculated to result from lower molecular weight &…

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Protamine Reaction

“It binds to heparin to form a stable ion pair which does not have anticoagulant activity; on its own, protamine has a weak anticoagulant effect.”   Protamine sulfate is a drug that reverses the anticoagulant effects of heparin by binding to it. Protamine was originally isolated from the sperm of salmon and other species of…

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Malignant Hyperthermia

Editor’s Note: Just a brief primer on Malignant Hyperthermia, should the need ever arise to place a patient on CPB who has been diagnosed with this condition. It is an unusual co-morbidity and should be approached and treated with an abundance of clinical respect and caution.  Any insight or recommendations from readers would be greatly…

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The MgSO4 Shortage: Now We Know Why …

Click Image to View Drug Shortages Listed on the Site … Was it Real ? UPDATE ! Yeah …  It was. Click image to view source article … Nurse spotted mold-tainted drugs right away, hospital says By JoNel Aleccia, Senior Writer, NBC News A sharp-eyed nurse at Yale-New Haven Hospital in Connecticut is being credited…

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CaCl Shortage ? FYI ( Yeah There Is … )

Is it Real ? UPDATE ! Yeah …  It is. I was just informed we have enough at one of our hospitals for about 4 cases… The impact here (for us) is that we have a practice that does a large volume of Platelet Gel cases, basically for every heart as well as vascular, ortho…

FFP and Heparin

Heparin: Factors Affecting & it’s Effects

HEPARIN ONSET: Maximal at 1 minute past atrial delivery: Measured at radial artery.  Note:  10-20% reduction in svr without affecting c.o. and or h.r. LUNG VS MUCOSAL: Mucosal requires larger doses- but can be reversed with 25-30% less protamine:  greater postoperative blood loss associated with mucosal heparin- speculated to result from lower molecular weight &…

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Cardioplegia 101

Cardioplegia Vinten-Johansen J, Nakanishi K. Postcardioplegia acute cardiac dysfunction and     reperfusion injury. Journal of Cardiothoracic and Vascular Anesthesia.     1993;7(Suppl 2):6-18.

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The “Hot Shot” : A Layman’s Approach Part II

Editor’s Note: The 1st post on this topic generated some good discussion- which is related below. To see Part 1– Click Here… The Discussion Got an Opinion ? Care to share it ? 🙂

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The “Hot Shot” : A Layman’s Approach to Myocardial Protection

A Salient Point from a Perfusionist: “I will give one good example of how a warm/hot shot worked for us. We finished up a normal 4 banger and before doing the proximals with the cross clamp on we routinely give a short hot shot, actually its room temperature shot, but I digress. The clamp was…

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HELP ! Potassium Acetate as a work-around for KCL Shortage ?

Editors Note: Have any of you out there ever used or considered using Potassium Acetate as a work around for KCL Shortage? I personally have zero experience with it- but the thought had crossed my mind in light of the current situation.  I saw this post from Jim Patterson, CCP on Perflist and asked him…

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KCL Shortage ? FYI ( Yeah There Is … )

Is it Real ? UPDATE ! Yeah …  It is. I was just informed we have enough at one of our hospitals for 16 cases… Any suggestions on resources ??? More Recent Resupply Dates 2 mEq/mL; 20 mL vial (NDC 0409-6653-05) (Standard) Next delivery June 10 mEq/100 mL (NDC 00409-7074-26) Ample supplies available to meet…

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KCL Shortage UPDATE

Most Recent Resupply Dates 2 mEq/mL; 20 mL vial (NDC 0409-6653-05) (Standard) Next delivery June 10 mEq/100 mL (NDC 00409-7074-26) Ample supplies available to meet market demand. 10 mEq/50 mL (NDC 00409-7075-14) Ample supplies available to meet market demand. 20 mEq/100 mL, (NDC00409-7075-26) Ample supplies available to meet market demand. 20 mEq/50 mL (NDC 00409-7077-14)…

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Are Drug Shortages the New Status Quo ?

Click above to view source article Editors Note: A List of articles on Perfusion related Med Shortages Below: Protamine MgSO4 Amicar NaHCO3 KCl WASHINGTON — At the Henry Ford Hospital in Detroit, pharmacists are using old-fashioned paper spreadsheets to track their stock of drugs in short supply – a task that takes several hours each day.…

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KCL Shortage ? FYI (In case you use it)

Is it Real ?

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Dabigatran (Pradaxa)

Dabigatran (Pradaxa) (Boehringer Ingelheim) It should be noted up front that while Dabigatran is indicated as an anticoagulation Rx for atrial fibrillation, it is not recommended for patient’s with concomitant valvular disease, and not indicated for anticoagulation therapy in patient’s receiving valve replacements or experiencing valve dysfunction. Mechanism of Action Dabigatran and its acyl glucuronides…