“Other than the uniqueness of the circuit set-up’s, the cases are very different.”
This is a continuation of a series with our newest associate editor, Shayla Johnson, who is currently enrolled in a perfusion program. I asked her to join the editorial team because she reflects the passion and excitement that every perfusionist has- or otherwise they wouldn’t do it.
I am impressed that as a perfusion student she has the initiative to share her thoughts and impressions with us regarding the process of learning the art of perfusion technology from her own unique perspective:
“I am a first year perfusion student.I follow your facebook and website to stay updated on perfusion news from all around the world, and I love it. I saw the posting about needing bloggers and wanted to find out if you were interested in a student blogger. Either way, thank you for the work put into the website, it was valuable as I prepared to apply for my program as well as throughout it.
The name of the series is as above- LPM: A Student’s Perspective. There is a slight play on the acronym as the L stands for Learning as opposed to a metric for Q.
As we all know- regardless of experience level- we all learn minute by minute.
Shayla Johnson: Associate Editor
LPM: Pediatric Observations
Until this rotation, I hadn’t yet had the chance to observe any pediatric cases and I am incredibly lucky to do so now with such a great group of people. Pediatric cases require a shift in thinking and it’s interesting to see the differences between pediatrics versus adults. While we learned about the customizable circuits in school, seeing it actually in practice is incredibly interesting. It requires a very thorough knowledge of the circuits and what exactly can be customized. The ancillary monitoring devices even need to be interchangeable to fit with various tubing sizes. While at first it was daunting to watch the circuit be set up due to general complexity with the circuits and additional lines (particularly for MUF), it does start to come together. I realized that while the reservoir and oxygenator and the line sizes may change, everything still connects in roughly the same location so that there is consistency to the circuit between patients.
Other than the uniqueness of the circuit set-up’s, the cases are very different. While on the adult side there are also interesting and complex cases, the pediatric side requires knowledge of the congenital defects. It has been great to be able to learn the procedures on the surgical side in order to better understand how certain defects have been corrected. There’s a different feeling with the patient’s, as some of them are babies and some of the patients are teenagers. The approach during the case is also altered for perfusion. Volume is carefully regulated and hemoconcentrators are used, as well as minimizing the prime volume from the start. At the end of the case, modified ultrafiltration is done, returning all the blood in the circuit back to the patient in order to raise the hematocrit and cut down the need for a transfusion.
Coagulation management is also more closely monitored due to the small patient sizes. The Hemostasis Management System (HMS) is used, as well as an ACT and TEG. The HMS will give the heparin dosing needed for the patient, as well as the protamine reversal. With the combination of all their devices, they are able to more accurately assess the patient’s needs particularly after the case when the final TEG is run.
Another aspect of pediatrics that I had never seen before was utilization of pH-stat management. While learning about it in school, it was hard to visualize and understand. I will admit, it was one of the more complicated management strategies to understand. However, seeing it in practice was extremely helpful in overall understanding. When running a blood gas, we simply input the temperature in order to temperature correct the analysis results. As far as adding CO2, I could never visualize how CO2 was added (was a container of CO2 gas connected to the circuit much like when CO2 flushing?). In the pediatric set-up, there is an additional gas line wired in that gives the ability to add CO2 if needed. The perfusionist also explained to me that simply turning down the sweep was sometimes good enough as well. The practical application of this technique helped solidify the knowledge I had gained didactically so that I could see the necessity for using pH-stat, and required understanding the relationship between the gases and temperature.
I’ve been lucky to observe great pediatric perfusion and can’t wait to continue to learn more.