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    Coll The Manual of Clinical Perfusion Perfusion 2004 1

    Uploaded by

    Made Ayu

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    © All Rights Reserved
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    - THE MANUAL OF CLINICAL PERFUSION SECOND EDITION UPDATED PHA Ae eee D. MARK BROWN, CCP APERFUSION.COM PUBLICATION t LJ 4 Cd bud Ed e © Ad J td e ® od @ nd e od e * lad hd ® r cd i e id 4 THE MANUAL OF CLINICAL PERFUSION SECOND EDITION UPDATED BRYAN V. LICH, CCP D. MARK BROWN, CCP APERFUSION.COM PUBLICATION PORTMYERS, FLORIDA Euitors: D.Mack Browa, CCP Bryan V Lich, CCP IMlustrations: Samuel Laterza Cover Design: Bryan V. Lich, CCP Project Manager: Bryan V. Lich, CCP Original Authors: Joba E, Brodie, MS, CCP, PA Ronald Jonson, CCP, PA Additional Contributions: Victor Lich J.,JD Richard A. Raley, CCP ‘Sam Dominico, CCP Iris J. Chacon, CCP Copyright © 2004 Rerfuston.com, Ine. llrightsreserved. No part of this book may be reproduced or transmitted in ‘ny form or by any meats, electronic ar mechanical including photocopying, recording or by any information storage and retrieval system, without the ‘written permission of Perfusion.com, Inc. Previous oditions copyrighted 1995, 1997 Printed in the United States of America PERFUSION.COM, INC. 900 Keenan Avenue Fort Myers, FL 33919 ‘Customer Service: (866)872-8065 huip:/'wwe.perfusion.com services@perfusion.com LOCN: 2004092235 ISBN:0-9753396-05 Foreword This book release, The Manual of Clinical Perfusion Second Edition Updated, is an update to the 1997 edition by John Brodie and Ronald Johuson. John and Ronald began this book project in 1994 and quickly developed what has ‘become one of the most valuable publications for perfusionists, perfusion students ‘and other perfusion-related medical professionals, As te new owners of this publication, we will do our best to preserve their concise and straight-forward ‘format that has made this book so popular, ‘As one might imagine, there have been quite a few advances in perfusion technology in the [ast seven years. Vacuum assisted venous drainage, modified ultrafiltration and platelet-rich plasma sequestration are just a few that come to ‘mind. ‘There has also been an agglomeration of new products released into the ‘market including; oxygenators, cannulae, filirs, medications and hardware devices. ‘We have spent considerable time and offort revising and updating the contents to bring this manual up-to-date, However, many of the planned updates ‘will not be included until the third edition isreicased sometime inthe fall of 2004. ‘While this is unfortunate, we felt twas prudent to satisfy the immediate customer demand by releasing this interim edition in lieu ofthe third edition. ‘With that said, we hope that you will find our new content and revisions practical and useful. We welcome your input and constructive criticism while the third edition of this hook is under development. Bryan V. Lich NOTICE “The information contained inthis Manual is for edueational purposes only. Reliance on or use of any information provided is solely at your own risk. Pesfusion.com and the authors, editors and revisers of this Manual are not responsible or liable for any outcome based on your decision to uilizethe information provided. The authors, editors and revisers ofthis Manual have nade extensive efforts to ensure tho treatments and procedures conform to accepted standards at the time of publication; but in view of the possibility of buman error neither Perfusion.com ‘nor any other party involved in the preparation of this Manual warrants that the information contained hereinis in overy respect aovurate or complete, andthey are not responsible for any errors or omissions or for the results obtained from the use of the information. You are encouraged and instructed to confirm the information contained herein with other sources including package inserts for drugs and other ‘medical literature, Perfusion.com does not recommend or endorse any specific products, procedures ‘or other information that may be mentioned in this Manual, The advertisers in this ‘Manual o other sponsors of this Manual have no influence on the content of the ‘Manual and the display of advertisements is uo: to be taken as an express or implied endorsement of any advertised product or service. Chapter3 Blo 0d eenreeonenn een Chapters Bl00d Ga8eS-nmvmecrnensnnnnnnnnnnnrinnnnenS Chapters Blood Diso1dernwmenenenrnininnnnnnannennnnnsSS Chapter6 Blood Conservation Techniques. onium 61 Chapter? Conduct of PertsiotneennnnnntiinnninnmnnenT Chapter’ Myocardial Protection. vee Chapier9 Effects of Cardiopulmonary Bypasseemrmrneil Chapter 11 (Cardiae Valve SurgerynicnneonsennnnsnnnsnTO5 Chapter 12 Special Case seen nani OS Chapter 13 Isolated Limb Perfusion.. Chapter 18 Congenital Pathology.rannennemn veel 7 Chapter 19 CiLCUHS wemnmninaninnniennnninnnnnnnnnl TS Chapter 20 Oxygenatariminnunennnnnnnninnnninnnnin EBL Chapter 23 Intra-operative Transesophageal Echocardiography (TEE) numtmnnannnumenn2OL ‘Chapter 24 Solutions, Chapter 25 Pharmacol0gyinmncnaenininmnnenannienanemanannc Dl] 207 “Appendix: Bibliographyneemnennmrenmnrnrrn OZ pose Chapter 1 Anatomy | Anatomy: ‘The cells of the body must receive a continuous supply of oxygen and nuttients. Waste products must also be removed. It is the circulatory system that transports the blood from the lungs tall parts ofthe body with its life giving oxygen and transports the cellular waste products. The average adult human contains over 60,000 miles of blood vessels. ‘The purap that ‘propels the blood through this long network of vessels is the heart Heart ‘The heart is cone shaped and found between the Ings inthe middle of the chest, behind the stemum, in the middle mediastinum. Ihe heart lies ‘with the blunt point the apex) pointing downward andtothelef. Approximately ‘wo thirds of the heart's volume isin the let thoracic cavity. The heart ofthe average male weighs about 280-340 grams, The heart of the average female ‘weighs about 230-280 grams. ‘The dimensions of the average heart area length of 12 cm,a width of8 emanda thickness of 5 em. There re four chambers in the heart with four one-way valves to direct blood flow through the chambers. ‘The upper chamiers are the right and left atria, They are divided by a thin ‘muscalar wal, the atrial septum. The septum contains a central depression of ‘hin fibrinous material known as the fossa ovals, ‘The lower chambers are the rightand leftventticles, They are divided by the ventricular septum. ‘This isa thick muscular wall with @ smal, thin ‘membranous portion atthe top. Frontal View “Mostheart surgery techniques require opening the stermum to expose the heart. This surgical opening, the median sternotomy, displays the right atrium and right ventricle. Seen inthe drawing below are the right ariurn and ‘ight ventricle separated by the tight atrioventricular suleus, ‘This suleus is a ‘groove in which the right coronary artery runs. Further left is the anterior interventricular sulcus separating the right and left ventricles. ‘The anterior descending branch of the left coronary artery runs through this suleus. The left atrium and ventricle have only small portions visible in this view because they lie posterior tothe right atrium and ventricle, Chapter 1 ‘The Manual Frontal View plonary artery Jef arial appendage eft ventricle right abioventioulr sles vit RCA running init anterior intervnticaiar suleus with the LAD sight vente ruming it Posterior View In the posterior view below, large portions of the left atrium and ‘ventricle are visible. Also soen are the pulmonary veins, the coronary sinus lying inthe posterior atrioventricular sulcus, and the posterior interventricular sulcus containing the descending branch of the right coronary artery Posterior View pelmorary sere let stsura Jet ventile > right atrium Chapter 1 Anatomy Heart Walls ‘The hearthas a protective covering called the pericardium. Thistwo layered covering allows the heart o move with a minimum of friction. ‘The loose outer layer, the fibrous layer, isa tough white connective tissue. This layer becomes continuous with the cuter layers ofthe great vessels. ‘The inner layers the serous pericardium. This layers further divided into the patietal and visceral layers. The parietal layer covers the fibrous layer. Itruns superiorly under the fibrous pericardium forapproximately 2m upthe great vessels, then turns back upon itself. Atthis point, it now becomes the visceral layer or cpicardium, and continucs back to cover the heart. Both layers ofthe serous pericardium are moist, smooth and mesothelial covered. Between the parietal tayer and the epicardium is 2 space containing approximately 50 ni of pericardial lid. ‘There are three layers of the heart wall, The outer most layer is the epicardium (the visceral pericardium). Thisisa single layer of cells of mesothelial calls over a fibroelastic membrane. The cardiac muscle wal isthe myocardium. ‘This muscle is similarto the voluntary muscles. The myocerdium muscle cells, are elongated and interconnected to allow coordinated contractions of the heat, There are two bands of muscles that form a latticework arrangement o accomplish these contractions. The innermost layers the endocardium. This fsa single layer of endothelial colls that ercates a very smooth lining of the interiorcharbers ofthe heart, This smooth ining allows blood tomove through the heart with a minimum of friction. Lesions of the endocardium caused by inflammation can cause Tocal thrombosis and thromboembolism, areal layer mrs hack apo elt XQ SEES te pare layer stor ayer oF pica Chapter 1 ‘The Manaal of Clinical Perfusion ee Right Heart ‘The superior vena cava retums blood fom the upper body to the right atrium, Blood from the head, arms and upper body is drained into the superior veri cava, The inferior vena cava drains blood from the lower body into the rightatrium. ‘The right atrium is the small charaber thats the sito of ‘venous cannulation for CPB. The walls ofthe right atrium are thin, about 2-3 amilinneters. "The blood moves from the right atrium through en atrioventelewlar (A-¥) valve. A-V values have leaflets which tethered by fibrous chords. The ‘chordae tendineae that are attachedto the papillary muscles in the wails ofthe ventricle, These chordae tendineae and papillary muscles prevent the leaflets from going back into the atriun when the heart contracts, ‘Thus, a complete

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