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PERFUSION TRAINEE LOG BOOK

SRM Institute of Science & Technology

CASE No:

DATE PAST HISTORY DIAGNOSIS


OT/HLM
SURGERY
SURGEON
ANAESTHETIST
PERFUSIONIST
PATIENT DETAILS
PATIENT NAME PRE MEDICATIONS
UHID No.
AGE/SEX
HEIGHT
WEIGHT
BSA
FLOWS PRE HB: K+ :
BLOOD GROUP UREA: NA+ :
EQUIPMENT CR: ALBUMIN:
OXYGENATOR GLUCOSE:
PUMP BOOT: ARTERIAL: VENOUS: CIRCULATION HCT:
CARDIPLEGIA:
VENT: ANTICOAGULATION
HEMOFILTER: HEP TIME :
ARTERIAL FILTER: HEP DOSE:
ACT TIME:
PUMP PRIME INITIAL DURING VALUE:
PLASMALYTE A PROTAMINE DOSE:
BICARB
HEPARIN CANNULATION
TOTAL PRIME ARTERIAL
FLUID ADDED VENOUS
CARDIOPLEGIA CARDIOPLEGIA
TOTAL CPB VOL VENT

TOTAL INPUT TOTAL OUTPUT PRE PUMP ABG ON PUMP ABG


PH
POST PUMP VOL: PO2
URINE: PCO2
CUF: MUF: HCO3
FLUID BALANCE BE
Sat
DRUGS ON CPB REWARMING DRUGS Na+
HEPARIN K+
HB
HCT
Lactate

TCA SACP-1 SACP-2 ROOT Pump time


PERFUSION LBP-1 LBP-2 CPB ON - ACC ON -
ON CPB OFF - ACC OFF -
OFF CPB TIME - ACC TIME -
TOTAL REWARMING TIME -

CARDIOPLEGIA HOTSHOT
PREPARATION VOLUME TEMP FLOW ROUTE PRESSURE
DOSE I

DOSE II

DOSE III

CP GIVEN TIME:

CIRCULATION CALCULATIONS CHECKS


Blood to be Added
PRE BY PASS CHECK LIST

ALL SAFETY ALARM LIMITS


Blood to be removed
SAFETY ALARMS FUNCTIONING
COP Pressure
SUPPORTS EVENT AND CORRECTIONS

PROCEDURE

GRAFTS / VALVE

PERFUSIONIST SIGNATURE

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