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1. Extracorporeal circulation (FCT)

Perfusion in infants, children and adult patients

Perfusion requires a very good understanding of the pathophysiology of the underlying disease and the implementation and application of extracorporeal circulation for cardiopulmonary bypass in humans is extremely important as excellent knowledge of biomedical principles, and adequate clinical experience. Apparatus (machines) for extracorporeal circulation completely takes over the function of the heart and lungs during open heart surgery. Perfuzer independently controlled extracorporeal circulation and keeps patients alive during surgery. Accountability is increased by the fact that unprofessional conduct perfusion directly affects the success of the surgery and of course the life of the patient.

Organization and planning of CPB (FTC) 
  • Preliminary discussion with the surgeon and anesthesiologist regarding the procedure
  • Collect and record relevant patient information
  • Selection of equipment for perfusion:
  1. Oksigenator
  2. Perfusion system (PVC hoses that connect the system components)
  3. Procedures for blood salvage (hemofilter, "cell-saver")
 

 
      • Choir perfusion modes (pulse or nepulsni flow) and perfusion characteristics of the system (open or closed)
      • The choice of the composition of the primary charging system ("priming")
      • Calculating the parameters of importance for perfusion (patient's body surface area, flow pumps, cooling rate, blood volume, hemodilution, and the like.)

 

Preparation FTC
  • Sterile handling and installation of the perfusion (PVC pipes) in the state of readiness for use
  • Filling and eliminate air from the system
  • System and functional verification system for FTC
  • Selection of appropriate cannula depending on the specifics of the surgery (aortic, arterial, venous cannula, etc.).
  • Preparation of appropriate drugs to be added to the primary charge ("Priming")
  • Selection and preparation system for cardioplegia
  • Connecting systems with cardioplegia system for FTC to ensure delivery of the solution pump kardioplegičnog anterograde or retrograde flow
  • The selection and placement system for saving and processing of blood

 

Independent management perfusion
  • Download and maintenance functions of the heart and lung machine using VTK (blood pressure, blood flow, oxygenation, CO2 elimination ...)
  • Temperature control (body temperature, arterial and venous blood cardioplegic solution, the water in the heat exchanger, etc.).
  • Regulation of fluid and electrolyte homeostasis, blood
  • Regulation of acid-base status
  • Extracorporeal blood volume control and the correction of its composition (transfusion, kristoloidni solutions, colloidal solutions)
  • Monitoring (supervision) FTC and timely response in terms of the potential correction of perfusion parameters:
          1. Pressure (blood pressure patients, the pressures of the components FTC)
          2. blood flow
          3. oxygenation
          4. The level of blood oksigenatoru
          5. Detection of air bubbles in the system
          6. Decompression of the left heart ("vent")
          7. Sukcioni systems
          8. Conditions blood
          9. Administration of medications in FTC (whenever possible, the administration of anesthetic gases through the system FTC)
          10. hemofiltration
          11. „Cell-saver“
      • Procedure after FTC operations:
                  • Calculating the volume balance
                  • Processing of residual blood volume machines FTC and providing re-transfusion
                  • Completion intraoperative documentation
                  • Scheduling and processing of materials
                  • Cleaning and disinfection of machinery for FTC

 

2. Methods of circulatory support

The Intraaortic balloon pump (IABP)

 

  • Storage (storage) IABP catheter (various sizes) and helijumskih cylinders
  • Extensive knowledge of physiology and pathophysiology IABP
  • Security check and control systems
  • Connection apparatus and setting appropriate ECG signals, ECG electrodes disposition and selection of trigger modes podesnog
  • IABP catheter choice and calibration
  • Kontrapulsacije introduction and regulation of the optimal diastolic amplification taking into account the vital parameters
  • Replacing helium cylinder chamber and the safety when necessary
  • Corrective actions in case of fault or alarm
  • Cleaning and re-rigging guide
  • Documentation on the use of data banks and filling if applicable

 

Other mechanical circulatory support systems for before and after operative use

 

  • Comprehensive knowledge of the principles of functional circulatory support systems that are available today (tršištu)
  • Close cooperation with the medical staff and provide support for all technical issues
  • Attendance at informational meetings leading vendors who are related to circulatory support systems
  • The presence of theoretical and practical training on working with circulatory support systems that are used in the respective institution
  • Providing the necessary materials available
  • Ensuring continuous availability of functional appliances
  • Work training (training) in connection with the use of equipment with special emphasis on providing support quickly in emergency situations
  • Mounting systems and providing support under sterile conditions and support systems during implantation patient
  • The introduction of machines and setting optimal parameters for support
  • Periodic review of the driving unit and functional parameters
  • Replacement components are broken under exigent circumstances if necessary
  • Recording data on the intervention
  • Checking camera and immediately after the intervention (immediately) re-training manual
  • The organization team for 24 hours (by invitation) observation system

 

3. Monitoring of vital signs

 

The scope of responsibility includes methods of measuring physiological signals of patients. Apart from the technical application of different measurement perfuzera responsibility lies in the specific interpretation of the data and checking the probability (eligibility) reported values. It requires a thorough knowledge of different methods of measurement and basic physiological principles.

Perfuzeri implement the following methods of measurement:

 

  • Blood flow measurement methods elektromagnenim
  • Measurement of blood flow using ultrasound
  • Intraoperative diagnostic measurement of blood pressure
  • Recording of ECG signals
  • Laboratory measurement of specific parameters (eg, the concentration of heparin in the blood)

 

4. Methods of processing blood

 

Hemofiltration (HF)

 

  • The selection of a suitable system and hemofiltera hemofiltration for active (with pump) or passive (with pressure) hemofiltration
  • Sterile assembly (installation) system for haemofiltration
  • Charging system for haemofiltration with kristaloidnog solution and added heparin
  • Safety checks (leaks - leaks, checking the pressure)
  • Integration of hemofiltration in coffee extracorporeal circulation
  • Monitoring haemofiltration on FTC
  • Ultrafiltrate fluid balance
  • Documentation

 

Autotransfusion

 

  • Selection System for autologous
  • Collection of residual blood volume and blood drainage under aseptic conditions
  • Providing blood for re-transfusion

 

Separation of cells / autotransfusion using machines (cell - saver)

 

  • Securing apparatus for autologous blood for suctioning, irrigation and concentration
  • Decision making and selection of the necessary materials: the size of the system, centrifugal bell, a catheter with a double lumen suction (to provide immediate heparinization of the blood), medicines, materials for re-transfusion
  • Assembling (mounting) system under aseptic conditions
  • Adaptation of the surgical field and a machine for FTC
  • Launching a cell separator
  • Checking functional control (monitoring)
  • Automatic or manual selection of cell separation
  • Provision of packed red blood cells for transfusion re-
  • Calculating the volume balance
  • Documentation

 

Hemodialysis (HD)

Conducting pre-, intra-, and postoperative dialysis in patients undergoing heart surgery

 

  • Preliminary discussion with senior staff regarding hemodialysis: discussion about the condition of patients with reviewing balance acid / base values and retention
  • Making a decision regarding the type of dialysis procedures: acetate or bicarbonate dialysis, ultrafiltration, hemodiafiltration
  • The selection of appropriate equipment for hemodialysis
  • The selection of appropriate filters for dialysis
  • Mounting - setting up a system for dialysis aseptic technique and priming with crystalloid solution, add medications if necessary
  • Preliminary configuration of dialysis (hemodialysis duration, ultrafiltration rate, set value limits, limits the pressure, the pressure trans-membralni, conductivity)
  • Chemical Laboratory control values for dialysate bicarbonate dialysis
  • Integration of a dialysis machine for the FTC or connect directly with the patient
  • Calculating the volume balance
  • Draining the dialysis
  • Documentation

 

 

5. Monitoring and analysis of blood gases values and biochemical values

Routine use of laboratory equipment for analysis and consistent response to the determined value of the daily duties perfuzera. It requires a thorough, comprehensive knowledge of the methods of analysis, hematology, microbiology, analyzer and clinical hygiene. Additional responsibilities include quality assurance and maintenance and taking care of the various appliances for analysis.

 
Assessment of quality

Assessment of quality involves the execution and monitoring of calibration and calibration equipment. It is necessary to document the - proved the accuracy of the analysis and to obtain basic information concerning the reliability of the measured value. Knowing the measurement accuracy is a prerequisite for the interpretation of the analyzed values.

 

Analysis

The most important values needed to implement the FTC include the following:

 

  • pH
  • The partial pressure of oxygen pO2
  • The partial pressure of carbon dioxide pCO2
  • Standard bicarbonate SBC
  • Base excesses BE
  • hematocrit Hct
  • hemoglobin Hb
  • Serum electrolytes: potassium, K +, Na + sodium, calcium Ca 2 +
  • The parameters of coagulation: clotting time (ACT), the concentration of circulating heparin (HPT), projected value of heparin (HDR) and others.
  • The concentration of anti-thrombin III (AT III)
  • The concentration of glucose in the blood
  • osmolarity
  • Colloid osmotic pressure of COP
  • The concentration of protein

The interpretation of these values and logical and self-regulation of laboratory tests in relation to clinical need specific values is one of the most important duties and responsibilities and thus perfuzera in FTC

 

 6. Documentation and Statistics

 

  1. The selection of relevant parameters for archiving - data collection
  2. The establishment of appropriate protocols for data collection
  3. Independent record preoperative patient information that is necessary for the establishment of the FTC
  4. Intraoperatively register data (handwritten or computerized)
  5. Knowledge of data protection law and the legal aspects of documentation
  6. As for written documentation: the selection of the appropriate method for assembling archives protocols to allow for later evaluation of data
  7. As for the documentation, which is based on the computer: a thorough knowledge of the software and hardware used and the regular installation backup of the data on the appropriate software
  8. Assessment data to regular quality control within the purview perfuzera
  9. Flexibility in the assessment of the existing data in response to requests from other departments (for PhD candidates, administration and research purposes)
  10. Market analysis with emphasis on new developments in software and hardware
  11. Suggestions for software and hardware opzimizaciju in decorating with producers
  12. Set up and operate oblašću specific database
  13. Knowledge of statistical methods in medicine
  14. The selection of appropriate statistical methods and mathematical implementation
  15. Assessment of the reasonableness of results
  16. Cooperation in terms of recording data in accordance with the requirements of quality control in cardiac surgery centers

 

7. Research

The scientific work that perfuzeri conducted in the past has contributed to today's technology standards in cardiac surgery. An important prerequisite is established scientific, medical and technical knowledge is fundamental. In this way, the new oxygenate and monitoring systems at the FTC as well as improved perfusion technique can be developed through close collaboration perfuzera, medical staff and industry (producers). Technological developments in cardiovascular equipment - technology now allows us to perform complex non-heart surgery

  • Testing new materials available (oxygenates, cardioplegia systems, devices for measurement and analysis)
  • Further development of the perfusion system for use in humans:
        1. Integrating new types of oxygenates or similar device to an existing machine for FTC
        2. The development of components for machine perfusion systems and the FTC, and clinical and internal, in cooperation with manufacturers
  • Scientific work
        • The concept of laboratory experiments for the installation and / or experiments on animals in terms of specific research in collaboration with the medical staff who conduct research
        • Setting and experimentation
        • Evaluation of measurements collected for an expert assessment
        • Application of experimentally achieved new aspects (observations) on clinical issues (problems)

 

 

8. Medical devices

 

  • Accepting responsibility for medical devices in use
  • Determining purpose devices which are used
  • Use the appliance only after labor training
  • Perform visual and functional check before each use
  • Adherence to the prescribed time for technical safety (with regular service)
  • Keeping the supporting documents regarding the cameras that are in use

 

 9. Procedures specific to hospital environment

This area includes tasks that take perfuzer in different hospitals. However, it is not generally perform tasks that most perfuzera. These are the specific areas that should bridge the gap between inžinjerestva (techniques) and medicine where perfuzer with their technical and medical knowledge may offer new ways to medical staff in terms of treatment of heart, lung and other organ diseases. In essence, it refers to the specific application in terms of interdisciplinary FTC, medical issues.

 

  • Isolated limb perfusion
  • FTC "environment" cardiological diagnosis and therapy (PTCA - ready mechanical circulatory support in the emergency cardiac catheterization)
  • FTC neurosurgical cases
  • FTC to be "warmed up" unexpected victim of hypothermia
  • FTC with CPR

 

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