Issue |
J Extra Corpor Technol
Volume 51, Number 2, June 2019
|
|
---|---|---|
Page(s) | 78 - 82 | |
DOI | https://doi.org/10.1051/ject/201951078 | |
Published online | 15 June 2019 |
Original Articles
Gravity Venous Drainage and the 3/8-Inch Venous Line: What Would Poiseuille Do?
* The Children’s Hospital of New Orleans, New Orleans, Louisiana
† The Heart Center, Arnold Palmer Hospital for Children, Orlando, Florida; and
‡ The University of Central Florida College of Medicine, Orlando, Florida
Address correspondence to: Bharat Datt, MSc, CCP, CPC, FPP, Chief Clinical Perfusionist, Perfusion Services, The Heart Center, Arnold Palmer Hospital for Children, 92 W Miller Street, Orlando, FL 32806. E-mail: canuckpumpman@gmail.com
Received:
17
October
2018
Accepted:
30
November
2018
The 1/2″ venous line has long been the drainage tubing diameter of choice for adult patients undergoing cardiac surgery. However, several programs use a smaller diameter venous line when used in conjunction with kinetic-assisted venous drainage or vacuum-assisted venous drainage. In 2014, our perfusion team made an institution-wide effort to miniaturize the cardiopulmonary bypass (CPB) circuit for children. One of our changes was the transition to a 3/8″ diameter venous line for drainage, even in our larger patients (up to 80 kg). We reviewed the current literature on this topic and delineated the various parameters required to be able to use the 3/8″ venous line with gravity drainage with the aim of using it on patients up to 115 kg with the appropriate venous reservoir. We have successfully used the 3/8″ venous line in more than 40 of our larger patients (35–90 kg) without the need for assisted venous drainage. We were able to reduce CPB prime from 625 ± 118 to 425 ± 52 mL before retrograde autologous priming (RAP)/venous autologous priming (VAP). The prime was further reduced to 325 ± 66 mL after RAP/VAP. Homologous blood utilization was reduced from 217 ± 311 mL to 27 ± 77 mL. Both results were statistically significant. We hypothesize that taking into account two of the parameters of Poiseuille’s law, namely length and diameter, it is possible to safely drain large children and mid-size adults via gravity venous drainage and the 3/8″ venous line. This technique allows reducing prime volume, simplifies CPB circuits with increased safety and potentially reduces the need for homologous blood transfusion.
Key words: Cardiopulmonary bypass / kinetic assisted venous drainage / vacuum assisted venous drainage / Poiseuille’s law
© 2019 AMSECT
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