Table 1
Example of a confirmation of oxygenator failure algorithm and preparation for an oxygenator change-out.
| Work with a backup perfusionist on the following: |
|---|
| 1. Assess arterial and venous lines for color difference. Confirm in-line gas values with lab specimen if possible. |
| 2. Confirm sweep gas is on with the proper source (and blender settings if in use). |
| 3. Confirm proper ventilation-to-perfusion (V/Q) ratio. |
| 4. Confirm integrity of sweep gas system all the way to the oxygenator exhaust port (vaporizer cap sealed – may bypass vaporizer altogether/turn off vaporizer). Discern proper function by tactile and audible means (sweep gas line to oxygenator creates pressure when disconnected from oxygenator and temporarily blocked). |
| 5. Confirm function of flow meter (if in use). |
| 6. Confirm proper blood flow (appropriate pump arterial line/system pressure and appropriate patient arterial pressure, correct tubing size selected on arterial controller, flow probe value verified, closure of recirculation/prime lines). |
| 7. Change to 100% oxygen if not already on that source (may change to stand-alone E-cylinder with flow meter to rule out issues with normal sweep gas system). |
8. Consider whether the oxygenator may be “wetted out”. Use manufacturer recommended guidelines for treatment.
|
| 9. Consult with the anesthesiologist to confirm proper muscle relaxants/anesthesia are in use (check reported VO2 value). Consider malignant hyperthermia if the CO2 is significantly elevated with a low SvO2 (if an isoflurane source is in the sweep gas system). |
| 10. Request second perfusionist to clear-prime a replacement oxygenator in the pump room with quick-connect tubing and connectors attached to replacement device. |
| 11. Inform surgeon of findings and discuss action plan (define lowest acceptable PaO2 before change-out). If change-out required, clarify if it will be with a relatively warm and ventilated patient that is ejecting versus hypothermic with circulatory arrest. |
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