Intraoperative Cell Salvage (ICS) is a technique used to recover and re-infuse red blood cells during and after surgery, to reduce transfusion requirements of the patient. It removes non-cellular matter by centrifugation commonly or a counter-current system. It receives blood from: Suction – use large-bore suction tip (>4mm; e.g. Yankauer), avoid surface skimming and set vacuum…
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Mechanism Roller pump at low RPM with gravity/siphoning principle Without roller-pump gravity-only circuit. Indications Reduce distension: blood leakage into heart during CPB causes distension àincreases O2 demand + impairs subendocardial perfusion Bloodless field Reduce myocardial rewarming Prevent ejection of air Usually only left heart is vented as right is vented by venous cannulae. Causes of…
Indications Maintain visibility in operative field Prevent distension of cardiac chambers Post-heparinisation suction device ‘Sucker bypass’ – if extreme haemorrhage, until venous cannulation is established Mechanism Suction driven by roller pump. The position adjusted by surgeon and flow rate adjusted by perfusionist to keep pressure as low as needed to prevent injury to blood and…
Devices Cardiotomy x 2: ‘Blue’, ‘Clear’ Cardiac Vent x 1: ‘Green’ Cell Salvage (ICS) x 1 Wall/generic suction Suction tips Plastic vs. Metal Yankauer vs Coronary/small Principles On CPB, Cardiotomy suction to catch all bleeding except: Topical cooling solution – can cause haemodilution Low visibility – use ICS, if not adequate, use wall sucker as well Debris (e.g. irrigation of…
Ideas and Lessons for Surgical Training from Fighter Pilots “Mental readiness is a combination of commitment, confidence, anticipation and positive thinking. What I have learned from my retraining is to regain confidence and also that one should never give up.” MR de Laval Multiple roles to fulfill – “”not simply pilots: They are instructors, supervisors, standards…
Palm/Thenar Eminence grip Key feature: Fingers do NOT go in the rings of the holder. Position: Middle+ring+little fingers wrapping around one of the rings with no fingers within the rings. Other ring resting on radial aspect of distal thenar eminence, just encircling thumb MCP. Distal part of thumb proximal phalanx against eye-ring insert. Index finger resting…