Clinical Procedure
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Have heparin drawn up prior to case commencing. May need to go onto suction bypass urgently if major vessels are disrupted during sternotomy. Give heparin immediately to prepare for bypass & return volume using cell saver blood if available.
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Dec 13, 2012
If a redo sternotomy is being performed in a patient having previously undergone a CABG, there is risk of rupturing grafts and developing myocardial ischaemia, especially with previous LIMA grafts. Prepare to administer heparin and crash onto bypass if the surgeon requests this.
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Jul 26, 2012
If patient has had previous repairs of major vessels, abnormal anatomy may make insertion of internal jugular or subclavian central lines difficult. Use ultrasound guided technique and be careful to not push through resistance. #safety
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Dec 22, 2011
Place defibrillation pads on the patient prior to surgical prepping. The patient is a risk of arrhythmia from extensive diathermy through scar tissue around the heart and placing the pads after the event will result in delayed defibrillation. #safety
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Jan 01, 2012
If a redo sternotomy is being performed in a small child that will have the pump primed with blood, there may be enough blood available from the perfusionist rather than needing to have another unit of blood available in theater.
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Aug 07, 2012
Five rules for a redo sternotomy:
1. Big drip
2. Defib pads on at induction
3. Have heparin drawn up in the event it is required to crash onto suction bypass
4. Have two surgeons in the room.
5. Have a blood in-motion bag in the room
#BT
1. Big drip
2. Defib pads on at induction
3. Have heparin drawn up in the event it is required to crash onto suction bypass
4. Have two surgeons in the room.
5. Have a blood in-motion bag in the room
#BT
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Dec 15, 2012