Perfline |  |
|
Neonatal perfusion has some particularities that can produce or avoid complications depending on how they are handled. Systemic heparinization is still a debatable question. A 3 kg newborn has a total blood volume of about 250 ml. If we administer heparin in a dose of 4 mg/kg and use a blood prime of 300 ml, the prime will contain additional heparin (5 mg/100ml blood). Total circulating heparin, after starting CPB will be 12 + 15 = 27 mg. This corresponds to a circulating heparin of 9 mg/kg, even considering that the total blood volume (perfusate) increased from 250 ml to 550 ml.
It has been well described that excess heparin contributes to an increased postbypass blood loss.
In our experience immediate postoperative blood loss in neonates is still a problem, sometimes difficult to manage. We would like to be aware of some other protocols to manage systemic heparinization during neonatal CPB. March 10, 2008 07:55 pm - Rio de Janeiro, Brazil |
Jorge Molina | |
|
Neonate Post operative bleeding. I will offer some recommendations. 1. Fast/excellent surgeon with the shortest perfusion times possible. 2. Heparin Management System (Medtronic HMS)instead of the regular ACTs. The knowledge of the patient's heparin resistance requiring higher or lower heparin dosages, maintaining heparin blood levels during bypass and a analysis if there is any residual free floating heparin post bypass is important. 3. Thromboelastograph (TEG)used appropriately allows for probably the best current way to choose blood products if there is bleeding and to predict possible bleeding. The cost is high for #2 & #3. Only the institution can make that decision if the cost is worth it. In our eyes, it is very much worth the cost. In addition, the TEG can be used by other surgical sub-specialties where bleeding or too much clotting is encountered. March 12, 2008 03:40 am - Jackson, Mississippi |
Gary Grist RN CCP, Kansas City, Mo. USA | |
|
Your heparinization seems excessive. Only give 3 mg/kg and 2 mg/100 mls of blood in the prime. You can also add 100 mg/kg of Amicar to the patient and prime. Also, consider using the MAX-ACT act tube which, I believe, gives a more accurate and consistant ACT value. Normal baseline for neonates using this tube is 120 seconds. Heparinized levels should be 3X baseline or more. Start modified ultrafiltration if you are not using it already. This is none to reduce blood loss. Also, your blood prime should include some FFP. If you are using just red cells you will have too low of fibrinogen concentration after CPB to effectively stop the bleeding. You should also consider washing your blood prime to reduce excess glucose, lactate and citrate. The citrate in particular can interfere with coagulation in nenonates. Adults metabolize citrate in about 6 minutes, but it takes about 6 hours in neonate. Also, make sure the iCs+2 levels are 1.3 mm/L or higher. March 26, 2008 06:08 pm - USA |
|
ds |
|
Replica bags
Replica handbags
Wholesale replica handbags
aluminum sheet
aluminium coil
WOW Gold
buy wow gold
world of warcraft gold
women's pumps
new women's shoes
women's shoes boots
cheap wow gold
wow gold
cheapest wow gold
car alarm
runescape money
runescape accounts
runescape gold
beijing massage
massage beijing
NFL jerseys
Basketball jerseys
BLIND RIVET NUT July 28, 2010 08:25 am |
|
