EVOLUTION OF CLINICAL PERFUSION RECORD IN HSA

AMELIORATE OF CLINICAL PERFUSION DATAMOHD. SASEEDHARAN BIN ABDULLAHSENIOR PERFUSIONIST

IntroductionDefinition of Clinical Perfusion DataDevelopment in Our SettingComponents of CPDConclusion Short Demonstration

OUTLINE

WHAT IS A PERFUSIONIST ?

PERFUSIONISTS

Operate the heart lung machine, Monitoring and controlling oxygen levels, blood pressure, body temperature and blood flow. They also administer anesthetics and other drugs during surgery.(Prof. Michael SmithQuinnipiac University School of Health Sciences)

Perfusion data is one of the major standards recommendations of monitoring during cardiopulmonary bypass (CPB). (Society of Clinical Perfusion Scientists of Great Britain & Ireland, 2007)

This includes monitoring for the onset of and weaning from CPB, confirmation of anticoagulation and ventilation of the lungs.

(Association of Cardiothoracic Anesthetics & Society for Cardiothoracic Surgeon in Great Britain & Ireland, 2007)

INTRODUCTION

Perfusion data can defined as:

The perfusion record (written or electronic) foreach (CPB) procedurewhich shall be included as part of patients permanent medical record.

(American Society of ExtraCorporeal Technology, 2013)

..is a legal presentation of the procedure, whether manually recorded or computerized which should be maintained & stored in patient's notes, according to institution policy for retaining medical records.

(Society of Clinical Perfusion Scientists of Great Britain & Ireland, 2007)

WHAT IS CLINICAL PERFUSION DATA (CPD)?

DEVELOPMENT IN OUR SETTING: HANDWRITTEN CLINICAL PERFUSION DATA

1996 till 1998

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FURTHER DEVELOPMENT : COMPUTERISED CLINICAL PERFUSION DATA ( EXCEL)

OT 3OT 4

COMPUTERISED CLINICAL PERFUSION DATA ( EXCEL) CONTINUE

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OUR DEVELOPMENT: COMPUTERISED CLINICAL PERFUSION DATA (DATABASE)

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2010 till 2014

CENTRALISING THE SYSTEM

CENTRALISE NETWORK STORAGE

PERFUSIONIST NETWORK-STATION

PUMP ROOM

CLIENT STATION ( FOR TWO OTS)

INTRANET NETWORKING SYSTEM

PUMP ROOMOT 11OT 12INTRANET BETWEEN THE TWO OTs & PUMP ROOM

OT 12

OT SET-UP JUST ABOUT TO GO ON BYPASS

COMPONENT OF CPDPatient information (demographics & pre-operative risk factors).

Information describing :- (procedure, personnel & equipment ).

Patient physiology parameters (documented at a frequency determined by institutional protocol).4. Blood gas & anticoagulation monitoring results.

Signature of the perfusionist (include relief).

(American Society of ExtraCorporeal Technology, 2013)

1. PATIENT INFORMATION, DEMOGRAPHICS & PRE-OPERATIVE RISK FACTORSPerfusion Record: Includes Single Entry Information

Medical Record Number ( RN).

Patient Name.

Demographics. ( Age, Gender, Height , Weight, Body Surface Area (BSA)

Laboratory Data. ( Hematocrit, Predicted Hematocrit on Bypass)

Patient Allergies.

Planned Procedure.

Medical History/ Risk Factors. (Cardiovascular, Renal, Neurologic, GI Track).

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2. INFORMATION DESCRIBING PROCEDURE,PERSONAL & EQUIPMENTPerfusion Record: Includes Single Entry And Recorded Lot Number. Record Lot Number

Equipment Heart Lung Machine Disposables:Oxygenator

Tubing pack/ Arterial Line Filter Centrifugal Pump Head

Ultrafiltration Device - Arterial & Venous Cannulae

Single Entry

Date of Procedure

Type of Procedure

Perfusionists Name

Surgeons Name

Anaesthesiologist's Name

Nurses Name

Operating Room Name

Comments/Events2

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CLINICAL PERFUSION DATA OF12

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3. PATIENT PHYSIOLOGY PARAMETERSPerfusion Record:Includes Multiple Entry Information At Least Every 15 mins

Venous Oxygen Saturation

Patient Temperature including:

- Nasopharyngeal

- Bladder

- Esophagael

- Rectal

- Tympanic

Blood Flow Rates (RPM)

Arterial Blood Pressure

Arterial Line Pressure

Central Venous/Pulmonary Artery Pressure

Vacuum Assist Venous Return (VAVR) - VAVR Pressure - Venous Inlet Pressure (VIP)

Arterial / Venous Blood Gases

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CLINICAL PERFUSION DATA OF

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4. BLOOD GAS & ANTICOAGULATION MONITORING RESULTSPerfusion Record: Includes Multiple Entry Information For LaboratoryValues At Least Every 30 Minutes

Arterial or venous blood Gases

Venous Oxygen Saturation

Potassium Concentration

Haemoglobin /Haematocrit

Anticoagulation monitoring - Activated Clotting Times (ACT) and/or Heparin level.

CLINICAL PERFUSION DATA OF

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4. BLOOD GAS & ANTICOAGULATION MONITORING RESULTSCONTINUEPerfusion Record: Includes Intermittent Information Entry At Appropriate Time

Input fluid volumes Blood Product Prime fluids Fluid Added

Output fluids Urine output Ultrafiltration

Perfusionist Administered Medication4

5. SIGNATURE OF THE PERFUSIONISTSignature of the perfusionist (and all relief perfusionists) performing the procedure.

Include the signature of physician(s) providing supervision for the CPB procedure.5

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It is the responsibility of the clinical perfusionist to assist the Surgeon/physician in any way possible in patient care & particularly within the defined areas of expertise of the clinical perfusionist .

(The American Academy of Cardiovascular Perfusion, 2008)

CONCLUSION

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PERFUSION DATABASE 2015

REFERENCES:

Banbury, M., White J., Blackstone, E., & Cosgrovo, D. (2003) Vacuum-assisted venous return reduces blood usage. Journal of Thoracic Cardiovascular Surgery. Vol. 126 (3), pp:680-687.

Jegger, D.,Tevaearai, H.T., Mueller, X.M., Horisberger, J., & von Segesser, LK. (2003). Limitations using the vacuum-assist venous drainage technique during cardiopulmonary bypass procedures. The Journal Of Extra-corporeal Technology. Vol. 35 (3), pp: 207 211.

Munster, K., Anderson, U., Mikkelsen, J., & Petterson, G.(1999). Vacuum Assisted Venous Drainage (VAVD). University of Copenhagen and Hamlet Private Hospital. Vol. 14 (6), pp: 419 423.

Shigang Wang & Akif Undar (2009). Vacuum-assisted venous drainage and gaseous microemboli in pulmonary bypass. The Journal Of Extra-corporeal Technology. Vol. 40 (4), pp: 249 256.

Sintya, T. et al. (2011). Vacuum-assisted venous drainage in cardiopulmonary bypass and need of blood transfusion: experience of service. Brazilian Journal of Cardiovascular Surgery. Vol. 26 (1).

Willcox, T. (2013). Vacuum Assist: Angel or Demon CON. The Journal Of Extra-corporeal Technology. Vol. 45 (2), pp: 128 141.

Willcox, T. (2002). Vacuum-assisted venous drainage: to air or not to air, that is the question. Has the bubble burst? The Journal Of Extra-corporeal Technology. Vol.34, pp:2428.

Y Hayashi et al. (2001). Clinical application of vacuum-assisted cardiopulmonary bypass with a pressure relief valve. European Journal of Cardio-Thoracic Surgery. Vol. 20 (3), pp: 621 - 627. . 21/9/201331

GET SOME CHAT SLIDES READY in case the video doesnt work

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