PRACTICE GUIDELINES

1. The perfusion record should include the following patient information:
   1. Hospital ID
   2. Age
   3. Gender
   4. Height
   5. Weight
   6. Body Surface Area (BSA)
   7. Allergies
   8. Blood Type
   9. Pre-op Laboratory Data
   10. Diagnosis/History

2. Additional procedure information should include:
   1. Date
   2. Procedure
   3. Perfusionist(s)
   4. Surgeon(s)
   5. Anesthesia Personnel
   6. Comments/Events

3. The following disposable supply lot numbers should be recorded:
   1. Oxygenator
   2. Cardiotomy reservoir
   3. Tubing pack/Arterial filter
   4. Cardioplegia set
   5. Ultrafiltration set
   6. Cell washing set
   7. Centrifugal pumphead and flow probe

4. The following patient parameters should be documented at a frequency determined by institutional perfusion protocol:
   1. Blood flow rates
   2. Arterial blood pressure
   3. Central venous/Pulmonary artery pressure
   4. Arterial/Venous Blood Gases
   5. Venous oxygen saturation
   6. Potassium concentration
   7. Ionized calcium concentration
   8. Sodium concentration
   9. Activated Clotting Times (ACT) and/or Heparin/Protamine assay results
   10. At least one of the following patient temperatures which may include:
       • Bladder
       • Esophageal
       • Rectal
       • Nasopharyngeal
       • Tympanic

   11. Additional temperatures may include:
       • Venous blood
       • Arterial blood
       • Cardioplegic solution
       • Myocardium
       • Water bath(s)

   12. Oxygenator gases including flow rate and concentration

   13. Input fluid volumes including:
       • Prime
       • Blood products
       • Asanquineous fluids
       • Cardioplegic solution
       • Autologous components

   14. Output fluid volumes including:
       • Urine output
       • Ultrafiltrate

   15. Medications and/or inhalational anesthetic agents administered via extracorporeal circuit

5. The perfusion record should be signed by the primary perfusionist and retained as part of the patient's medical record. Additional copies of the perfusion record may be retained in the perfusion department and/or patient database.

6. Patient parameters that are monitored/measured during the conduct of cardiopulmonary bypass should be documented.

PRACTICE GUIDELINES

1. The perfusion checklist(s) employed by the perfusionist during CPB should include a pre-bypass checklist.

2. Checklist(s) should be retained.

PRACTICE GUIDELINES

1. Extracorporeal circulation should be conducted by a certified or board eligible perfusionist. Certification by the American Board of Cardiovascular Perfusion or its equivalent meets this requirement.

2. A perfusionist should conduct cardiopulmonary bypass with perfusion assistance available.

3. For emergency situations, a perfusionist should be available within 30 minutes of the hospital.

4. Perfusion department/services should maintain a policy and procedures manual which includes:
   1. Routine and emergency procedures
   2. Departmental policies
   3. Continuing education policies
   4. Catastrophic perfusion event management
   
   
5. Policy and procedures should be reviewed and revised on a periodic basis.

PRACTICE GUIDELINES

1. Monitoring of the anticoagulation status of the patient intraoperatively should include the testing of activated clotting time (ACT). Other monitoring tests may include:
   1. Platelet count
   2. Heparin/Protamine assay
   3. Prothrombin Time (PT)
   4. Partial Thromboplastin Time (PTT)
   5. Thrombelastogram
   
   
2. Patient specific initial Heparin dose should be determined by one of the following methods:
   1. Weight
   2. Dose Response Curve, automated or manual
   3. Blood Volume
   4. Body Surface Area

3. Additional doses of Heparin during cardiopulmonary bypass should be determined by using an ACT and/or Heparin/Protamine assay.

4. The perfusionist may determine the Protamine dose.

PRACTICE GUIDELINES

1. Appropriate oxygenator gas flow rate and concentration should be determined by using blood gas analysis which may include monitoring devices. Further determinations may be guided by oxygenator directions for use and perfusion parameters such as blood flow rate and temperature.

2. Blood gas analysis should be performed and recorded a minimum of every 30 minutes. Blood gas analysis may be performed at reasonable intervals as clinical conditions dictate.

PRACTICE GUIDELINES

1. Calculated blood flow rate should be determined prior to cardiopulmonary bypass using the patient's body surface area (BSA).

2. Appropriate blood flow rate should be determined by evaluation of a combination of:
   1. Venous oxygen saturation
   2. Body surface area
   3. Arterial blood pressure
   4. Temperature
   
   
3. Additional parameters that may guide blood flow rate include:
   1. Base excess
   2. Oxygen consumption
   3. Venous pO2
   4. Arterial pO2
   5. Circuit volume
   6. Physician request
   7. Body weight
   8. Anesthetic level
   9. Arterial oxygen saturation

PRACTICE GUIDELINES

1. Arterial blood pressure should be monitored and recorded.

2. Maintenance of arterial blood pressure may be influenced by factors other than the conduct of cardiopulmonary bypass.

PRACTICE GUIDELINES

1. The perfusionist should pre-determine a safe operational level for each perfusion circuit used.

2. A method of safe level detection should be employed. Appropriate blood volume should be maintained to allow for sufficient reaction time in the event of a decrease or loss of circulating volume.

PRACTICE GUIDELINES

1. The following devices should be employed during cardiopulmonary bypass:
   1. Arterial line filter in with a one-way valved purge line
   2. Bubble detector
   3. Level sensor
   4. Anesthetic gas scavenge line
   
   
2. Additional safety devices or techniques may include:
   1. One-way valve in the intracardiac vent/sump line
   2. Bubble trap
   3. Ventilating gas oxygen analyzer
   4. A method of preventing retrograde flow when using a centrifugal pump

PRACTICE GUIDELINES

1. These should include the following patient/circuit devices:
   1. Blood flow indicator
   2. Gas flow meter
   3. Physiologic monitor(s)
   4. Hematologic monitor(s)
   5. Temperature monitors
   6. Timers
   
   
2. These may also include:
   1. Blood gas analyzer
   2. Oxygen saturation monitor(s)
   3. Chemistry monitor(s)

PRACTICE GUIDELINES

PRACTICE GUIDELINES

1. The perfusionist should check for the function of all pumps prior to each case. Roller pump occlusions should be verified and adjusted as necessary prior to each case. Blood flow sensor(s) should be checked for proper installation and calibration.

2. Preventive maintenance on perfusion equipment should be performed on a regularly scheduled basis. The interval of such maintenance may be determined any or all of the following:
   1. Manufacturer recommendations
   2. External accrediting agency guidelines
   3. Institutional requirements