CABG complications.

1. COMPLICATIONS DURING BYPASS
AND
ITS MANAGEMENT
PRAVIN.M,
CLINICAL PERFUSIONIST,
PSGHOSPITAL.

3. COMPLICATIONS..
Two categories :
1. Equipment error
2. Human error
•That makes a situation hard to
understand or to deal with.

4. Major complications
• Air embolism
• Oxygenator failure/leak
• Pump boot rupture
• Arterial filter failure
• Gas failure
• Electrical failure
• Circuit clot
• Arterial pump head failure

5. Minor complications
• Line pressure
• Venous line air lock
• Hemodilution

6. HUMAN ERROR..
• Carelessness
• Perfusionist fatique
• Too many inputs
• Miscommunication
• Poor investigations

8. • Most sudden and distressing incident
during CPB
• Mostly occurs due to non usage of
safety devices
• Not venting of oxygenator
• Break in oxygenator connections
• Break in 3 way

9. Management…
•Prevention is the best way of management
•Inform to the surgeon and anaesthetist
•Stop arterial pump immediately
•Clamp venous line
•Place patient in a head down position
•Try to cool down upto 20o C
• Connect arterial and venous line for
de-air the line.

10. • Failure of the oxygenator during
CPB is rare
• It cause due to manufacturer error
• Clot in membrane

11. • Rule out the error
• Inform to the surgeon and anaesthetist
• Cool down the patient to 28 deg to buy
time and reduce metabolic requirement
• Cover the patient’s head with ice pack
• Close all purge ports and three ways
then clamp the arterial line and venous
line
• Connect primed (new) oxygenator
• Open arterial and venous line and
resume bypass

12. Pump boot rupture
• Long time bypass
• High occlusion
• Glass particals in raysway

13. Pump boot rupture
Management
• Inform to the surgeon and anaesthetist
• Stop the arterial pump immediately
• Clamp the venous and arterial line
• Clamp resevoir outlet and oxygenator
inlet
• Change the new primed pump boot
• Unclamp the reservoir outlet and
oxygenator inlet
• Open the Recirculation and prime the
pump boot

14. Arterial filter failure…
Clot
Excessive air
Connection rupture
Long time bypass
Manufacture defect

15. Arterial filter failure…
Management
• Clamp the inlet and outlet
of arterial filter

16. Gas failure…
Pendant failure
Central oxygen supply failure
Blender tube leakage
Blender mixing problem

17. Gas failure…
Managenment
•Rule out the error
•Connect oxygen cylinder line to
the oxygenator

18. Electrical failure….
• High voltage
• Short circuit
• Central electrical supply
failure

19. Electrical failure….
Management
• Inform to the surgeon and
anaesthetist
• Use hand krank for manually run
the pump
• Connect the power plug to the
another UPS port
• Immediately inform to the
maintanance and arrange some

20. Circuit clot…
HIT
Long term bypass
Inadequate of heparin dose

21. Circuit clot…
Management
• Give additional dose of
anticoagulant and maintain ACT
• Identify the clotted line and
change the circuit

22. Arterial pump head failure…
Mechanical error
Error in HLM

23. Arterial pump head failure…
Management
• Inform to the surgeon and
anaesthetist
• Hand krank
• Change the pump boot to
the next pump as soon as
possible

25. Line pressure…
Causes :
• Mal position of cannula
• Improper zero of pressure line
• Kink in arterial line
Management
• Reposition the cannula
• Recheck the arterial line
• Recheck the pressure line

26. Venous line air lock…
Causes
• Mal position of venous cannula
• Air suck from venous cannula
Management
• Immediately open the RA
• Immediately go on sucker bypass
•Refill the venous cannula and resume
bypass

27. Haemodilution…

28. Haemodilution…

29. HUMAN ERROR..
• Carelessness
• Perfusionist fatique
• Too many inputs
• Miscommunication
• Poor investigations