This document discusses techniques for hemofiltration, blood conservation, and ultrafiltration during cardiopulmonary bypass. It describes:
1. Ultrafiltration and hemofiltration remove fluid and solutes from the bloodstream using semipermeable membranes to create concentration gradients. This can effectively remove edema and concentrate blood.
2. Modified ultrafiltration after bypass can immediately increase hematocrit, decrease right atrial pressure, and improve organ function and hemostasis.
3. Blood conservation techniques during cardiac surgery aim to reduce blood transfusion needs through measures like autologous donation, cell savers to retrieve shed blood, and minimizing priming volume.
EMBOLISM AND FILTERS USED IN CARDIOPULMONARY BYPASSGLORY MINI MOL. A
FILTERS USED IN CARDIOPULMONARY BYPASS
EMBOLISM
DEFINITION: obstruction of an artery, by a clot of blood or an air bubble.
This emboli is categorized to
Biological emboli
Foreign emboli
Gaseous emboli
There are current technologies to decrease this embolic event delivered to patient
Membrane oxygenators
FILTER
Blood surface coating
Bubble traps
Emboli detection system
Blood Filters
Depth filters
Consist of packed fibers of Dacron wool or
polyurethane foam .
No defined pore size
These filters have large wetted surface
areas to filter the blood by absorption , they are effective in
trapping gross bubbles.
Screen filters
composed of a woven
mesh of polyester fibers
defined pore sizes
From 20 -40 μm
(all of the arterial line filters used are the screen type)
EMBOLISM AND FILTERS USED IN CARDIOPULMONARY BYPASSGLORY MINI MOL. A
FILTERS USED IN CARDIOPULMONARY BYPASS
EMBOLISM
DEFINITION: obstruction of an artery, by a clot of blood or an air bubble.
This emboli is categorized to
Biological emboli
Foreign emboli
Gaseous emboli
There are current technologies to decrease this embolic event delivered to patient
Membrane oxygenators
FILTER
Blood surface coating
Bubble traps
Emboli detection system
Blood Filters
Depth filters
Consist of packed fibers of Dacron wool or
polyurethane foam .
No defined pore size
These filters have large wetted surface
areas to filter the blood by absorption , they are effective in
trapping gross bubbles.
Screen filters
composed of a woven
mesh of polyester fibers
defined pore sizes
From 20 -40 μm
(all of the arterial line filters used are the screen type)
Renal Replacement Therapy: modes and evidenceMohd Saif Khan
Renal replacement therapy is a supportive care often required in critically ill patients who develop acute renal failure and its complications. Complexity arises when such patients become hemodynamically unstable and pose special challenge to critical care clinicians in ICU to carefully choose dialytic modality to tackle volume and solute overload. This presentation is about short description of modalities of RRT and current evidence regarding initiation, dose and type of modality.
Renal Replacement Therapy: modes and evidenceMohd Saif Khan
Renal replacement therapy is a supportive care often required in critically ill patients who develop acute renal failure and its complications. Complexity arises when such patients become hemodynamically unstable and pose special challenge to critical care clinicians in ICU to carefully choose dialytic modality to tackle volume and solute overload. This presentation is about short description of modalities of RRT and current evidence regarding initiation, dose and type of modality.
The Norwood procedure is the first of three surgeries required to treat single-ventricle conditions such as hypoplastic left heart syndrome (HLHS). Because the left side of the heart can’t be fixed, the series of surgeries rebuilds other parts of the heart.
The Norwood procedure is performed in the baby’s first or second week of life.to redirect the blood flow.
Three goals for the Norwood procedure:
1, Build a new aorta.
2, Direct blood from the right ventricle through the new aorta and on to the rest of the body.
3, Direct the right ventricle to pump blood to the lungs until the next surgery.
Anomalous left coronary artery from the pulmonary arteryManu Jacob
In a normal heart, both coronary arteries arise (branch) from the aorta.
In anomalous left coronary artery from the pulmonary artery (ALCAPA), something goes wrong while the heart is forming in the womb
The left coronary artery arises from the pulmonary artery instead of the aorta
n a Ross procedure, a surgeon removes the abnormal aortic valve. The surgeon then replaces it with the child's own pulmonary valve. The surgeon uses a valve from a cadaver donor (conduit) to replace the pulmonary valve.
CHAPTER 1 SEMESTER V PREVENTIVE-PEDIATRICS.pdfSachin Sharma
This content provides an overview of preventive pediatrics. It defines preventive pediatrics as preventing disease and promoting children's physical, mental, and social well-being to achieve positive health. It discusses antenatal, postnatal, and social preventive pediatrics. It also covers various child health programs like immunization, breastfeeding, ICDS, and the roles of organizations like WHO, UNICEF, and nurses in preventive pediatrics.
Explore our infographic on 'Essential Metrics for Palliative Care Management' which highlights key performance indicators crucial for enhancing the quality and efficiency of palliative care services.
This visual guide breaks down important metrics across four categories: Patient-Centered Metrics, Care Efficiency Metrics, Quality of Life Metrics, and Staff Metrics. Each section is designed to help healthcare professionals monitor and improve care delivery for patients facing serious illnesses. Understand how to implement these metrics in your palliative care practices for better outcomes and higher satisfaction levels.
Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
The Valsalva maneuver exerts pressure to expel faeces through a voluntary contraction of the abdominal muscles while maintaining forced expiration against a closed airway. Patients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greater risk for cardiac dysrhythmias and elevated blood pressure with the Valsalva maneuver and need to avoid straining to pass the stool.
Normal defecation is painless, resulting in passage of soft, formed stool
CONSTIPATION
Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration
HEMORRHOIDS
Hemorrhoids are dilated, engorged veins in the lining of the rectum. They are either external or internal.
FLATULENCE
As gas accumulates in the lumen of the intestines, the bowel wall stretches and distends (flatulence). It is a common cause of abdominal fullness, pain, and cramping. Normally intestinal gas escapes through the mouth (belching) or the anus (passing of flatus)
FECAL INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patient’s body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
An enema is the instillation of a solution into the rectum and sig
CRISPR-Cas9, a revolutionary gene-editing tool, holds immense potential to reshape medicine, agriculture, and our understanding of life. But like any powerful tool, it comes with ethical considerations.
Unveiling CRISPR: This naturally occurring bacterial defense system (crRNA & Cas9 protein) fights viruses. Scientists repurposed it for precise gene editing (correction, deletion, insertion) by targeting specific DNA sequences.
The Promise: CRISPR offers exciting possibilities:
Gene Therapy: Correcting genetic diseases like cystic fibrosis.
Agriculture: Engineering crops resistant to pests and harsh environments.
Research: Studying gene function to unlock new knowledge.
The Peril: Ethical concerns demand attention:
Off-target Effects: Unintended DNA edits can have unforeseen consequences.
Eugenics: Misusing CRISPR for designer babies raises social and ethical questions.
Equity: High costs could limit access to this potentially life-saving technology.
The Path Forward: Responsible development is crucial:
International Collaboration: Clear guidelines are needed for research and human trials.
Public Education: Open discussions ensure informed decisions about CRISPR.
Prioritize Safety and Ethics: Safety and ethical principles must be paramount.
CRISPR offers a powerful tool for a better future, but responsible development and addressing ethical concerns are essential. By prioritizing safety, fostering open dialogue, and ensuring equitable access, we can harness CRISPR's power for the benefit of all. (2998 characters)
The Importance of Community Nursing Care.pdfAD Healthcare
NDIS and Community 24/7 Nursing Care is a specific type of support that may be provided under the NDIS for individuals with complex medical needs who require ongoing nursing care in a community setting, such as their home or a supported accommodation facility.
ICH Guidelines for Pharmacovigilance.pdfNEHA GUPTA
The "ICH Guidelines for Pharmacovigilance" PDF provides a comprehensive overview of the International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use (ICH) guidelines related to pharmacovigilance. These guidelines aim to ensure that drugs are safe and effective for patients by monitoring and assessing adverse effects, ensuring proper reporting systems, and improving risk management practices. The document is essential for professionals in the pharmaceutical industry, regulatory authorities, and healthcare providers, offering detailed procedures and standards for pharmacovigilance activities to enhance drug safety and protect public health.
2. Concept of ultrafiltration
• To remove large volume of fluid from the
intravascular space in short duration
• Movement of water across a membrane due to
hydrostatic pressure gradient
• No dialysate required
• The fluid removed is called ultrafiltrate
3. Concept of dialysis
• It is a process in which blood is separated from
crystalloid solution by a semipermiable membrane
• A solute concentration gradient exsists b/w the blood
and dialysate
4. purpose
• Effective removal of edema fluid in over hydrarted
patients.
• In renal impairment.
• To concentrate hemodiluted blood.
• Blood conservation through preservation of platelets
and coagulation factors.
• Reduced post cpb inflamatory response.
5. Purpose contd.,
• Decreases complement activation and inflamatory
response.
• Improves pulmonary cardiac and neurologic function
• Moderates temperature elevations by removing
circulating pyrogens
6. Advantages of Hemofiltration
• Advantages of Hemofiltration:
• Removal of water.
• -Reduces tissue edema .
• - Increase Hct
• Increase Coagulation factors
• Removal of inflammatory mediators
• -(tissue necrosis factor,C3a,
interleukins –1 & 6 etc)
• Removal of any solutes < Cut off
value(60,000daltons)
7. Physiologic principles
• “Selective seperation of plasma water and low
molecular weight solutes from intravascular cellular
components and plasma protiens of blood using a
semipermiable membrane filter”
9. Efficacy of ultrafilter
• Efficacy is determined by the equation
Qf = Uc X TMP _ IP
Qf – ablity to remove fluid
Uc- Ultrafiltration coefficent
Ip- Protien oncotic pressure
10. Factors affecting the
filtration:
• Factors affecting the filtration:
• Diameter of pores(10-35A)
• Number of pores
• Thickness of membrane
• Viscocity of blood, Hct, Protein levels
• Temperature
• Absolute ultration can be increased by:
• Increasing inlet pressure
• Clamping outlet partially
• Increasing filtrate side negative pressure
• Increasing blood flow
13. Efficacy contd.,
• The efficiency of the ultrafiltration will depend on
• HB concentration
• Temperature
• Rate of blood flow
• Serum protien concentration
• Membrane structure
14. Sieving co-efficient
• The efficiency of an ultrafiltration device to remove a
soluble molecule is called sieving coefficient and is
directly related to molecular size.
• The larger the molecular size the less eficient the
ultrafiltration device
17. Effect of ultrafiltration on drugs
• Heparin
• Decreases serum level of anesthetic agents
• Decreases aprotinin level
• Removes pharmacological agents with low molecular
weight
18. Technical Aspects
• Hollow fiber construction
• Materials:-
1. Polysulfone
2. Polyacrylonitrite
3. Cellulose acetate
• Pore size 180 to 200micrometers in dia
• Pores of the microporous membrane 5 to 10 nm
• Placement in extracorporeal circuit
24. Organ effects
• Reduction in PVR, Lung water, Increase in Lung
compliance
• Reduction in HR, Increase Systolic Pressure,
• Inrease in CI
• Better renal function(secondary to removal of mediators)
• Reduced cerebral edema
• Increased cerebral oxygen delivery
25. MUF advantages
• Immediate responses:
• HCt Increase (by 60-70%)
• RA Decrease (by 50-60%)
• LA Decrease (by 25-35%)
• Tidal Volume Increase (by 20—40%)
• P A Decrease (by 30-50%)
• Contractility Improved
• Haemostasis Improved
• Heart size Reduced (to be correlated)
• Blood Sugar Levels Decreased(40-50%)
• Blood transfusion No R C required
26. MUF diaadvantages
• Disadvantages:
• Time Delay
• Temperature drift if Heat Exchanger is not
available
• Homodynamic instability in the initial period
• Air embolism
• -Proper snugger around Aortic Cannula
• -Isolate Oxygenator from MUF circuit
• Disposable Cost
29. Hemodialysis during CPB
• Membrane material is similar to ultrafilter
• The difference is dialysate is passed through the
nonblood side of membrane
• Removes diffusible solutes based on concentration
gradient by the dialysate soln
• Water and solutes are removed by convection
30. Circuit design for dialysis in
CPB
• Hemodialysis machine not used in CPB
• Dialyser positioned parallel to the ECC
• Dialysate solution - .9%NS
• Dialysate can be configured so as to achieve efficient
diffusion rate
• Dialysate flow should be 3 times the blood flow
31. Advantages
• Hemodialysis is effective in removing potassium and
small molecular wt solutes
• Small molecules like urea and electrolytes can be
removed.
• Hemofiltration is better for middle molecules .
(because of convection rather than diffusion)
32. Blood conservation Techniques
• Cardiac surgery has propensity of excess blood usage
due to
• Extensive intervention involving major vascular
structures
• Destruction of rbc and coagulation factors during
CPB resulting in increased need of blood
• Extracorporeal circuit
33. Blood conservation stratagies
1. Retropriming and reduction in priming volume
2. Autologus donation
3. Scavenging of shed blood(cell savers)