1 / 20

ASSISTED VENOUS DRAINAGE

ASSISTED VENOUS DRAINAGE. Gravity Drainage. Patient to reservoir height gradient [ table height ] Venous line resistance as contributed by the venous cannulae ( cannulation site ) Central venous pressure Venous line length & size Venous reservoir. Why Assisted Venous Drainage?. Adults

neve-fry
Download Presentation

ASSISTED VENOUS DRAINAGE

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. ASSISTED VENOUS DRAINAGE

  2. Gravity Drainage Patient to reservoir height gradient [ table height ] Venous line resistance as contributed by the venous cannulae ( cannulation site ) Central venous pressure Venous line length & size Venous reservoir

  3. Why Assisted Venous Drainage? • Adults • Video-assisted surgical procedures and minimally invasive techniques with CPB • Higher support flows can be achieved with cannulae of smaller diameter • The primary aim of AVD is to optimize venous return flow with the utilization of a reduced diameter venous cannulae • Pediatrics • Reduce priming volume (VAVD) • To facilitate drainage with complex venous cannulation (air locks)

  4. Assisted Venous Return Techniques: • Roller- Pump Assisted • “Better-Header” • Kinetic-Assisted • Vacuum-Assisted

  5. Kinetic-Assisted Venous Drainage • Involves the integration of a centrifugal pump into the venous line to actively aspirate venous blood from the patient

  6. Roller Pump Assisted Venous Drainage • Involves the integration of a roller pump into the venous line to actively aspirate venous blood from the patient

  7. Vacuum-Assisted Venous Drainage • With this technique, the venous line is connected directly to a sealed hard shell venous reservoir • A regulated suction to the venous reservoir and closing all vented ports.

  8. Vacuum-Assisted Venous Drainage

  9. Advantages of VAVD • Improved venous return • Lowering the priming volume. • Markedly reduced intra-cardiac suction levels • Improved visibility and ability to use smaller incisions • Alternative venous cannulation sites • In some Re-Do cases, may eliminate need to dissect for snares around the Cava • Almost impossible to have an air-lock in the venous line • Improved drainage in special procedures. [ Heart port, modified access cases ]

  10. Disadvantages and Pitfalls • Possibility of transmission of gaseous micro-emboli form the venous line to the arterial side of the circuit • Concerns on the effect of higher negative pressure on the RA and coronary sinus(due to Vacuum) • It may cause displacement of retrograde cardioplegia cannulae • It may distort the inter-atrial septum due to negative pressure in the RA • Over pressurization of the sealed venous reservoir • Increase arterial line filter shunt

  11. Advantages of VAVD over other AVD Techniques • Superior handling of Venous Line Air • Easy to set-up • Cheaper

  12. Equipment • CPB circuit with a sealed hard shell venous reservoir & integrated oxygenator • Pressure vacuum regulator with custom VAVD tubing set • Negative and positive pressure monitoring device • A very responsive positive pressure relief valve

  13. Special Considerations • Care should be taken when adding fluids through the quick prime line • Care should be taken when administering pharmaceuticals through the manifold. • Watch the negative pressure when adjusting the vent and the inter-cardiac suction flow. • If venous return ceases during CPB, clamp the venous line for a second and release. • Preventative measures to prevent air being pulled in the circuit have to be taken.

  14. Special Considerations • In the event of atrial tear or unsecured caval canulae, side clamping of the venous line is essential • VAVD is no substitution for good cannulation • If excessive venous chatter occurs, consider hypovolemia, cannula size and cannula position • If circulatory arrest is required, vacuum is removed from the reservoir and only applied again when restarting bypass • Always remember to vent the venous reservoir when down on flow or when VAVD is not in use.

More Related