Page 21 - ANZCP Gazette-August-Booklet

Figure 1: Cardioplegia checklist used at the Children’s Hospital at Westmead for blood mix cardioplegia (AHK5560) and del Nido cardioplegia delivery
At the same time we placed a card (Figure 2) detailing the appropriate pump settings and dosage requirements into the drawer of each heart lung machine to serve as an extra reminder of the appropriate settings, to be used in emergencies, or to confirm configuration in the event of a second perfusionist being unavailable. The calculated dose of cardioplegia delivery is written in the units it is displayed on the pump to prevent errors in unit conversion.
Figure 2: Card placed in each heart-lung machine detailing control module settings and del Nido dosing interval guide
Early this year another potential complication presented, as there was a temporary manufacturing issue with the supply of 1/8” ID silicone replacement tubing (SRT) used for the pump boots in the cardioplegia circuit. Some circuits were now going to be supplied with 3/16” ID pump boots instead. Being a paediatric unit and having to accommodate patients ranging in size, we have four different sized heart- lung machine circuits. Some circuits would now contain the temporary replacement pump boot diameter and some of the less frequently used circuits containing the normal sized pump boot. Depending upon the circuit that was being set up, we were required to change the pump module’s tubing collets and calibration.
To minimize this pump boot variance being a source of error, each time a pump is set up, a sequence of visual checks are completed – this includes confirming the size of the tubing in the circuit, that the appropriate sized tubing collets are in situ and that the correct tubing size is selected on the pump controller. If the tubing collet required changing on set up, the last used one is then left sitting on the pump in clear view, to alert the next user that the tubing size has changed and to double check all settings. This also signals to the perfusionist the potential for a significant change in roller pump occlusiveness.
To date, del Nido cardioplegia is the preferred method of myocardial protection for all of our surgeons, therefore we no longer routinely offer the traditional blood mix cardioplegia. With more and more units opting to provide more than one method of myocardial protection, we hope that by sharing our experience we may help other units to reduce the potential for human error during cardioplegia delivery.
SEPTEMBER 2020 | www.anzcp.org 18