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STANDARDS of PRACTICE |
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A Statement of Adopted September, 1987 - Revised January, 1994 |
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The American Academy of Cardiovascular Perfusion acknowledges and concurs that the primary responsibility for the care of the patient undergoing procedures involving cardiopulmonary bypass rests with Surgeon/Physician in charge. The Academy believes that it is the responsibility of the perfusionist to assist the Surgeon/Physician in any way possible in this patient care, and particularly within the defined area of expertise of the perfusionist, that of cardiopulmonary bypass equipment, ancillary equipment, and procedures. The American Academy of Cardiovascular Perfusion endorses the following standards of practice in the art of Cardiopulmonary Bypass, and acknowledges the necessity fir the membership to participate in the preparation, presentation and publication of scientific information. The American Academy of Cardiovascular Perfusion acknowledges that the development of standards of is an ongoing process due to evolving technology. RECORDS. A written perfusion record must be kept of each procedure, and must include pertinent direct or indirect patient information during the procedure e.g., medical record number, age, weight, important preexisting conditions, diagnosis, equipment used including serial and/or lot numbers. Drugs and fluids added through either the prime or bypass circuit during the procedure must be upon the prescription of a physician, and time and amounts recorded as part of the record. Perfusion parameters must be recorded at no less than every 15 minutes or whenever on one the parameters is changed or changes, whichever is shorter. Perfusion parameters that must be recorded (but not limited to) are: time; flow rate; perfusion pressure; temperature; perfusion gas mixtures and flow rates. Blood gases must be recorded when obtained, and any other pertinent information (e.g., drugs added, fluid added, instructions regarding changes to flow, cooling and rewarming). A copy of the perfusion record must be retained by the perfusionist. A copy should be placed in the patient chart if that is within the particular hospital rules and regulations. This record should contain all other information pertinent to the bypass procedure. PERSONNEL. Two qualified perfusionists are preferable during a cardiopulmonary bypass procedure. If the primary perfusionist is required to do more than operate the heart lung machine, including the cardiopulmonary bypass circuit, and perform manipulations with this circuit (e.g., draw blood gas samples and add drugs on prescription) then the perfusionist must have a qualified assistant present. PREBYPASS. A prebypass check list must be employed. This list should include, but not be limited to, evaluation of, e.g., mixing valve, flow meters, RPM gauges, pressure monitors, direction of intended flow in tubing through the pump head, connections, safety devices, temperature probes, and general integrity and security of the cardiopulmonary bypass system. Initial heparin dose and time must be verified and should be recorded. EQUIPMENT. Otimal performance and safety of the perfusion circuit is the prime concern of the perfusionist. Although the weight of the patient, preexisting conditions and the selected procedure will dictate certain aspects of the selection of equipment, other aspects of equipment selection are not so affected. The perfusionist should make genuine efforts at cost containment through the various methods available to them. Perfusionists must utilize safety equipment currently available in the selection of the perfusion circuit (e.g., low level alarm sensors, bubble detectors, bubble traps, automatic shutoff devices, arterial line filters, and others deemed appropriate for safety). Suction and vent lines must be tested immediately prior to use. Permanent equipment must have periodic scheduled preventive maintenance, and records of such maintenance must be kept by the perfusionist. The perfusionist should consult with the Surgeon/Physician in charge of the procedure regarding equipment. PERFUSION. During cardiopulmonary bypass, an adequately safe volume must be maintained in the perfusion circuit. This volume of fluid should permit a reaction time of at least 15 seconds should venous return be interrupted. Perfusion flow rate must be maintained at such a level that inadequate tissue perfusion is not permitted (e.g., increasing metabolic acidosis, venous desaturation, EEG changes). Perfusion pressure must be maintained at an adequate level so that organ preservation and function are not compromised or impaired function detected. Anticoagulation assessment must be performed on a routine basis during cardiopulmonary bypass, and must be included as part of the perfusion record. Anticoagulation should be adequate to prevent clotting in the extracorporeal circuit and consumption of clotting factors.During the time that the heart lung machine is not being used actively to transfuse or support the patient, both the arterial and venous lines must be securely clamped. GENERAL. The Academy encourages the perfusionist to take an active role, in consultation with the Surgeon/Physic charge, in developing patient contact. It is through this personal contact that promotion of responsibility and accountability of perfusion services is developed. Each patient is an individual whose preexisting clinical condition and disease dictates specific cardiopulmonary bypass considerations. A thorough knowledge and understanding of the patient's medical history through study of the medical record must be developed.
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Perfusion |
