THE PERFUSION PROGRAM CHALLENGE Presented by The Missouri Perfusion Society

Transcription

1 THE PERFUSION PROGRAM CHALLENGE Presented by The Missuri Perfusin Sciety The Perfusin Prgram Challenge is a simple tl t evaluate yur prgram. Determine if yur practice fllws the current standards f practice and essentials recmmended by the American Academy f Cardivascular Perfusin and by the American Sciety f Extracrpreal Technlgy. This self-assessment can identify any areas that require attentin and/r need imprvement. Once yu have cmpleted yur self-assessment and achieved a scre f 119 r greater, The Missuri Perfusin Sciety will list yur perfusin prgram n ur web site alng with thers wh have achieved the same high standard f practice. Let s make Missuri the first state in the Unin t have 100% vluntary participatin in the Perfusin Prgram Challenge with scres f 95% r greater. MISSOURI PERFUSION SOCIETY PERFUSION PROGRAM CHALLENGE SELF-ASSESSMENT SCORE Self-assessment Ttal Pssible Scre : Meets greater than 95% f current standards : Meets 85-94% f current standards f practice. Minr imprvements needed t meet current standards f practice. 105 r less: Meets less than 85% f current standards f practice. Majr imprvements needed t meet current standards f practice. Certain items may nt apply t yur specific perfusin prgram. Fr example, Assessment Sectin #1, Perfusin Recrd: includes recrded lt #, if applicable: Item # 26. Centrifugal pump head and flw prbe If yur prgram des nt use centrifugal pumps and flw prbes, give yurself a pint if yu wuld recrd their lt numbers if yu used them. In anther example, Assessment Sectin #1, Perfusin Recrd: includes multiple entry infrmatin fr labratry values at least every 30 minutes: 33. Arterial r venus bld gases 34. Venus xygen saturatin 35. Ptassium cncentratin 36. Inized calcium cncentratin

2 37. Sdium cncentratin 38. Anticagulatin mnitring If yur prgram des nt recrd labratry values directly n the Perfusin Recrd, but n a separate labratry frm that is part f the patient recrd, give yurself the pints as lng as the perfusinist has immediate access t the labratry values fr evaluatin and review. Hwever, d nt give yurself the pints if the testing is perfrmed at intervals greater than 30 minutes even if they are recrded directly n the perfusin recrd. The spirit f the Perfusin Prgram Challenge is that all items listed belw are addressed in smeway by the perfusinists invlved. If yu feel yu have addressed a specific item, but in a manner different than that described by the PPC, then give yurself the pint. Hwever, an utside agency reviewing yur prgram shuld be able t select any item frm the checklist and cnfirm yur prgram s cmpliance t the satisfactin f any reasnable assessr. T make cmments and suggestins, please cntact The Missuri Perfusin Sciety. Assessment Sectin #1 Pssible Scre 42 Perfusin Recrd: includes single entry infrmatin: 1. Hspital ID 2. Age 3. Gender 4. Height 5. Weight 6. Bdy Surface Area (BSA) 7. Allergies 8. Bld Type 9. Pre-p Labratry Data 10. Diagnsis/Histry 11. Date 12. Prcedure 13. Perfusinist(s) 14. Surgen(s) 15. Anesthesia Persnnel 16. Cmments/Events 17. Prime vlume and cmpnents 18. Signature f perfusinist Perfusin Recrd: includes recrded lt #, if applicable:

3 19. Oxygenatr 20. Carditmy reservir 21. Tubing pack 22. Arterial filter 23. Cardiplegia set 24. Ultrafiltratin set 25. Cell washing set 26. Centrifugal pump head and flw prbe Perfusin Recrd: includes multiple entry infrmatin at least every 15 minutes: 27. Bld flw rates 28. Arterial bld pressure 29. Central venus/pulmnary artery pressure 30. At least ne f the fllwing patient temperatures: Bladder Esphageal Rectal Naspharyngeal Tympanic 31. At least ne f the fllwing system temperatures: Venus bld Arterial bld Cardiplegia slutin Mycardium Water bath(s) 32. Sweep gas flw rate and cncentratin Perfusin Recrd: includes multiple entry infrmatin fr labratry values at least every 30 minutes: 33. Arterial r venus bld gases 34. Venus xygen saturatin 35. Ptassium cncentratin 36. Inized calcium cncentratin 37. Sdium cncentratin

4 38. Anticagulatin mnitring Perfusin Recrd: includes intermittent infrmatin entry at the apprpriate time: 39. Input fluid vlumes including all f the fllwing: Bld prducts Asanquineus fluids Cardiplegia slutin Autlgus cmpnents 40. Output fluid vlumes including all f the fllwing: Urine utput Ultrafiltrate Estimated irretrievable bld lss while n pump 41. Perfusinist administered medicatins 42. Perfusin recrd retained as part f medical recrd Assessment Sectin #2 Pssible Scre 44 Pre Bypass Checklist: Patient infrmatin 1. Patient/Hspital ID 2. Review f chart 3. Prcedure verified Pre Bypass Checklist: Sterility Pre Bypass Checklist: Pump 4. Expiratin/sterility f dispsables verified 5. Heat exchangers leak tested 6. Speed cntrls peratinal 7. Rller heads smth and quiet 8. Occlusins set 9. Flw meter calibrated & in crrect directin 10. Flw rate indicatr crrect fr patient and/r tubing size 11. Hlders secure Pre Bypass Checklist: Electrical Pre Bypass Checklist: Gas supply 12. Pwer crds securely cnnected 13. Gas line securely cnnected 14. Flw meter/blender functinal 15. Hses leak-free

5 16. Gas exhaust unbstructed Pre Bypass Checklist: Lines/pump tubing 17. Cnnectins secure 18. Tubing directin traced and crrect 19. N kinks nted 20. One-way valves in crrect directin 21. De-bubbled/leak free 22. Patency f arterial line/cannula verified prir t the initiatin f CPB Pre Bypass Checklist: Cardiplegia 23. Cardiplegia slutin checked fr prper K + and additive cntent 24. Cardiplegia system de-bubbled/leak free Pre Bypass Checklist: Safety mechanisms 25. Alarms peratinal and engaged 26. Arterial filter/bubble trap de-bubbled 27. Carditmy reservir vented Pre Bypass Checklist: Mnitring 28. Temperature prbes in place and calibrated 29. Pump pressure mnitrs calibrated 30. In-line and/r n-line sensrs calibrated 31. Sweep gas analyzer calibrated Pre Bypass Checklist: Temperature cntrl 32. Heater/cler water surce cnnected and functinal Pre Bypass Checklist: Supplies 33. Tubing clamps available; arterial and venus lines clamped when heartlung machine is nt in use. 34. Perfusin drugs available and prperly labeled and must include the fllwing: Heparin Sdium bicarbnate 35. Crystallid IV slutins available 36. Bld available

6 37. Sampling syringes/labratry tubes available Pre Bypass Checklist: Anticagulatin 38. Heparin administratin time and dse verified 39. Anticagulatin tested and reprted befre initiatin f CPB Pre Bypass Checklist: Backup systems 40. Hand cranks available 41. Emergency lighting available 42. Duplicate circuit cmpnents available Pre Bypass Checklist: Perfusinist and dcument retentin 43. Checklist signed and dated. 44. Checklist retained Assessment Sectin #3 Pssible Scre 9 Extracrpreal circulatin shall be cnducted by a knwledgeable and cmpetent perfusinist. 1. Qualificatins f staff perfusinists dcumented, including current state license, prvisinal license r registratin if applicable in the state the perfusin prgram is lcated. 2. Perfusin assistance readily available 3. Perfusinist n-call at all times within 30 minutes Perfusinists shuld participate in writing and review f : 4. Departmental plicies including cntinuing educatin plicy. 5. Department prtcls/prcesses 6. Department prcedures 7. Emergency and Catastrphic perfusin event management prcedures 8. Plicies and prcedures reviewed peridically Assessment Sectin #4 Pssible Scre 4 The perfusinist shall mnitr the anti-cagulatin status f the patient accrding t established prtcl. 1. An established prcedure fr mnitring the anti-cagulatin status shall be fllwed. 2. Anticagulatin is mnitred using ne r mre f the fllwing: Activated cltting time Platelet cunt Heparin/prtamine assay

7 Prthrmbin time Partial thrmbplastin time Thrmbelastgram 3. Patient specific heparin dse shuld be determined by ne r mre f the fllwing methds: Weight Dse respnse curve, autmated r manual Bld vlume Bdy surface area 4. Additinal dses f heparin during CPB shuld be determined by use f an ACT and/r heparin/prtamine assay. The perfusinist may determine the prtamine dse. Assessment Sectin #5 Pssible Scre 2 An apprpriate gas exchange shall be maintained during extracrpreal circulatin accrding t an established prcedure. 1. An apprpriate sweep gas flw rate and xygen cncentratin shuld be determined using bld gas analysis which may include mnitring devices. Additinal factrs may include: Oxygenatr directins fr use Bld flw rate Temperature 2. Bld gas analysis shuld be perfrmed and recrded every 30 minutes r less as clinical cnditins dictate. Assessment Sectin #6 Pssible Scre 3 The perfusinist shall maintain an apprpriate bld flw rate during extracrpreal circulatin accrding t an established prcedure. 1. A calculated bld flw rate shuld be determined by the perfusinist based n established prtcl prir t cardipulmnary bypass using the patient s bdy surface area. 2. An apprpriate bld flw rate used by the perfusinist shuld be determined nce n CPB by evaluatin f a cmbinatin f the fllwing factrs: Venus xygen saturatin Bdy surface area Arterial bld pressure

8 Temperature 3. Additinal parameters used by the perfusinist t guide bld flw rate may include ne r mre f the fllwing: Base excess Oxygen cnsumptin Venus po2 Arterial po2 Circuit vlume Physician request Bdy weight Anesthetic level Arterial xygen saturatin Assessment Sectin #7 Pssible Scre 2 The perfusinist shall maintain an apprpriate bld pressure during extracrpreal circulatin accrding t an established prcedure. 1. Bld pressure shuld be mnitred and recrded 2. Maintenance f arterial bld pressure at prcedural levels may be influenced by factrs ther than the cnduct f CPB but review f recrds shuld establish that arterial bld pressure is maintained at prcedural levels 95% f the time. Assessment Sectin #8 Pssible Scre 2 The perfusinist shall maintain a safe peratinal vlume in the extracrpreal circuit accrding t an established prcedure. 1. A safe peratinal level fr each perfusin circuit shuld be determined fr each circuit used. 2. A methd f safe level detectin shuld be emplyed. Assessment Sectin #9 Pssible Scre 5 The perfusinist shall emply apprpriate safety devices. 1. An arterial line filter r bubble trap with a ne-way purge line. 2. Bubble detectr 3. Level sensr 4. Anesthetic gas scavenge line 5. Additinal safety devices r techniques may include ne r mre f the fllwing: One-way valve in the intracardiac vent/sump line Oxygenatr ventilating gas xygen analyzer

9 Assessment Sectin #10 Pssible Scre 7 Retrgrade flw preventin valve with centrifugal pump The perfusinist shall emply apprpriate mnitring devices. 1. Bld flw indicatr 2. Gas flw meter 3. Physilgic mnitr (i.e in-line SVO2 r SAO2 mnitr r pint-fcare analyzer) 4. Hematlgic mnitr (i.e. in-line hematcrit r hemglbin mnitr r pint-f-care analyzer) 5. Temperature mnitrs 6. Timers 7. Other items may include: Bld gas analyzer Oxygen saturatin mnitr Chemistry mnitr Assessment Sectin #11 Pssible Scre 2 The perfusinist shall make a respnsible effrt at cst cntainment. 1. Active participatin in a cst cntainment prcess 2. Active participatin in a quality management prcess. Assessment Sectin #12 Pssible Scre 4 The perfusinist must assure that equipment used in the cnduct f extracrpreal circulatin is prperly maintained and adjusted prir t use. 1. Rller pump cclusins set 2. Bld flw sensr prperly set and calibrated 3. Regularly scheduled preventative maintenance perfrmed within prtcl/prcess established time frame. 4. Regularly schedule preventative maintenance is perfrmed based n ne f the fllwing: Manufacturer recmmendatins External accrediting agency guidelines Institutinal requirements

10 THE PERFUSION PROGRAM CHALLENGE: VOLUNTARY PARTICIPANTS The fllwing is a list f perfusin prgrams in the State f Missuri that have assessed themselves using the Perfusin Prgram Challenge and are in substantial cmpliance by meeting greater than 95% f current standards. January 2007 Perfusin Services, Department f Cardivascular Surgery, The Children s Mercy Hspitals and Clinics, Kansas City, Missuri, Chief Perfusinist: Gary Grist RN, CCP LCP Department f Cardivascular Surgery-Perfusin, The Mid America Heart Institute f St. Luke's Hspital, Kansas City, Missuri, Chief Perfusinist: Try Sydzyik, BS, CCP, LCP