ABCP Clinical Application of Perfusion Exam Questions & Answer Correct 100%

What are cannulation sites for an LVAD? - Answer Pulmonary Vein and Aorta What is the minimum pressure for an LVAD inflow, before you are at risk for drawing air? - Answer 5 mmHg Correction for cannula entrapment in LVAD's can be accomplished by doing what? - Answer increasing the left atrial preload (decreasing flow) -- Cannula is sucking down in the LVAD inflow either in the pulm vein, lv apex, or just below crossing the aortic valve. What is the indication that indicates to add an RVAD? - Answer Right atrial pressure 20 mmHg with IABP and inotropic support Cannulation sites for RVAD support? - Answer Right atrium and pulmonary artery. Which would not be an important consideration in cannula selection? A. size B. Shape C. Cannula Circuit connector Size D. Flow requirements - Answer C. Cannula Circuit Connector Size Right Ventricular flow rates should be adjusted in relation to what? - Answer Left ventricular flow rate. In RVAD's, pump inflow cannula entrapment is indicated by? - Answer snapping or chattering of the line What action can correct RVAD cannula entrapment? - Answer Increasing the right atrial preload. (slow flow) When is heparin therapy to maintain coagulation in VAD's usually started? - Answer Within 24 hours after initial bleeding from surgery has been controlled. Sometimes patients will get protamine. ACT's should be between 150-200 seconds. When do patients diagnosed with atrial petal defects become diagnosed in relation to Qp/Qs ratio? - Answer 1:1.5 What would normal urine output for a child who weights 12 kg be? What is the standard for urine output in cardiac patients? - Answer ~20 ml/hour In cardiac patients it is suggest that urine output should be .5-1.0 ml/kg/hour What is the estimated blood volume of a child who weights 12 kg? - Answer 75 * 12= 900 ml clinical manual of perfusion states that blood volume for a 11-20 kg child should be 80 ml/kg A 2 year old child weighting 12 kg is going on bypass. Prebypas Hct is 40% and priming volume is 1200 ml what is the diluted hematocrit? - Answer ((12*75)*40)/((12*75)+1200)= 17.1% How is venous cannulation usually done in repair of an ASD? - Answer bicaval cannulation Upon going onto bypass pressure will drop in direct proportion to what? - Answer viscosity Flow=perf pressure/(vasc resistance x viscosity) Which of the following would most likely be used to treat hypotension on a jehovah witness patient who requests no blood products be utilized. a) aramine b) ephedrine c)neosynephrine d) regitine - Answer C. neosynephrine (phenylephrine) 2 yr old 12 kg child is placed on complete bypass, when RA is opened large amount of venous blood is present. What is the cause - Answer Persistent left superior vena cava During CPB arterial blood gas for 2 yr old 12 kg patient : pH 7.35, pO2 188 mmHg, pCO2 27 mmHg. - Answer increase blood flow, decrease sweep, give NaHCO3 What best characterizes cold agglutinin disease? a) collagen vascular disease b) serum antibody disease c) bacterial infection d) autosomal dominant trait - Answer B-- serum antibody disease. cold agglutinins is an auto immune disease Clinical signs of cold agglutinins include a) acute onset shivering b)erythematous rash c) Acrocyanosis of the digits d) piloerection - Answer c) acrocyanosis of the digits piloerection is hair standing up on arms and legs. stupid trick answer. What is the most clinically relevant characteristic of cold agglutinins? - Answer Thermal Amplitude A clinically insignificant cold agglutinin characteristic would be? a) irreversible agglutination b) complement binding c) hemolysis d) peak activity at 0-4 degrees celsius - Answer D. peak activity at 0-4 degrees celsius. It is usually considered clinically insignificant if the thermal amplitude test is less than 30 C. What causes cold agglutinin manifestation - Answer low critical temperatures. What of the following is a pre operative indication for IABP support? a) a fib b)transient ischemic attack c)Ao dissection d) post infraction angina - Answer d) post infarction angina Which is a contraindication of a balloon pump? a)RV dysfunction b) vent arryth. c)Ao regurg d)bivent. fail - Answer C-- Ao regard IABP would cause blood to be pushed back into the left ventricle. Where should the IABP balloon be position in aorta before pumping begins? - Answer In the descending aorta just distal to the left subclavian artery base. In a patient recommended for a CABG what type of venous cannulation should be used. - Answer Single two stage cannula. Cavoatrial cannula. (IVC/RA) In a patient with cold agglutinins what type of cardioplegia should be given? - Answer warm crystalloid cardioplegia. Effluent from integrate cardioplegia is typically collected from where? - Answer The right atrium. What is the max temperature gradient between the heat exchanged water bath and patient blood? - Answer 10 C? Practice test answer is 12 C. What temperature does destruction to formed elements and protein denaturation occur? - Answer 42 C. Osu Board review states that temps should not exceed 38 C. In which way would an increase in blood shift the oxyhemoglobin curve. - Answer Shifts to the right. Increase in O2 metabolism causes decreased O2 levels and shifts the curve to the right. SKIP - Answer SKIP Late IABP deflation results in what. a. Enhanced after load reduction b. sub optimal coronary perfusion c. decrease pulm wedge pressure d. increase in myocardial O2 demand. - Answer D. increase in myocardial O2 demand. Late deflation would cause the heart to have to pump harder against the balloon costing it more O2 and energy. What IABP trigger mode is appropriate for a patient in Ventricular Fibrillation? - Answer Internal triggering, which will cause the balloon to deflate anytime it detects an r wave. Management of a patient with clinically significant cold agglutinins would include all of the following EXCEPT ? a) bicaval venous cannulation b)hemodilution c)hypothermic CPB above critical temperature d) high systemic flows(2.6-2.8 L/min/M^2) - Answer A. bicaval venous cannulation.