Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content ++ Bypass blood circulation of the heart and lungs while still perfusing other organsDiversion of blood flow through a circuit located outside of the body, yet in continuity with itPrimarily used for cardiac surgery, but also for major vascular surgery, neurosurgery, and transplant surgery ++ See Figure 85-1. ++ Venous cannula to remove blood from the patientVenous reservoirPump to return bloodOxygenator to add oxygen (and remove CO2)Heat exchanger to warm or cool bloodFilter to remove debris and airArterial cannula to return blood to the patient ++Figure 85-1. Basic Diagram of CPB MachineGraphic Jump LocationView Full Size||Download Slide (.ppt)Reproduced with permission from Hessel EA II, Edmunds LH Jr. Extracorporeal Circulation: Perfusion Systems. In: Cohn LH, Edmunds LH Jr, eds. Cardiac Surgery in the Adult. New York: McGraw-Hill, 2003:317-338. Copyright © The McGraw-Hill Companies, Inc. All rights reserved. ++ Pulse oximetry—monitor for peripheral oxygen saturationEKG—monitor for dysrhythmias, ST segment changesArterial line—necessary for cardiac surgery as noninvasive cuff measurement will not work during CPB (nonpulsatile flow)Central line—monitor for volume status, rhythm disturbances, superior vena cava (SVC) syndrome, and adequate venous drainage during CPB. Used for rapid volume resuscitation and medication administrationPulmonary artery (PA) catheter—should be placed in patients having off pump CABG, pulmonary hypertension, low EF. May not be routinely placed; depends on preference of surgical team for postoperative careTransesophageal echo (TEE)—if available, should be placed in every cardiac case. If limited availability, should be used preferentially for valve procedures. Monitor for contractility, volume status, valve competence, and presence of air prior to CPB separation. This is now becoming a standard of careProcessed EEG monitor—level of anesthetic depthCerebral oximetry—monitor for cerebral oxygenation and perfusion +++ Arterial Line Placement ++Table Graphic Jump Location|Download (.pdf)|PrintArterial Line Location According to the Location of the Arterial CannulaLocation of arterial cannulaPossible arterial line locations for monitoringAscending aortaRight or left radial artery; right or left femoral arteryAxillary/innominate arteryLeft radial artery; right or left femoral arteryFemoral arteryRight or left radial arteryBalloon endoclamp in ascending aortaTwo arterial lines, right and left radial artery++Table Graphic Jump Location|Download (.pdf)|PrintArterial Line Location According to the Type of SurgeryType of surgeryPossible arterial line locations for monitoringCoronary artery bypass surgeryRight or left radial artery, unless using radial artery graft; right or left femoral arteryValve surgeryRight or left radial artery; right or left femoral arteryAscending aorta surgeryRight or left radial artery; right or left femoral arteryAortic arch surgeryPossibly need two arterial lines, discuss with surgeon about location +++ Central Line Placement ++Table Graphic Jump Location|Download (.pdf)|PrintCentral Line LocationsLocation of central venous ... Your MyAccess profile is currently affiliated with '[InstitutionA]' and is in the process of switching affiliations to '[InstitutionB]'. Please click ‘Continue’ to continue the affiliation switch, otherwise click ‘Cancel’ to cancel signing in. Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Username Error: Please enter User Name Password Error: Please enter Password Forgot Username? Forgot Password? Sign in via OpenAthens Sign in via Shibboleth