MDT In Cardiac Theatres: Case Study

The Role of Clinical Perfusionists within the MDT in Cardiac Theatres

SSU Title: WK008- Cardiopulmonary Bypass

30th November 2015

Word count:1998

Student No: 10438077

All operating theatres are pressurised environments with a low tolerance for error. It could be argued that none are more so than the cardiac theatres. It is here as part of a group of highly skilled professionals that forms the complex machine of the cardiac multidisciplinary team that perfusionists work. In taking over the role of the patient 's heart and lungs (amongst other roles) they allow a greater scope of surgical practice by providing a bloodless field, circumventing difficulties of operating on a moving heart and give the ability to perform surgery that requires opening

Whilst the checklist’s main focus is to ensure that key factors have been accounted for by the appropriate staff member it’s an opportunity to promote team cohesion. Having nursing staff lead helps recognise nurses as equals to remove the hierarchy and egos which may prevent good communication and team working. Furthermore, it provides the opportunity to introduce new members and their roles (Wahr et al., 2013;World Health Organisation, 2008).

Additionally it affords a chance to ask questions and clarify patient specific protocols. Such as flow direction of cardioplegia. In the case below it may have been appropriate initially to run the cardioplegia in a retrograde fashion instead of the more usual anteriorgrade as the incompetence of the aortic valve could allow the plegia to leak into the left ventricle instead of running down the coronary arteries (Cheng and David, 2006).

Case study- Aortic valve and root

Below this level increases the risk of thrombus formation within the bypass machine Therefore the anaesthetist administers heparin allowing sufficient time for it to work before bypass is initiated. One method to do this is to be familiar with the steps the surgeon takes so they know approximately when in this sequence administration is optimal. The ACT is then checked by before aortic cannulation. In this case ACT reached 480, which was relayed to the surgeon with an indication that he could go ahead and cannulate. Cannulation requires careful co-ordination between surgeon and perfusionist to avoid air embolus formation which is associated with significant morbidity as the brain is susceptible to injury from micro-embolisms(Moorjani, Viola and Ohri, 2011). This should then be monitored at regular intervals whilst on bypass by the perfusionist (Curle et al., 2007; Hwang and Sinclair, 1997).

After cannulation, high pressure within the aortic cannula might indicate a problem with the positioning of the cannula, such as inside a false lumen or the wall creating a iatrogenic dissection(Khonsari, Sintek and Ardehali, 2008). It is for this reason that it should be announced by the perfusionist whether or not a “good swing” is achieved to confirm lumen placement(Moorjani, Viola and Ohri, 2011; Hwang and Sinclair, 1997). The other two alarms which turn off the pump if activated are