10/18/2017. Pediatric Readiness. What you need to know. Renee Axdorff-Dickey B.S.C.C.P., M.B.A., FPP. Disclosures. I have no financial Disclosures.
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1 Pediatric Readiness What you need to know Renee Axdorff-Dickey B.S.C.C.P., M.B.A., FPP N Disclosures I have no financial Disclosures. 1
2 Pillars of Seattle Children s STANDARDS FOR PERFUSION PRACTICE Standard 1: Development of Institutionallybased Protocols Standard 2: Qualification, Competency and Support Staff Standard 3: Communication Standard 4: Perfusion record Standard 5: Checklist Standard 6: Safety Devices Standard 7: Monitoring Standard 8: Anticoagulation Standard 10: Blood Flow Standard 11: Blood pressure Standard 12: Protamine and Cardiotomy Suction Standard 13: Blood Management Standard 14: Level of Readiness Standard 15: Staffing Standard 16: Duty hours Standard 17: Quality Assurance and Improvement Program Standard 9: Gas Exchange Standard 18: Maintenance 2
3 What you need to know Developing Institutional protocols based on AmSECT Standards Standards drive disposable choices (kids come in all sizes) Case-by-case readiness Communication standardization ECLS: AmSECT standards on the go Quality assurance and improvement Developing institutional protocols In-house published protocols and guidelines Reviewed annually Online for easy access Signed Since
4 Using institutional protocols Standardized pump setups Readiness and staffing Blood management Blood gas monitors/analyzers NIRS monitors Standards Drive Disposable Choices Cannula 70 Oxygenators 4 Multiple sizes of tubing packs Hemoconcentrators 3 MUF circuit 1 4
5 10/18/2017 Case-by-Case Readiness Do the math in advance Double check with patient EMR Electronic by-pass record Time-stamped checklist Height: Weight: BSA: Patient Blood Volume: Cardioplegia Arrest Dose: Cardioplegia Second Dose: Cardioplegia Delivery Rate: cm kg m2 FLOWS: 3.2 = 3.0 = 2.8 = 2.6 = 2.4 = 2.2 = 2.0 = 1.8 = 1.6 = 40/kg Sweep Gas: 0.28 M.U.F. Delivery: 0.04 Communication Standards Communication equals quality care WHO Surgical Safety checklist National Patient Safety Foundation Procedure readiness and communication 5
6 ECMO: AmSECT standards on the go Pediatric ECLS ecpr QA and Improvement Drive Innovation Teamwork Collect data Innovation 6
7 Pediatric Readiness: What you should know Develop usable institutional protocols and practice guidelines for pediatric perfusion and ECLS Choose disposables that work for your patients and team Use apps or spreadsheets and electronic records for easy and accurate calculations Team communication standards prevent errors Training and readiness go hand in hand for ECLS QA and Improvement drive innovation and excellence References J.du PlessisMBChBP.BurkeMDAldo R.CastanedaMDJohn E.MayerJr.MDJane W.NewburgerMD Perioperative effects of alpha-stat versus ph-stat strategies for deep hypothermic cardiopulmonary bypass in infants, The Journal of Thoracic and Cardiovascular Surgery,Volume 114, Issue 6, December 1997, Pages Skaryak LA 1, Chai PJ, Kern FH, Greeley WJ, Ungerleider RM. Blood gas management and degree of cooling: effects on cerebral metabolism before and after circulatory arrest. J Thorac Cardiovasc Surg Dec;110(6): Lori J. West, M.D., D.Phil., Stacey M. Pollock-Barziv, M.A., Anne I. Dipchand, M.D., K. Jin Lee, M.D., Carl J. Cardella, M.D., Leland N. Benson, M.D., Ivan M. Rebeyka, M.D., and John G. Coles, M.D. ABO-Incompatible Heart Transplantation in Infants N Engl J Med 2001; 344: March 15, 2001 Kevin Charette, Yasutaka, Hirata, Emile Basha, 180 and less: Cardiopulmonary bypass techniques to minimize Hemodilution for neonates and small infants, Safe Journal, Sept 2007,Jamie Dickey, and Ross M. Ungerleider. Improved Quality and Outcomes through Congruent Leadership, Teamwork and Life Choices. Progress in Pediatric Cardiology, vol. 32, no. 2, 2011, pp , doi: /j.ppedcard Developmental and Neurologic Effects of Alpha-Stat versus PH-Stat Strategies for Deep Hypothermic Cardiopulmonary Bypass in Infants. The Journal of Thoracic and Cardiovascular Surgery, Mosby, 23 Apr. 2003, ME Richmond, K Charette, JM Chen, The effect of cardiopulmonary bypass prime volume on the need for blood transfusion after pediatric cardiac surgery, The Journal of Thoracic and Cardiovascular Surgery, Volume 145, Issue 4, April 2013, Pages Likosky, D S, et al. Report from AmSECT's International Consortium for Evidence- Based Perfusion Consensus Statement: Minimal Criteria for Reporting Cardiopulmonary Bypass-Related Contributions to Red Blood Cell Transfusions Associated With Adult Cardiac Surgery. The Journal of Extra-Corporeal Technology., U.S. National Library of Medicine, June 2015, Big- Dog- Little- Dog. Vampire Diaries, Vampire Diaries Wiki, vampirediaries.wikia.com/wiki/file :Big-dog-little-dog.jpg. Accessed October 5,2017 Thank You for Listening 7
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