The Turbo-encabulated Oxygenator by Gary Grist RN CCP Emeritus
Hey guys, I am excited about a new oxygenator from the Evergassed Corporation, Nome Alaska, a new manufacturer in the field. Below is a detailed description of the turbo-encabulated oxygenator. Turbo-encabulated Oxygenator ( See Figure) For a number of years… Read More
The Complacency Trap and Perfusionists Part 2 by Gary Grist RN CCP Emeritus
“Complacency is the lethal enemy of excellence.” Clark Gaither, MD, FAAP, Medical Director of the North Carolina Physicians Health Program. CPB CHANGES Shaken from my complacency, I realized that I could not prevent all of the complications associated with the… Read More
The Complacency Trap and Perfusionists Part 1 by Gary Grist RN CCP Emeritus
“Complacency is the lethal enemy of excellence.” Clark Gaither, MD, FAAP, Medical Director of the North Carolina Physicians Health Program. COMPLACENCY Complacency is a human failing that is very hard to quantify, but that has not stopped some from trying… Read More
Job Hunting and Interview Advice for Perfusion Students and Perfusion Job Hunters by Gary Grist RN CCP Emeritus
I would like to offer my advice to all the perfusion students who will eventually be seeking employment and unemployed perfusionists who are job hunting. I am retired but, that doesn’t stop me from giving some advice on what I,… Read More
Goal Directed Perfusion: Genuinely Beneficial or Smoke and Mirrors? By Gary Grist RN CCP Emeritus
History of Goal Directed Therapy. Goal Directed Perfusion (GDP) is a concept inspired by Goal Directed Therapy (GDT). GDT was first described in 2001 by Rivers (1). The technique uses rigorous monitoring and intensive management of hemodynamics in high-risk perioperative… Read More
PREVENTING PERFUSION INCIDENTS: A RISK REGISTER by Gary Grist RN CCP Emeritus
Playing It Safe A recent Perfusion Improvement Reporting System (PIRS) report (8/12/2021) describes the changeout of an oxygenator because it appeared to have a manufacturing defect that was only noticed once blood entered the fiber bundle of the oxygenator (1)…. Read More
Critical Reflection: Disparate Behavior Between Dedicated Healthcare Providers And Business by Stacy Blythe RN PhD.
Critical reflection bridges the gap between theory and practice. This paper will provide reflection on my own experience as a Registered Nurse undertaking a Master of Business Administration (MBA). In particular, I will reflect on what I considered to be… Read More
A Face Full of Blood by Gary Grist RN CCP Emeritus
Pet Peeve I will use this article to address a pet peeve that I have had for over 50 years; the lack of eyewash stations at scrub sinks in ORs. How many of you have seen eyewash stations in the… Read More
THE THREE “P’s” OF PERFUSION: POLICIES, PROCESSES AND PROCEDURES AND THEIR ORGANIZATION by Gary Grist RN CCP Emeritus
I am sorry about this but the job is never done until the paperwork is done. So, this is how I organized my paper work for the Perfusion Department. It is based on a Quality Management System that I picked… Read More
HE, Me, and the FBI. by Gary Grist RN CCP Emeritus
The title is not a typo. The HE stands for ‘heat exchanger.’ The Me stands for me, myself, and I. And FBI stands for…the FBI. In the late 1980’s I was using one of the first disposable pediatric membrane oxygenators…. Read More
UTAH PROTOCOL by Thomas N. Muziani PA-C, CP June 30, 2005- revised December 23, 2018
This protocol’s premise is based upon a microplegia philosophy and application. Its clinical efficacy reflects 50 years clinical cardiac experience of-what will work and what does not. The basic postulation of the UTAH PROTOCOL (UP) on first review is counterintuitive… Read More
A Guide to Good Practice in Clinical Perfusion by Gary Grist RN CCP Emeritus*
On May 27, 2005, there was an incident resulting in the death of a child undergoing heart surgery at the United Bristol Healthcare Trust. The Bristol hospital is a part of the British National Health Service (NHS). The death was… Read More
Cutting Blood Tubing…..Professionally! – By Gary Grist RN CCP Emeritus
One definition of a professional is a person who performs a task with “great competence.” But I have seen blood tubing cut with “great incompetence” by perfusionists over the years. You might think that I am judgmental if I accuse… Read More
The PRONTO Procedure: A New Safety Standard For Oxygenator Change Out by Gary Grist RN CCP Emeritus
I first learned of the PRONTO procedure when I heard Robert Groom*, the Director Of Cardiovascular Perfusion, Maine Medical Center in Portland give a talk about it many years ago. PRONTO stands for Parallel Replacement of an Oxygenator that is… Read More
Dogma of the Arterial Blood Gas
Modern blood gas analysis came into widespread use during the polio epidemic of the early 1950s to assess the respiratory status of patients and the efficiency of the new breathing support equipment, i.e., the iron lung. Smaller and faster testing… Read More
WHAT IS A NEVER EVENT?
A “never event” is an informal term for a serious reportable event (SRE) that could cause patient harm or death as defined by the National Quality Forum (NQF). The NQF is an organization working toward safety in healthcare among other… Read More
Better Brains
From the very beginning of my career I always worried about patient brain damage after cardiopulmonary bypass (CPB). Back then we called it “pump head” . “Pump lung” (now called adult respiratory distress syndrome or ARDS) was a common concern… Read More
The Impaired Perfusionist
It is easy to change a failing oxygenator or fix a broken pump. But how do you fix a broken perfusionist? Even more importantly, how do you know when a perfusionist is broken? There is failure on the part of… Read More
Oxygen Or Nitrogen: Which Is The Lesser of Two Evils?
Comment on “Hyperoxia – A Review Of The Risks And Benefits In Cardiac Surgery”. Ever since it was discovered in the 1770s, the risks and benefits of oxygen have been hotly debated [1]. In the review article (Young RW…. Read More
Searching for the Lethal Corner By Gary Grist RN CCP Emeritus
In November of 1990, I was searching the medical library for new ideas pertaining to the perfusion profession. Having been a perfusionist since 1968, I knew all the common pertinent facts relating to cardiopulmonary physiology and extracorporeal support. But I… Read More
Safe Use of Bicarbonate
Sodium bicarbonate (NaHCO3) is a medication often given during cardiopulmonary bypass (CPB) by perfusionists. I think this medication hurts patients more than most perfusionists realize. Giving a lot of NaHCO3 just to restore the bicarbonate level and keep the… Read More
Checklist Errors
Many decades ago, when I first started using checklists, I thought they were an annoyance that just slowed me down. I did not see much value in them. But as I aged I began to realize that I was not… Read More
The Physiology of ECPR
Extracorporeal cardiopulmonary resuscitation (ECPR) patients have a unique physiology that is radically different than the run-of-the-mill ECMO patient. Beginning within the first 5 minutes of chest compressions and manual ventilation aka cardiopulmonary resuscitation (CPR) there are changes that can have… Read More
Stress and PTSD in Perfusion and ECMO
I am fat. Not only that, but I have a lot of health problems as well; diabetes, sleep apnea, hypertension, hyperlipidemia, kidney stones; all comprising the full range of the “metabolic syndrome”. How did I get this way? The change… Read More
CPB FMEA #3: Heat exchanger leak in the oxygenator or cardioplegia heat exchanger.
This week’s FEMA is prompted by the recent chatter on the list servers about cleaning heater/coolers (H/C). The discussion centered on two aspects: 1) how to clean the water reservoir to kill microbial contamination without damaging the equipment and 2)… Read More
What Are The Native Reservoir And The Ready Reservoir?
Yes, it is possible to to ‘dry out’ a patient during cardiopulmonary bypass (CPB). The article (referenced below) is about pediatric patients, but I believe there is an adult correlation as well. What I learned is that patients coming off… Read More
Working Conditions for Perfusionists
I am retired now, but when I was a chief I knew that morale was a key element in managing the perfusion staff. If morale is poor, staffers will hesitate to go the extra mile that is sometimes needed to… Read More
“World Peace…One Conversation at a Time” By Barbara Grist
“World Peace…One Conversation at a Time”. What a great quote to post on the home page of US Servas, a non-profit organization who’s mission is peace and cultural understanding. Thich Naht Hahn is just one author advocating peace by starting… Read More
Not A New Pump, Rather A “NuStep” From Dick Sarns
I retired in December of 2014. Anyone who retires thinking all their problems are solved should think again; finances, health care, estate planning, etc. My primary concern, however, was not any of those things. I was primarily concerned with staying… Read More
The Bicarbonate Lag Phenomenon in Neonates
—– Original Message —– Dear Gary- My chief of surgery indicated to me a couple of weeks ago that we have had some issues in the ICU with a couple of neonates having a significant metabolic alkalosis that persisted for… Read More
Blood and Fava Beans (glucose-6-phosphate dehydrogenase (G6PD) deficiency)
No, this is not an article about the favorite side dish of a bloodthirsty murderer (ala Hannibal Lecter of “The Silence of the Lambs” fame). It is about broad beans, blood and a rare perfusion complication. Favism, named after the… Read More
Why Do We Wash The Blood Prime in the ECMO Pump? Nobody Else Does!
The initiation of CPB or ECMO results in the rapid exchange of blood at the rate of 100 ml/kg/min in infants. Cardiac arrest from the rapid infusion of PRBC is a well known complication of blood transfusions. Other electrolyte imbalances… Read More
Should Perfusionists Use a Transfusion Trigger on Cardiopulmonary Bypass?
I recently attended both the New Advances in Blood Management (NABM) and the Society for the Advancement of Blood Management (SABM) in Kansas City in 2009. At both meetings the consensus was that a low hematocrit is bad and a… Read More
Malignant Hyperthermia Part II
The perfusionist’s preparation to deal with malignant hyerthermia (MH) and its variants should begin with the education of other health care professionals. Because the resuscitation of a patient enduring MH can be lengthy, sufficient time is usually available for… Read More
Malignant Hyperthermia Part I
Hazardous material (HAZMAT) teams are community resources that maintain constant vigilance against toxic contamination of the environment. Each HAZMAT team maintains training and readiness for the rarest and worst of all toxic contamination accidents ,a nuclear reactor meltdown, even though… Read More
Say “Hello” To ECMOjo !
Perfusion simulators for training are becoming very popular and a new Source Forge open source simulator called “ECMOjo” from Hawaii is now available to anyone wishing to test their skills in using a heart/lung machine in the form of an… Read More
How Ultrafiltration And MUF During Cardiopulmonary Bypass Really Work!
The mechanical separation of capillaries by edema decreases perfused capillary density which disrupts the oxygen pressure field. This can impact most of the soft tissues and organ systems in several ways and is frequently associated with organ failure. For… Read More
The Oxygen Challenge On ECMO
THE OXYGEN CHALLENGE OR HYPEROXIA TEST ON ECMO The oxygen challenge or hyperoxia test for respiratory ECMO patients makes it easy to evaluate the lungs ability to transfer oxygen. The FiO2 on the ventilator is increased to 100% for 5… Read More
Chest Tubes And ECMO by Gary Grist RN CCP
Chest tubes can significantly contribute to complications in respiratory ECMO patients primarily due to bleeding from the chest wall into the chest cavity. One internal chest wound can seriously complicate ECMO efficacy and the need for a second tube amplifies… Read More
Who Really Invented the Heart/Lung Pump And ECPR?
A cult film is one that has special meaning for its viewers. “Casablanca” and “The Rocky Horror Picture Show” are two that immediately come to mind. Cult films attract a special following, the many fans having their own reasons on why they… Read More
Perfusionists Need To Partner With A New Type Of Physician
The partnership between the perfusionist and the cardiac surgeon goes back to the very beginnings of open heart surgery. Even today, most perfusionists work under the auspices and authority of the heart surgeon or anesthesiologist. The vast majority of perfusion… Read More