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

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,… 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

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

Perfusion Theory is an educational platform for the Oxygen Pressure Field Theory (OPFT). August Krogh’s theoretical concept of the oxygen pressure field is explained and then applied to clinical applications in perfusion practice.

Main Menu