FOR CASES WITH PR9 (Coronary Sinus Catheter placed in neck by Anesthesia) 

  • 3/16” line
  • 3/16” “Y”
  • 3/16” adapter with male luer
  • Cut the connector off the plegia circuit outlet
  • Place on 3/16” Y to outlet of Cardioplegia circuit
  • Connect single leg of 3/16” Y, to the 2” piece of 3/16” tubing on outlet of Cardioplegia circuit
  • Place remainder of 3/16” tubing on 1 leg of 3/16” Y
  • Place dead-ender cap on one leg of 3/16” Y
  • Place 3/16” adapter with male luer on end of 3/16” tubing
  • Attach to reservoir with a stopcock.
  • This will allow you to prime the 3/16” tubing and recirculate through it to remove air
  • After lines have been passed up to the table.  Run the 3/16” line with the male luer adapter up to anesthesia. 
  • Anesthesia will attach it to the appropriate stopcock
  • Have anesthesia attach a syringe to the stopcock, close it to the patient, so you can de-air into the syringe.
  • After all air is gone, open stopcock to patient.  Making sure that PA pressure is reading the retrograde pressure.  And test the retrograde.
  • Make sure you get a pressure response
  • You need to ramp up your retrograde flows fairly quickly.  You don’t want to be giving plegia forever.  Just a quick up and down to make sure you get a pressure response.
  • If only small pressure response wait until you are on bypass and you can check it again. 
  • Pressure may be better when the heart empties out, if there is a large coronary sinus
  • If still no pressure response, have anesthesia add more volume to the balloon.

Please keep Dr. Lewis in the loop at all times about if the retrograde is working or not.