Dr. Lewis - CABG 

  • Cannulates aorta
  • If your blood pressure is too high, Dr. Lewis will cannulate venous first and want you to take off volume. Slowly remove volume via venous line/opening venous occlude slightly until the patient’s BP if under 100 systolic.
  • “Up you go”
  • Parrot back, watch for connection, turn roller head off
  • Moves arterial line in tubing holder, puts one last stitch in around the arterial line mid-chest
  • At this point you can test your line – pulsatility first, then with roller head
  • Cannulates venous
  • “Let me know”
  • Let Dr. Lewis know if/when you are ready to go on bypass
  • “Go”
  • You: “going on bypass”
  • Cannulates retrograde
  • Grabs retrograde pressure line
  • You flush it from your retrograde pressure transducer – Dr. Lewis will usually NOT tell you to flush the line, he will grab the transducer line and raise it in the air or wiggle it
  • Flush cardioplegia/octopus – run it until he says “off”
  • Just flushing/de-airing clear up to the field
  • “Run your vent, cardioplegia on” OR “test retrograde”
  • You: “retro looks good…or bad” (He does NOT want to know specifics or numbers)
  • If he says keep running, keep both your plegia and your vent running.
  • If he says nothing, turn your plegia OFF and keep vent running
  • “Ren retro”
  • “Drop flow”
  • Crossclamp on, come back up on flow (he may or may not verbalize this)
  • Keep running your retrograde!
  • “Change it up” – turn your vent OFF and come up on cardioplegia flow to hit a nice antegrade/root pressure
  • Deliver 1.0 liters antegrade
  • You: “Antegrade is in and off”
  • Dr. Lewis: “Off, vents on, drain him out” OR he will want you to give more retrograde (~200mL or until he tells you off)
  • Redose at 12 minutes, then 17, then 22 – give 200mL retrograde unless otherwise stated
  • Dr. Lewis will say “go” or “run it” when he is ready for you to deliver redose…or “wait” or “hold” if he wants you to wait a second.

 

 




 

 

  • “Rewarm” – when starting LIMA or finish cor-knots usually
  • Make sure he wants you to rewarm the patient AND the cardiopleia. If he says yes to both, hit “main” on heater-cooler, rewarm the patient, clamp white cricket clamp on cardioplegia line, move metal pump clamp off the bypass line, and open red cricket clamp (preparing to run warm blood only)
  • “Go” or “run warm”
  • “Drop flow, back up” – removal of cross-clamp
  • “Drop your flow, back up” – placing of proximal clamp
  • Keep running warm until he says “off” or “off on warm”
  • Dr. Lewis will take the root vent out to use at one SVG proximal, he may said drain your plegia
  • Open purge line/yellow stopcock at the top of your cardioplegia to take back some blood from the tip of the retrograde cannula (to ensure that blood doesn’t escape out and onto the field/floor/shoes)
  • Attestation code: 1942 -> he does not put this in, make sure to attest for Dr. Lewis once he breaks scrub