As we practiced in all our scenarios in school, turn your pump sucker off as soon as protamine is started. If only it were that simple. Today I pumped an atrial myxoma removal/CABG. We came off bypass, the decannulated the venous line, with the root vent was still running with me occasionally transfusing the volume back to the patient. I guess there was still a lot of air showing up on the TEE, so we continued to do this. Then the surgeon asks for protamine. As anesthesia starts protamine, I tell the surgeon that protamine has been started and the root vent is still on. I'm told that yes, they know, and leave the vent on and continue to transfuse volume back. A few minutes later they took the root vent out, and decannulated the aorta. I went to go bag the blood in the pump, and it wouldn't come out. I kept checking and rechecking trying to find what I was doing wrong. My preceptor pointed out my problem, my pump was full of 'jello.' So the circuit, filled with almost a liter of blood, went straight into the trash. Thank goodness we didn't need to crash back on. Of course everyone had lots of advice afterwards for how to 'handle' that kind of situation. Ultimately, I feel like I did what I as a student could. I informed the surgeon immediately like I'm supposed to, and documented this. Afterward the surgeon said they realized that the pump would clot, but that de-airing was more important. I can only imagine what it would be like to be on pump still and have protamine given too soon.
Kelly Crews
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