Rupture of extra-corporeal circuit tubing during cardiopulmonary bypass.
Roller pumps are widely used for cardiopulmonary bypass in developing nations by virtue of proven safety during several years of institutional use and cost effectiveness. However, careful adjustment of roller occlusion is needed because they are known to cause spallation, tubing wear, and the occasional incident of rupture of tubing in the extracorporeal circuit. Rupture of polyvinylchloride tubing in the pump raceway during repair of a ventricular septal defect in a 4-year-old child is discussed. The event was managed by exclusion and replacement of the defective tubing during a short period of arrest. Use of an inappropriate boot pump and failure to detect its inclusion in the bypass circuit was a significant departure from protocol. However, because occlusion settings and duration of perfusion were within acceptable limits, a manufacturing flaw could also have contributed to tubing failure, and the event may or may not have been averted by the use of larger tubing. In conclusion, this incident reiterates the need for adherence to established protocol during assembly of the pump and draws attention to the fact that tubing integrity is not a guarantee and vigilance is warranted to handle its failure.
Sai Krishna
Cheemalapati
C
Department of Cardio-Thoracic Surgery, Apollo Heart Institute, Visakhapatnam, Andhra Pradesh, India. csaikrishna@yahoo.com
Naresh Kumar
Palli Venkata
PV
Satpathy
Soumya Kanta
SK
Ram Mohan
Kanteti
K
Ramesh Babu
Vedangi
V
D002315:Cardiopulmonary Bypass / Q000009:adverse effects*; D002675:Child, Preschool; D004867:Equipment Design; D004868:Equipment Failure; D005112:Extracorporeal Circulation; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects* / Q000295:instrumentation; D006323:Heart Arrest / Q000209:etiology; D006345:Heart Septal Defects, Ventricular / Q000601:surgery; D006801:Humans; D008297:Male; D010477:Perfusion; D011143:Polyvinyl Chloride
D011143:Polyvinyl Chloride