Programs in ALLIED HEALTH CARDIOVASCULAR PERFUSION TECHNOLOGY

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CARDIOVASCULAR PERFUSION TECHNOLOGY
CVP 501

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Course Description
CVP 501 will provide the detailed foundation and skills that are necessary to understand the basic science of extracorporeal technology. Students will examine the relationship between blood flow within and outside of the body, and the cardiovascular devices utilized to facilitate extracorporeal circulation. Physiological, anatomical and biochemical aspects will be examined, along with the effect of extracorporeal circulation on organs and tissues.

Course work will include both class time and observation within the surgical suite, as well as on the patient wards as warranted. Laboratory participation is an important aspect of perfusion training.

Instructor:

James J. Ramsey, J.D., C.C.P.
Office: 322-6575; 322-0064
e-mail: james.ramsey@vanderbilt.edu
Fax: 343-9194
Beeper: 252-1276

Location and meeting time: tba

THIS COURSE IS PRESENTED FOR THREE (3) CONSECUTIVE SEMESTERS

Required Texts:

Cardiopulmonary Bypass: Principles and Practice
Editors: Gravlee, Davis, Utley, Kurusz
Williams & Wilkins, publishers
Latest edition: (new edition out spring 2000)

Suggested Texts:

Cardiopulmonary Bypass, Second Edition
Reed and Stafford
Surgimedics/TMP

The Manual of Clinical Perfusion, Second Edition
Brodie and Johnson
Glendale Medical Corporation

Cardiopulmonary Bypass; Principles and Practice
Editors: Gravlee, Davis, Utley
Williams & Wilkins, 1993

Safety and Techniques in Perfusion
Reed, Kurusz, Lawrence
Quali-Med, Inc.

Suggested Reading:

Cardiopulmonary Bypass, Principles and Techniques of Extracorporeal Circulation
Editor: Christina T. Mora
Springer

Cardiopulmonary Bypass; Principles and Management
Editor: K.M. Taylor

Course Objectives:

This class provides the entry-level student with the fundamental historical and theoretical concepts of extracorporeal circulation, and includes among other concepts orientation to the program, orientation to the hospital environment, and orientation to the profession of perfusion care. Scientific theories, perfusion techniques, and perfusion equipment is included in class work and operating room orientation and observation. Instruction includes substantial course work regarding blood pumps, intra-aortic balloon counterpulsation, ventricular assist, extracorporeal membrane oxygenation, filtration, artificial and natural gas exchange, principles of acid-base analysis, hypo- and hyperthermia, hemodilution, and blood conservation techniques. Additional course work includes detailed studies of oxygenators, myocardial protection, CPB circuits, and the conduct of perfusion, including accidents and safeguards regularly used during CPB. Matters of practice including but not limited to professionalism, ethical behavior, and business management models are explored.

During the three (3) semesters that this course is offered, students will for the most part experience training in the basic science of perfusion care. Course work is offered in both a traditional educational manner, and (in appropriate instances) in a problem-based learning environment. Regarding some basic science topics that we consider require more advanced and thorough training (for example: the physics of flow/pressure/resistance; circulatory dynamics; cardiac dynamics; microcirculation; acid-base; and hemostasis/coagulation management), course work is presented in separate lectures by M.D.-level research instructors, so as to provide the student with a thorough understanding of those topics. Laboratory and wet lab experiences are included when appropriate. Additionally, matters regarding professional practice (ethics, informatics, business practices, and similar topics) are interspersed throughout this eighteen (18) month period.

Advanced course work regarding special procedures in perfusion science (advanced circuitry, complex congenital pediatric/infant procedures, long-term circulatory assist devices, transplant/organ procurement technology, and other topics not included herein but which are part and parcel to the most recent copy of the Perfusion Education Consensus Curriculum as adopted by the AC-PE) are taught in the CVP-502 course, which course immediately follows CVP 501 and is taught during the spring semester of the 2nd year students’ matriculation.

Upon completion of the course, students will be able to:

  1. understand the historical foundations of perfusion technology;
  2. understand the theoretical foundations of techniques and equipment for CPB;
  3. describe the function, principles of, and problems, appropriate use, and application of the various devices associated with CPB, including all circuitry components and the aseptic assembly thereof (including filters contained therein);
  4. discuss the various physical principles associated with pressure/flow relationships in the circulatory and extracorporeal systems;
  5. understand the relationship with the initiation, maintenance, and termination of CPB and appropriate anatomic structures associated with ECC;
  6. describe the various devices and techniques utilized to reduce a patient’s exposure to homologous blood transfusion, including cell saving and hemoconcentration;
  7. describe normal electrolyte values and recognize the abnormal related to physiological disturbances caused by CPB, including the use of cardioplegic solutions;
  8. recognize definitions of physics related to gas laws as they apply to the maintenance of normal or near-normal partial pressures of important gases within the blood as it circulates both through the patient and through the extracorporeal circuit;
  9. discuss the various mechanisms by which blood carries important gases, and the calculation of values necessary to ensure adequate gas exchange within the patient and the extracorporeal circuit;
  10. understand the factors that affect acid-base homeostasis and how they are affected by extracorporeal circulation;
  11. understand how to establish and maintain acid-base homeostasis during CPB;
  12. understand the role of hyper-, hypo-, and normothermia during CPB, and how they affect other perfusion parameters such as acid-base balance, metabolism, oxygen and carbon dioxide transport and exchange, and other important physiological parameters;
  13. understand the application of, calibration of, and use of various safety devices, measurement devices, and monitoring of various parameters associated with the interplay between artificial circulation and the mechanical devices utilized to support CPB;
  14. understand the ethical, professional, and legal implications of the practice of perfusion care, as well as the interplay between and among the various participants within the surgical team;
  15. understand and apply the various techniques utilized in the preservation of the myocardium as may be necessary during CPB;
  16. understand and apply the various techniques associated with the concept of heparinization anticoagulation and other methods of preserving the number and function of various coagulation processes within the blood during CPB;
  17. understand the theory of intra-aortic balloon counterpulsation and be able to initiate and troubleshoot IABP consoles;
  18. understand the various formed elements present within blood and how the extracorporeal circuit may affect their structure and function;
  19. understand and discuss the history and application of hemodilution CPB, including an understanding of the benefits and detriments associated therewith;
  20. understand and discuss the various effects of CPB, including but not limited to: splanchnic, hepatic, neurologic, visceral, pulmonary, endocrine, hematologic, and renal effects;
  21. understand and discuss the effects of the air-blood interface;
  22. understand and discuss the principles associated with ECMO support and its application as related to perfusion care.

Note: the Consensus Curriculum as created by the PPDC and adopted by the AC-PE in its present form should be considered as further evidence of curriculum, and the latest edition of said Curriculum is herein adopted and incorporated by reference regarding the subject matter.

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Programs in Allied Health:
Cardiovascular Perfusion Technology
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