Perfusion Help Nationwide

Vivacity Perfusion has several traveling perfusionist ready to take action from coast to coast. We are here to help cover all your temporary and full contract needs for perfusion services. Vivacity Perfusion works along side many perfusionist as well as other perfusion companies to help you get the coverage you need. Please feel free to reach out to us for more information. All of Vivacity Perfusion’s staff members are Cardiohelp “trained”.

-Pediatric ECMO (shifts, Initiation)

-Adult ECMO (Shifts, Initiation)

-Hyperthermic Intraperitoneal Chemotherapy

-Adult CVOR

-Pediatric CVOR

-Transport

-VADs (heartwear, heartmate, centrimag, Pedimag, berlin heart, Impella, and more)

 

 

Staff perfusion, Locum Perfusion, Contract Perfusion, perfusion coverage

Complications of Femoral Cannulation

Femoral cannulation is commonly used to obtain central access during cardiac bypass using various versions of the Seldinger technique. Caparas, Hu and Hung (2014), in a comparison study of the modified Seldinger technique (MST) and the accelerated Seldinger technique (AST), found the AST was both faster, resulted in less blood loss, decreased air-to- vessel exposure incidence, and decreased infection in their small sample.  These differences were statistically significant.  Tsiouris, Elkinany, Ziganshin, and Elefteriades (2016) analyzed the use an open Seldinger guided femoral cannulation procedure on 303 patients.  The survival rate overall was 97% (98% for elective surgeries).  However, femoral cannulation can cause significant complications.

According to Malviyal, Yadav, Negi and Singh (2011), complications resulting from femoral vein cannulation include hemorrhage, phlebitis, thrombosis, fistulas, pseudo-aneurysms and damage to the femoral nerve. Saadat et al. (2017) compared 72 cardiac surgeries from September 2012 to September 2013 where femoral cannulation (FC) was used to 274 surgeries which used aortoarterial cannulation (AC).  The incidence of stroke in FC was 1.39% compared to 2.19% when A/C was used.  Incidence of atrial fibrillation for FC was 13.9% and for AC was 16.5%; renal failure was 2.78% versus 4%, hemorrhage with need for an additional operation was 4.17% versus 4.74%. These differences were not statistically significant; however, because of the findings the authors postulated femoral cannulation has no significant differences in complication and mortality rates than aortoarterial cannulation.

Tsiouris et al. (2016) noted risk of stroke is a concern since FC can mobilize plaque and debris from arterial walls leading to emboli in the brain; but, this has not been universally reported as a complication (Fusco, Shaw, Tranquilli, Kopf, & Elefteriades, 2004; Kouchoukos, Masetti, Rokkas & Murphy, 2002; Lakew, Pasek, Zacher, Diegeler & Urbanski, 2005; Okita et al., 1998). In Tsiouris et al.’s study of 303 FC patients using the open Seldinger technique, there were zero instances of malperfusion, ischemia, dissection or vascular injury.  Wound complications were present in 1% of patients and the stroke incidence was 1%.

Bangalore (n.d.) notes to prevent complications, a detailed patient history is crucial.  In patients with a weak or absent femoral pulse, iliofemoral bypass grafts, prior vascular complications, prior groin surgery with scarring, morbid obesity, or the inability to lie flat for extended periods are all contra-indications that may result in procedural complication.  In addition, Bangalore and Bhatt (2011) note the groin and leg area should be inspected for incidence of an active infection.  Regarding complications, Bangalor (n.d.) states the incidence of an arteriovenous fistula after femoral cannulation is less than 0.1% and the incidence of pseudoaneurysm is between 1-3% of patients undergoing this procedure. He indicates dissection of the femoral artery can occur which may cause acute limb ischemia in less than 1% of patients. He also notes retroperitoneal hemorrhage; a serious complication occurs in less than 2% of patients.

 

Both patients and physicians must be cognizant of the complications that can arise from femoral cannulation though overall incidence rates are small.  An analysis must be made to ensure there are no contraindications and the benefits of the procedure will outweigh the cost of complication and mortality for the patient.

 

References

Bangalore, S.  & Bhatt, D.L. (2011, August 2). Femoral arterial access and closure.  Circulation, 124, e147-e156.   https://doi.org/10.1161/CIRCULATIONAHA.111.032235

Bangalore, S. (n.d.) Femoral arterial access and its complications. Journal of Family Practice. Retrieved from https://www.mdedge.com/jfponline/dsm/9019/cardiology/femoral-arterial-access-and-complications

Caparas, J., Hu, J.P. &Hung, H.S. (2014) Does a novel method of PICC insertion improve safety? Nursing,44(5) 65-7.  https://doi.org/10.1097/01.NURSE.0000444725.83265.1d.

Fusco, D.S., Shaw, R.K, Tranquilli M., Kopf, G.S. & Elefteriades, J.A. (2004). Femoral cannulation is safe for type A dissection repair. Annals of Thoracic Surgery,74,1285–9.

Kouchoukos, N.T., Masetti, P, Rokkas, C.K. & Murphy, S.F. (2002). Hypothermic cardiopulmonary bypass and circulatory arrest for operations on the descending thoracic and thoracoabdominal aorta. Annals of Thoracic Surgery,74 (9), 1885-1887(Suppl).

Lakew F., Pasek, P., Zacher, M., Diegeler, A. & Urbanski, .P.P. (2005). Femoral versus aortic cannulation for surgery of chronic ascending aortic aneurysm. Annals of Thoracic Surgery, 80, 84-88.

Malviyal, A., Yadav, J.K., Negi, N. & Singh, C.G. ( 2013, February). Learning from mistakes:  Femoral vein cannulation-an unusual complication or blessing in disguise.  Indian Journal of Surgery, 75(1), 79-81. https://doi.org/10.1007/s12262-011-0323-5

 

Okita, Y., Takamoto, S., Ando, M., Morota, T., Matsukawa, R. & Kawashima, Y. (1998). Surgery for acquired heart disease. Journal of Thoracic Cardiovascular Surgery,115(8)129–138.

Saadat, S., Schulheis, M., Azzolini, A., Romero, J., Dombrovskiy, V.,…Lee, L. (2016). Perfusion, 31(2), 131-134. https://doi.org/10.1177/0267659115588631

Tsiouris, A.,  Elkinany, S., Ziganshin, B.A. &  Elefteriades, J.A. (2016, July). Open Seldinger femoral artery cannulation technique for thoracic aortic surgery.  The Annals of Thoracic Surgery, 101(6)2231-2235. http://dx.doi.org/10.1016/j.athoracsur.2015.12.032

Perfusion, Cardiopulmonary bypass, ECMO, Perfusion services

Perfusion Training

We had great success at the 2017 OR managers conference in Orlando Florida. We had the opportunity to meet Some great individuals and received a lot of positive feed back on our perfusion program, ECMO training, and Remote autotransfusion.

We are currently recruiting any great perfusionist as well as autotransfusionist. Unlike most companies we have an array of positions. We can offer locum contract perfusion, per diem, long-term travel assignments and short-term assignments. Also, we have several Perfusion accounts that need staff.

Please reach out to us for more information.

Autotransfusion’s New Limits

“Nearly 50% of all transfusions are considered inappropriate, this total contributes to the nearly 3 billion in cost added to the hospital“¹.Vivacity Perfusion is striving to reduce the number of patients needing transfusions. With the help of some of the most advance technology and outstanding staff members we can help cut down on this tremendous cost.

Not only are we able to reach out to more patients to decrease the possibility of transfusion reactions and life threating diseases. We are able to help cut the cost to hospitals by limiting hospital stays; “A 25% reduction in hospital stays for non-transfused vs. transfused patients”¹, while keeping the highest standards.

¹ The Joint Commission

Autotransfusion

Autotransfusion is a resource not utilized enough.  “Although an estimated 38 percent of the U.S. population is eligible to donate blood at any given time, less than 10 percent of that eligible population actually do each year”¹, forces us to widen our grasp of autotransfusion. Now with HIPAA compliant video assistance, we are able to help train any staff member to become a vital assistant in the conservation of blood. With our patented system, we are able to be anywhere in the United States within minutes. We follow AABB, IBBM, and AMSECT standards.

The Process:

With video assistance telepresence, we help set up the circuit.

• Help in setting up disposables safely with sterile technique.
• Determine if there is enough clean/safe blood loss to have a positive return.
• Help process the blood and wash it.
• Safely transfer the blood to be re-infused.
• Help breakdown the system and discard it safely.

Using our system allows for significant cost savings allowing for more procedures to be on “standby” for potential mass blood loss.

The training is fast, effective, and safe.

 

¹American Red Cross