VAVD Controller Guide July 2013

VAVD CONTROLLER

CONTENT  How to achieve venous drainage  Reasons for reduced venous drainage  User requirements  MAQUET’s VAVD CONTROLLER  Intended use  Benefits compared to other drainage methods  Function and operation  Accessories  Technical data  Summary

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VAVD CONTROLLER

HOW TO ACHIEVE VENOUS DRAINAGE  Gravity (height) between patient and reservoir  Centrifugal pump in the venous line  Roller pump in the venous line (potentially dangerous)  Vacuum assisted venous drainage (VAVD)

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VAVD CONTROLLER

GRAVITY DRAINAGE  Most used during CPB is gravity drainage: A venous reservoir is positioned about 70 cm below the level of the patients, so that the venous blood can flow into the reservoir.  Problem: In some cases the return flow from the patient is not efficient enough.

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VAVD CONTROLLER

REASONS FOR REDUCED VENOUS DRAINAGE  Gravity drainage height is not adequate  Venous catheter is to small  Venous catheter is blocked  Venous line is kinked or a too small diameter

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VAVD CONTROLLER

VACUUM ASSISTED VENOUS DRAINAGE What are the needs of the user regarding venous drainage?  Use of smaller venous return catheters (esp. for minimally invasive surgery with small incision, particularly in pediatric cardiac surgery)  Reduced priming volume (smaller tubing size, shorter venous line due to higher position of the reservoir)  Continuous and optimum venous drainage during CPB

MCV-PP-91000027-EN-01-e · 07/13

VAVD CONTROLLER

MAQUET’s VAVD CONTROLLER Intended Use: The VAVD CONTROLLER is intended to supply and regulate a controllable vacuum of between 0 and -100 mmHg to a sealed venous reservoir during ECC procedures. Contraindication: When the VAVD CONTROLLER is used as recommended, and for the specified intended use, there are no currently known contraindications.

MCV-PP-91000027-EN-01-e · 07/13

VAVD CONTROLLER

BENEFITS OF MAQUET’s VAVD CONTROLLER Compared to conventional gravity drainage:  The perfusionist can influence the quality and efficiency of venous drainage (independent of the reservoir height)  VAVD gives the perfusionist better control of venous return Compared to a permanent/constant vacuum source:  The VAVD CONTROLLER maintains a constant vacuum in the reservoir independent of  Volume level  Sucker inflow  Output conditions

 Safe operation: pressure relief valves protect the venous reservoir from a pressure  Above 3 mmHg  Below –100 mmHg

MCV-PP-91000027-EN-01-e · 07/13

VAVD CONTROLLER

CENTRIFUGAL AND ROLLER PUMP ISSUES A centrifugal pump in the venous line compared to VAVD is:  More difficult to set up and regulate  Possible de-priming of the pump, if air enters the venous line (time-consuming to re-establish flow patient hazard)  Very expensive compared to the VAVD solution A roller pump in the venous line compared to VAVD is:  More difficult to set up and regulate (an additional pump is needed)  Difficult to control the negative pressure – can rise quickly to dangerous levels  Compared to the centrifugal pump system it is inexpensive

MCV-PP-91000027-EN-01-e · 07/13

VAVD CONTROLLER

BENEFITS OF THE MAQUET VAVD CONTROLLER Examples of the effects of vacuum:  20 cm reservoir drainage height + 40 mmHg vacuum to the reservoir is equivalent to a 72 cm drainage height.  A single 24Fr catheter + 70cm drainage height gives a flow of approx. 2.4 lpm.  Adding 40 mmHg vacuum to the reservoir increases flow to approx. 3.8 lpm a 58% increase.  Two 21Fr catheters + 70 cm drainage height gives a flow of approx. 3.2 lpm.  Adding 40 mmHg vacuum to the reservoir increases flow to approx. 5 lpm a 56% increase.

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VAVD CONTROLLER

MAQUET’s VAVD CONTROLLER Simple and safe drainage control

Pressure gauge ON/OFF switch

Vacuum control knob MCV-PP-91000027-EN-01-e · 07/13

VAVD CONTROLLER

MAQUET’s VAVD CONTROLLER Rear side

Connection (1/4“ rotatable) to the venous reservoir

Holder locking knob

Connection (1/4" rotatable) to the vacuum source

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VAVD CONTROLLER

ACCESSORIES FOR THE VAVD CONTROLLER Holder for pole mouting

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VAVD CONTROLLER

ACCESSORIES FOR THE VAVD CONTROLLER Mounting the VAVD CONTROLLER on the pole holder

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VAVD CONTROLLER

ACCESSORIES FOR THE VAVD CONTROLLER Sterile tubing set  Connects the VAVD CONTROLLER easily and safely to the reservoir  The tubing set is equipped with a moisture trap to prevent suction blood entering the controller in cases of too high vacuum.  The moisture trap has a self adhesive pad, so that it can be attached easily to the reservoir surface – no special holder is required.  A sterile tubing set must be used for each clinical procedure.

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VAVD CONTROLLER

FUNCTION OF THE VAVD CONTROLLER

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VAVD CONTROLLER

VACUUM ASSISTED VENOUS DRAINAGE

MCV-PP-91000027-EN-01-e · 07/13

VAVD CONTROLLER

TECHNICAL DATA

Technical Data

VAVD CONTROLLER

Dimension (W x H x D)

183 x 100 x 200 mm

Weight

3.3 kg

Vacuum source requirement

continuous vacuum, -200 to -760 mmHg, min. flow 11 l/min.

Vacuum regulation limits

0 to -100 ± 10 mmHg

Vacuum regulation tolerance

± 10 mmHg

Negative pressure relief valve

opens at -100 ± 10 mmHg

Positive pressure relief valve

opens at 3 ± 2 mmHg

Pressure gauge

mechanical

MCV-PP-91000027-EN-01-e · 07/13

VAVD CONTROLLER

USE OF THE VAVD CONTROLLER Special precautionary measures  Only use an airtight, sealed venous reservoir with a positive pressure relief valve.  Two-stage catheters with a large lumen diameter may lead to increased suction in venous drainage. Take special care when using such catheters.  MAQUET recommends monitoring the central venous pressure constantly.  Ensure that the inlet and outlet tubes are always open and not kinked.  If moisture, liquid or blood has penetrated the VAVD CONTROLLER, stop the CONTROLLER immediately and have it tested and serviced.  A functioning hollow fiber oxygenator and arterial filter should prevent gaseous macroemboli entering the arterial line and reaching the patient.  The best way to safely use VAVD is ultrasound real-time monitoring of gaseous microemboli in arterial and venous lines, so that gas emboli forming (e.g. due to high temperature gradients and excessive cardiotomy suction) can be detected and accidents be prevented.

MCV-PP-91000027-EN-01-e · 07/13

VAVD CONTROLLER

VACUUM ASSISTED VENOUS DRAINAGE Clinical evaluation of VAVD (Shigang Wang, Akif Ündar, 2008):  The benefits of VAVD include augmented venous drainage, the ability to use smaller venous cannulae, and decreased priming volumes.  According to an animal experiment VAVD (−40 to−60 mmHg) does not increase thrombocyte and white blood cell trauma in comparison with standard gravity drainage after 6 hours of CPB. (Mueller XM, Tevarearal, HT, Horisberger, J., et al. 2001)  Carrier et al. (2002) reported that VAVD did not increase the neurologic risk in adult valvular replacement surgery. They emphasized that VAVD was a useful adjuvant to the modern CPB system when used carefully and applied with the proper equipment and techniques.  A study of pediatric patients with VAVD (−10 to −40 mmHg) did not show any neurologic complications, even without an arterial line filter in circuit (Nakanishi et at., 2001).

MCV-PP-91000027-EN-01-e · 07/13