1-
« In 1983 and updated in 1995 a retrospective study is carried out in the
USA over a 500 000 CPB cases. It is reported that 20% of the incidents/accidents
during CPB are linked to the products(pumps, oxygenators etc
) and 75% to human
errors or mistakes
» by Marc KURUSZ 1983/95.
This
retrospective study is far from being outdated. Its spirit and statistical
values are still valid to day. However it triggers numerous questions as it
relates to training and education of the clinical perfusionist. Here are a just few
-
What can we do collectively to prevent those incidents/accidents to
happen?
-
How can we enforce and test at regular intervals the knowledge and skill levels of the Perfusionist to
perform her or his function?
-
Have the prerequisite skills and education levels be thorougly defined for
a potential candidate as Perfusionist? Does a complete job description exist?
-
When training
is dispensed to the Perfusionist, should it be also to the other members of the
clinical perfusion team?
-
Are the links between the perfusion medical industry and all the actors of
education well established and strong enough?
-
Have we come to realize that too much of the perfusion medical industry
money is spent on festive activities and too little on education.
-
Is there really a risk that the medical education sector be taken as
hostage by financial or lucrative interests?
-
Can the
perfusion medical industry become a true partnership or a consulting force for
everything linked to the education of the clinical perfusionist?
2- How can the medical industry help? (This list is far from being exhaustive )
-
Provide
excellent, complete and readable instruction manuals. (They should be considered as the product and application training
manuals).
-
Perform
mandatory dry and wet product in-services or runs before moving to the clinical
use of a given product or system.
-
Perform
mandatory change over procedure of the product or system if applicable.
-
Perform
mandatory risk analysis. What if?
examples:
Venous assist drainage with P.
Use of certain drugs
On this
point of risk analysis, in light of the fact that more and more complexity
is added to CPB with new plastic, new chemical, new drugs, new mechanical and
electronic materials or devices we must motivate ourselves to carry out
systematically a risk analysis on potential hazards incompatibilities, failure
modes or any potential malfunctions that can lead to disasters...that may never
happen but could happen.
-
Promote or
emulate group training as opposed to individual training ( learn from others).
-
Spend money
wisely by investing on more education programs for the clinical perfusion team.
3-
How can the clinical perfusion team or the Perfusionist help?
(This list is far from being exhaustive
)
-
Assure that
the instruction manuals are fully read and understood.
-
Assure all the
above #2(dry/wet run), #3(change over), #4(risk analysis)and
#5(group training) points are followed.
-
Create and
favor an ad hoc atmosphere and cooperative forum to solve a new or nagging
problem.
Examples from the past:
1-
Leaking effects of propofol on polycarbonate molded parts
2-
Occurrence of high excursion transient pressure
across an oxygenator
3-
Treatment or management of the highly activated cardiotomy aspirated blood
4-
Low prime oxy design for adults?!.
Those
desires , wishes wants or expectations may pave the way for our future.
In this case when the word future is used it
means our collective future in this important field of education.
-
CPB does
continue to be the preferred H&L
support to open heart surgery
-
Develop self
motivated individual capable of long term personal
investment in training or education. (Self learning is an attitude that does
require owns time investment).
-
Develop a well
Design bypass simulator
-
Set up once a
year at each cardiac center level a meeting with the entire clinical perfusion
team for an update in cardiac perfusion.
( What have we learnt this year, what are still the holes or voids etc
)
-
Assess the
area of opportunity and growth within
the hospital for the Perfusionist and
her or his expertise to be exercised in extra
corporeal circulation:
° General AutoTransfusion
° Autologous platelet gel for plastic reconstructive
surgery.
° New treatment or management of
the highly activated cardiotomy
aspirated blood
both for coronary and valvular cardiac surgery.
Etc
-
Re-eavalute
the relationship with the perfusion medical industry with clear set objectives:
° Education involvement and
financing.
° Improvement of the genuine attendance of perfusionist at medical meetings.
° Continue to improve the accuracy of patient data collection during CPB in order to improve the quality of care. Etc
