Setup & Use - Integrated Set OrthoPAT® System Setup & Use - Integrated Set Copyright © 2009, 2011 Haemonetics Corporation. All Rights Reserved. Haemonetics, OrthoPAT, Cell Saver, cardioPAT, SmartSuction Harmony, and TEG are trademarks or registered trademarks of Haemonetics Corporation in the USA, other countries, or both. TRN-PPT-100031-IE(AA) Copyright © 2009 Haemonetics Corporation. All Rights Reserved TRN-PPT-100031-US-(AA) Haemonetics, cardioPAT, Cell Saver, Infonalé, OrthoPAT, SmartSuction Harmony, and TEG are trademarks or registered trademarks of Haemonetics Corporation in the USA, other countries, or both.

Welcome to Haemonetics Training for the OrthoPAT® System and Disposables

Prerequisites Before taking this lesson, the following module(s) should have been completed: Cell Salvage Introduction: Transfusion OrthoPAT® System and Integrated Disposable

Topics IntraOp Setup Transition from IntraOp Mode to PostOp Mode Transporting OrthoPAT® System OrthoPAT® System and Patient in PostOp Mode PostOp Only Setup Transfusing OrthoPAT® Product

OrthoPAT System & Integrated Disposable Objectives Be able to: Name the steps required to setup the OrthoPAT® System for IntraOp use Name the steps required to transition the OrthoPAT® System from Intra-Op mode to PostOp mode Name the steps required to setup the OrthoPAT® System for PostOp use only Name the steps required to transfuse an OrthoPAT® System product

Device and IV Pole Setup

Mounting OrthoPAT® System on IV Pole It is recommended to use a sturdy IV pole that has at least 5 wheels for extra stability Place OrthoPAT® System on the edge of a stable surface with the IV Pole Clamp facing out

Mounting OrthoPAT® System on IV Pole Completely loosen right-hand wing bolt Partially loosen left-hand wing bolt until the right-hand wing bolt and right-hand side of IV Pole clamp can hang down

Mounting OrthoPAT® System on IV Pole With the OrthoPAT® System still on the stable surface, move the IV Pole into the space on the back of the device Raise the right-hand side of the IV Pole Clamp and start the right-hand wing bolt into its threads Do Not tighten the right-hand side of the IV Pole Clamp, yet!

Mounting OrthoPAT® System on IV Pole Place the left-hand side into the proper mounting grove and tighten left-hand wing bolt The right-hand wing bolt may now be tightened Move IV pole and device away from the surface, supporting the device until you are sure it will not slide down the pole

Mounting OrthoPAT® System on IV Pole Finally, place your hand under the OrthoPAT® System and loosen the right-hand wing bolt enough to let it slide down the IV pole Position the OrthoPAT® System so that the top of the cover is no more than 3 feet (36”) above the ground. Re-tighten the right-hand wing bolt The device is ready to use

What do you think? Why is it important to keep the device no higher than 3 feet off of the ground?

What do you think? Why is it important to keep the device no higher than 3 feet off of the ground? Height from the floor affects PostOp suction. Increased height will reduce suction to the wound

IntraOp Setup

IntraOp Setup - Loading Integrated Set Load Integrated Disposable Set as follows

IntraOp Setup - Loading Integrated Set Seat Reservoir Remove Retainer Ring and seat Dynamic Disk

IntraOp Setup - Loading Integrated Set Load Retainer Ring Lower header arm and verify it is securely latched

Why is it important to verify that the Header arm is securely latched? What do you think? Why is it important to verify that the Header arm is securely latched?

What do you think? Why is it important to verify that the Header arm is securely latched? An unlatched Header Arms is the most common cause of noisy disk’s and rotating seal failure leading to blood spills.

IntraOp Setup - Loading Integrated Set Hang RBC and Waste Bag with labels facing out Close Cover and ensure there are no pinched tubes

IntraOp Setup - Loading Integrated Set Close all 3 reservoir port clamps* 2 IntraOp Ports 1 PostOp Port

IntraOp Setup - IntraOp Use Plug in and turn power on Device will now initialize Connect to regulated wall vacuum or SmartSuction Harmony® (AABB guidelines suggest –150 mmHg) Spike 1 liter bag 0.9% Saline for injection

What do you think? If wall suction is being used, what is the proper way to set the Regulator suction level?

What do you think? If wall suction is being used, what is the proper way to set the Regulator suction level? Close off the tubing between the regulator and OrthoPAT, then set the regulator lever

IntraOp Setup - IntraOp Use Press RUN key to prime Dynamic Disk™ with saline solution (This will take approximately 3 minutes) Operator may attend to other work until surgeon is ready to hand off IntraOp Suction tubing.

IntraOp Setup - IntraOp Use When Surgeon is ready to begin: Receive Yellow capped end of the A&A line and drip chamber from the field Attach Yellow capped end of the A&A line to intra-op reservoir port, and open clamp

IntraOp Setup - IntraOp Use Close the roller clamp, spike the anticoagulant prime the drip chamber with ACD, CPD or 30,000 IU heparin/1 L bag 0.9% saline for injection Open the roller clamp to prime reservoir (100–300 mL’s) Set drip rate to approximately 1 drip per second

What do you think? If vacuum were not turned on when the roller clamp was opened to prime the reservoir, what would happen?

What do you think? If vacuum were not turned on when the roller clamp was opened to prime the reservoir, what would happen? Anticoagulant would likely run out of the suction tip instead of being drawn into the reservoir.

IntraOp Setup - IntraOp Use Place patient label on reservoir (optional) Place patient label on RBC bag and note start time Shed blood can now be aspirated

Transition From IntraOP Mode to PostOp Mode

PostOp Setup - PostOp Use When surgery is complete, close anticoagulant roller clamp Press the Suction key to turn off suction Close clamp to reservoir port that is being used Remove IntraOp Suction set and discard according to hospital biohazard policy

PostOp Setup - PostOp Use Receive Yellow-capped end of post-op suction set tubing and attach to post-op reservoir port (Don’t Unclamp Port Yet!) Press Run key to turn suction back on When the wound is fully closed, unclamp reservoir port leading to the post-op suction tubing

PostOp Setup - PostOp Use In PostOp mode an internal vacuum system maintains -75 mmHg suction to the wound drain. If vacuum cannot be maintained at acceptable levels, Suction will be turned off and an alarm will be sounded. The Suction key light will be turned off until the vacuum issue is resolved and the Suction key is pressed

PostOp Setup - PostOp Use In order to facilitate drainage there is an intermittent vacuum release. Every 10 minutes the OrthoPAT® System automatically releases vacuum for 30 seconds Suction key light will remain on during this normal process

Transporting OrthoPAT® System and Patient In PostOp Mode

Transportation in PostOp Mode Beginning Transport Ensure a person is designated to assist with movement of the OrthoPAT® System. Just before beginning transport, unplug OrthoPAT® System DO NOT TURN OrthoPAT® SYSTEM OFF Internal battery power will maintain suction and volume accounting for at least ½ hour for transport. As a precaution it is recommended that the screen volumes be written down prior to transport

Transportation in PostOp Mode Arriving at PACU/Ward Plug in device! Assure clamps at the reservoir are open to the wound drain line and the other ports are clamped Assure the 4 appropriate keypad lights are lit: POST-OP, RUN, SUCTION, and PROCESS. If not, press RUN key

What do you think? If you were a nurse and wanted to know if the device was functioning properly from a distance what could you look for?

What do you think? If you were a nurse and wanted to know if the device was functioning properly from a distance what could you look for? Look for the 4 display lights! If 4 are not on you know something needs attention.

Transportation in PostOp Mode Arriving at PACU/Ward Finally… Note RBC bag reinfusion time – reinfuse RBC bag per hospital policies/procedures Check saline bag and replace if necessary

Transfusing OrthoPAT Product (IntraOp or PostOp)

Transfusion of OrthoPAT Product Press PROCESS key to stop processing (Leave suction on) Close slide clamp on RBC line Disconnect Luer connection/ bag from set Cap bag using sterile (Red) cap tethered to bag

Transfusion of OrthoPAT Product Connect replacement bag to processing set Place patient label on new bag and note start time Press RUN key to resume processing Hand off removed RBC bag for reinfusion to patient Reinfuse according to hospital policy

Transfusion of OrthoPAT Product WARNING: Bag contains air – DO NOT pressure reinfuse. Transfuse packed RBC’s using a filter designed to retain particles potentially harmful to the donor-patient. NOTE: This is a physician/hospital decision Expiration dates and times for OrthoPAT product should be set in accordance with AABB Standards.

How is a blood administration set attached to the RBC bag? What do you think? How is a blood administration set attached to the RBC bag?

What do you think? How is a blood administration set attached to the RBC bag? There are two reinfusion ports on the top of the RBC bag. Remove one of them and spike in the blood administration set.

Questions?

OrthoPAT® System Setup & use – Integrated Set Quiz OrthoPAT® System Setup & use – Integrated Set

Quiz Question The top of the cover of the OrthoPAT unit should be Less than 3 feet above the patient bed Less than 3 feet from the patient bed Less than 3 feet above the ground Less than 3 feet from the wall vacuum Answer: C

Quiz Question While loading the OrthoPAT, The next step will be to close the OrthoPAT cover. Which steps have been completed? Select all that apply Header arm raised and latched Header arm lowered and latched Retainer Ring loaded Retainer Ring removed RBC and waste bag hung labels out Set vacuum regulator after opening tubing clamp between the regulator and the OrthoPAT Answer: B, C, E

Quiz Question An unlatched Header Arm is the most common cause of a noisy disk and rotating seal failure leading to blood spills. True False Answer: A - True

Quiz Question When using wall suction, the proper way to set the Regulator suction level is Close off the tubing between the regulator and OrthoPAT, then set the regulator lever Open the tubing between the regulator and OrthoPAT, then set the regulator lever Do not set the wall vacuum level. OrthoPAT automatically controls the vacuum level Wall vacuum connections should not be used Answer: A

Quiz Question On the Display Unit keyboard, which key is pressed to prime the Dynamic Disk™ with saline solution? INTRAOP POSTOP RUN RETURN PROCESS Answer: C

Quiz Question When the surgeon is ready to begin, what is the order of steps listed below? Prime the drip chamber with ACD, CPD or 30,000 IU heparin/1 L bag 0.9% saline for injection Close the roller clamp, spike the anticoagulant Attach Yellow capped end of A&A line to intra-op reservoir port, and open clamp Open the roller clamp to prime reservoir (100–300 mL) Set drip rate to approximately 1 drip per second Answer: C, B, A, D, E

Quiz Question On the Display Unit keyboard, which key is pressed to prime the Dynamic Disk™ with saline solution? INTRAOP POSTOP RUN RETURN PROCESS Answer: C

Quiz Question When the surgeon is ready to begin, what is the order of steps listed below? Prime the drip chamber with ACD, CPD or 30,000 IU heparin/1 L bag 0.9% saline for injection Close the roller clamp, spike the anticoagulant Attach Yellow capped end of A&A line to intra-op reservoir port, and open clamp Open the roller clamp to prime reservoir (100–300 mL) Set drip rate to approximately 1 drip per second Answer: C, B, A, D, E

Quiz Question When surgery is complete, what is the order of steps listed below? Close anticoagulant roller clamp Press the Suction key to turn off suction Close clamp to reservoir port that is being used Remove IntraOp Suction set and discard according to hospital biohazard policy Answer: A, B, C, D

Quiz Question Which is true about OrthoPAT PostOp use? An internal vacuum system maintains 75 mm Hg to the wound Alarm sounds if vacuum is not maintained Every 10 minutes the OrthoPAT® System automatically releases vacuum for 30 seconds Suction key light remains on during automatic vacuum release All of the above are true Answer: E

Quiz Question To use the OrthoPAT during transport, turn the system off and unplug from the wall. True False Answer: B - False

Quiz Question In the PACU, a convenient way to check if the OrthoPAT is functioning correctly is to Listen for a beeping sound Look to see if it is plugged in Look at the keypad to see if the POST-OP, RUN, SUCTION, and PROCESS keys are lit Look at the vacuum level Answer: C

Quiz Question To change the reinfusion bag, what would be the order of the steps listed below? Connect replacement bag to processing set Press PROCESS key to stop processing (Leave suction on) Press RUN key to resume processing Cap bag using sterile (Red) cap tethered to bag Disconnect Luer connection/ bag from set Close slide clamp on RBC line Answer: B, F, E, D, A, C

Quiz Question Which is not true about using the reinfusion bag? It is recommended that the bag is full before reinfusing Using pressure on the bag is not recommended as the bag may contain air Using filter designed to retain particles is recommended when transfusing product back to donor-patient Transfusion procedures are physician/hospital decisions Expiration dates and times for OrthoPAT product should be set in accordance with AABB Standards Answer: A