6th Terumo Advanced Perfusionists Seminar (TAPS) Chiang Mai, Thailand Title: “Perfusion Technology, Technique, and Safety Practices at the Philippine Heart Center” Alma C. Luces, RMT Chief Perfusionist

The Philippine Heart Center Easy Avenue, Diliman, Quezon City Inaugurated on February 14, 1975 Presently has 372 bed capacity

The Operating Room Complex

The Operating Room Complex Perfusion Set-Up Room & Point-of-Care The Perfusion Office

OPEN-HEART SURGERY STATISTICS

Open-Heart Surgery 2010 (Adult and Pediatric patients) Total No. of Open-Heart Surgery: 1,521

Open-Heart Surgery 2011 (Adult and Pediatric patients) Total No. of Open-Heart Surgery: 1,364

Introduction The Safety Practices and Conduct of cardiopulmonary bypass must always be a joint responsibility of the Open Heart Surgery Team, namely the surgeons, anesthesiologists, and perfusionists. Hence, there should always be a high level of communications between the members of the Team. In our Center, we require that during cardiopulmonary bypass the surgeon, anesthesiologist, and perfusionist must be present in the operating room theater at all times to ensure patient safety.

Cardiovascular Surgeons (32)

Cardiovascular Anesthesiologists (26)

Senior Members of the Perfusion Team

Perfusion Team

Perfusionist Profile Initial requirement for Training: Educational attainment: Bachelor of Science in Medical Technology Eligibility: - Medical Technology Board Examination (Board Rating of at least 80%) Two (2) weeks qualifying written and practical examinations in the actual Perfusion setting.

Perfusion Trainees Started Training: February 2012

PERFUSIONIST’S PROFILE NAME DATE STARTED 1 ACL MARCH 1986 2 RM JUNE 1999 3 JAb JULY 2002 4 ADC JANUARY 2004 5 WO OCTOBER 2003 6 GR JULY 2005 7 JB 8 JRP AUGUST 2006 9 RS OCTOBER 2009 10 MB MAY 2012 11 VL 12 EJ 13 JAd NOVEMBER 2012 14 SR

TRAINING ACTIVITIES 1. Orientation } 1 day a) Hospital Facilities b) Hospital Policies 2. Introduction to Perfusion (Theoretical) } 3 weeks I. Introduction to Perfusion A. Definition of Perfusion B. Job Description of a Perfusionist II. The Cardiovascular System A. Anatomy of the Heart B. Blood Circulation C. Pathology / Physiology III. Definitions A. OHS/Fundamentals and Physiological Management of CPB B. Extracorporeal Circulation C. Common Terms in Open-Heart Surgery D. Introduction to Perfusion Hardware

TRAINING ACTIVITIES 4. a) Hands-on Operation of Perfusion Laboratory } 1 week instruments/equipment b) Scrubbing / Sterile Set-up of Pump Tubings / Circuitry 5. Heart-Lung Machine (Part I) } 2 months a) Set-up of pump tubings including priming, de-bubbling. b) Preparation of accessory equipment necessary during Open Heart Surgery such as Heater/Cooler, Activated Coagulation Time machine, temperature probes and gas blender. c) Circulates / Assists Pump Perfusionist 6. Heart-Lung Machine (Part II) } 3 months Operates Heart-Lung Machine under direct supervision of a Senior Perfusionist. 7. Examination (Practical and Theoretical)

Pre-Bypass Checklist adapted from AMSECT

Sterile Set-up of Pump Tubings

Centrifugal Pump Set-up

Standard Pump Set-Up

Central Control Monitor (CCM) and CDI Systems 500 In-Line Blood Monitoring Parameter System

Standard monitoring parameters: ECG, Systemic Arterial Pressure, PA Pressure, CVP, Pulse Oximetry

SAFETY DEVICES

Oxygen Analyzer

Level and Bubble Sensors Hemoconcentrator

Leukocyte Filter Arterial Filter

Retroguard Arterial Safety Valve for Centrifugal Pump

Cardioplegia Delivery System

Hemochron Response ACT Machine & Hemochron Jr. Signature ACT Machine

IRMA Blood Gas Analyzer

Auto-Transfusion System

Intra-Aortic Balloon Pump Machines

EQUIPMENT MAINTENANCE All our equipments have preventive maintenance schedules which is every six (6) months.

ACCREDITATION CANADA

The Perfusion Team

Boracay Island, Aklan It’s more F U N in the Philippines