[HSF] AV fistulas- CPB flows

[prasannasimha]

If they are Brescio Cimino fistulae  the shunt flow is not 
"hemodynamically really significant". The problem can be significant if 
it is a shunt to the brachial artery.
You could place a femoral venous cannula but remember that the venous 
cannula if placed at the level of the renals or hepatic veins can give a 
falsely high venous sat too.
Monitoring Lactate would probably be a better option. The better option 
as far as monitoring venous oximetry is to perfuse at MVO2 max by 
measuring the O2 content of the arterial and venous side and  
calculating the O2 consumption and determining (titrating) increasing 
flows till MVO2 max is reached. This can easily bedone and is a standard 
exercise I give for my final year perfusion students. it tkes 5 minutes 
and a couple of ABG's (and is still

Prasanna
sekhar le wrote:
>
> We occasionally have patients with upper limb  AV fistulas for CRF 
> coming for surgery. Sometimes the Fistulas appear to be aneurysmal 
> and   having high flows.
> We have been managing by empirically increasing CPB flows by 20%.
> Should we have a venous catheter in the femoral vein to be able to 
> check venous saturation in the lower segment of the body   to make 
> sure that adequate flows are delivered to lower segment of the body?
>
> Dr Sekhar
>
> _________________________________________________________________
> FREE pop-up blocking with the new MSN Toolbar - get it now! 
> http://toolbar.msn.click-url.com/go/onm00200415ave/direct/01/
>
> _______________________________________________
> OpenHeart-L mailing list
>
> Send postings to:
> OpenHeart-L at lists.hsforum.com
>
> To UNSUBSCRIBE, to CHANGE email address, or to view archives:
> http://mmp.cjp.com/mailman/listinfo/openheart-l
>
> All messages transmitted by the OpenHeart-L are subject to the 
> policies and disclaimers posted at:
> http://www.hsforum.com/listdisclaim
> -----------------------------------------
>
>