[HSF] Peroxide test

Thu Sep 3 12:02:03 EDT 2009

Dear Prasanna 
- How would you get H2O2 sterilized ? 
- What concentration of Phenylepherine / anti-fibrinolytic do you use for
irrigation ? 
- which anti-fibrinolytic do you use ? 

NFA

-----Original Message-----
From: openheart-l-bounces at lists.hsforum.com
[mailto:openheart-l-bounces at lists.hsforum.com] On Behalf Of Prasanna Simha M
Sent: Thursday, September 03, 2009 10:51 AM
To: OpenHeart-L
Subject: [HSF] Peroxide test

Someone asked me about the peroxide test  and I am forwarding an old
email conversation in HSF.
Prasanna

---------- Forwarded message ----------
From: Prasanna Simha M <prasannasimha at gmail.com>
Date: Wed, Sep 3, 2008 at 7:15 AM
Subject: Re: [HSF] No bleeding?
To: OpenHeart-L at lists.hsforum.com

Nothing complesx really. Taught to me during my student days and used
to this day. Basically take Peroxide and film it serially over all the
surfaces that you have cut. (Preferably isolate the area to be
ssearched with 3 gauze 4x4s.Any Bleeding points that stand up are
tackled by whatever means. Specific points get highlighted against the
white back ground whereas a general ooze will not highlight it.Check
the cardiotomy sites. Check all raw areas. Check the sternal wire
holes and periosteal edges before closing. This allows you to get a
surgically dry field quickly especially in the face of coagulopathy.
You will be surprised at the number of pericardial small collaterals
which are actually spurting in a case like an adult Tetralogy or small
bleeders in a redo. Little drops of water byut these can make an ocean
and tackling these causes a significant reduction in chest tube
output.For those who arestill wet after this I gamble and close with a
caveat to quickly reexplore or directly place the Phenylephrine
antifibrinolytic irrigant based on gut feeling.
Prasanna

Prasanna when you say "film it serially", how much peroxide are you
talking about per case? Do you pour it on or simply apply it lightly?
Put some on you finger and wipe or film it over. This allows a film of
white foam to form and the red spots are the significant bleeders that
need to be tackled (usually buzzed or whatever).
Today did an adult TOF who had tremendous bronchopulmonary collaterals
(Not MAPCA's) and myriad of collaterals over the pleura pericardium
etc. Used the H202 foam technique and was worried because of
coagulopathy (oozing despite no anatomical bleeders and placed the
phenylephrine catheter and started to irrigate. Ptatient has bled just
30 ml in the first hour so stopped the irrigation too.
The H2O2 allows us to systemically highlight bleeders agains a white
foam background and so we do not miss significant bleeders.
Prasanna

On Wed, Sep 3, 2008 at 5:46 AM, Ani Anyanwu <anianyanwu at hotmail.com> wrote:
>
> Prasanna,
>
> Please describe your peroxide test to check for bleeding.
>
> Thanks
>
> Ani
>
>
>
>
> > Date: Wed, 27 Aug 2008 18:42:41 +0530> From: prasannasimha at gmail.com>
To: OpenHeart-L at lists.hsforum.com> Subject: Re: [HSF] No bleeding?> CC: > >
Went throught the IAS (I wrote IVC) by mistake) so one less external suture>
line. Peroxide checked all bleeding and dissected areas and meticulously>
burnt all "bleeders that were seen with the peroxide test.> Prasanna> > On
Wed, Aug 27, 2008 at 5:53 PM, Prasanna Simha M>
<prasannasimha at gmail.com>wrote:> > > Don't know but that is what it is and
it is a consistent finding in these> > patients with the suprahepatic
perfusion catheter though I am not sure as to> > why they bleed so less. But
they do !! As I said I was mentally expecting> > higher blood losses but she
did not. Another thing is that I do redos with> > minimal dissection and so
what you don't cut doesn't bleed. I just go> > through intact pericardium,
used vacuum assist and did not tape SVC or IVC,> > went through the IVC and
dissected just enough aorta to recannulate (there> > was some problem with
the femoral artery cannula) and cross clamp and> > plege.Rapid entry into
both pleura and no unnecessary dissection and> > continuous cold K free
retrograde after initial arrest to keep myocardium> > cold and avoid
rewarming.I also think avoiding transfusions and blood> > products helps in
preventing ongoing postop hepatorenal dysfunction.> > Incidentally bagged
out 3 bottles of blood and retransfused them after the> > first 3 hours post
CPB.> > I also gave Tranexamic acid for what its worth> > Patient is in the
ward .> > Prasanna> >> >> >> > On Wed, Aug 27, 2008 at 5:29 PM, Ajit Damle
<damle at cableone.net> wrote:> >> >> Re-do MVR+TV repair, hepatic dysfunction,
prolonged PT and total blood> >> loss> >> of only 180 mls?> >>> >>
Incredible. And I have in this business for 28 years. Am I missing> >>
something> >> here? Super hper coagulable state?> >>> >> Ajit Damle> >>> >>>
>>> >> -----Original Message-----> >> From:
openheart-l-bounces at lists.hsforum.com> >>
[mailto:openheart-l-bounces at lists.hsforum.com] On Behalf Of Prasanna> >>
Simha M> >> Sent: Tuesday, August 26, 2008 10:19 AM> >> To:
OpenHeart-L at lists.hsforum.com; Discussion of Critical Care Medicine> >>
Subject: [HSF] Image of the week - wht CPB can do to hepatic flow> >>> >>
Lady who had an MV repair at St Elswhere 9 years back. Came to us with> >>
severe MR, Severe TR , hepatorenal dysfunction. Childs A. Gross failure.> >>
Did nutritional supplementation for a week. Did her Redo MVR and TV> >>
plasty.> >> Placed a suprahepatic perfusion catheter with NTG. Doppler
studies with> >> NTG> >> on and off shows clear loss of normal flow with NTG
stopped for just 5> >> minutes even 12 hours after surgery.> >> Patient has
no liver enzyme/renal marker bump. Done bloodlessly and wuith> >> total
blood loss of 180 ml. (Was expecting bleeding in view of prolonged> >> PT>
>> despite preop Vitk etc. Incidentally had some blood cross match problems>
>> so> >> only 3 units cross matched despite testing over 40 bottles.> >>
--> >> Prasanna Simha M> >>> >>
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Simha M> >> > > > -- > Prasanna Simha M>
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Prasanna Simha M

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