[223548]
Anticoagulation management of the cardiac surgery patient. In 11/99, heparin assay dosing was eliminated from the perfusion anticoagulation protocol by the cardiac cqi committee. Heparin is currently dosed at 300 u/kg or 400 units/kg to achieve a target act of 480 seconds. In january and february of 2001, the hemachron 8000 instruments were removed from svc and returned to the mfr for evaluation of "early and prolonged detection" values. Within the last 4 mos, clinical difficulties with the hemachron 8000 have been addressed, internally and externally, with the mfr. Initially, the occurrence of "early clot detection" (an act <80 secs) was thought to be the result of a quality control issue with the mfg of the act tube itself. Perfusion inventory was replaced with "spider" act tubes by the mfr in hopes of eliminating the occurrence of "early detection". In may of 2001, the mfr removed and replaced both hemachron 8000 instruments. In june of 2001, the frequency of early detection decreased slightly. However, difficulties with wide range variance and dosing with the rxdx program arose. Add'l concerns: accuracy of act values, add'l cost from duplication of tests, quality control of product, unexplained pt outcomes, accessibility of sales rep and responsiveness of mfr. Hemochron 8000 maintenance history: model # ctor-a (h1005). Purchased aug 1997. 9/26/97 - installed. 6/2/98 - would not boot - returned for svc. 12/10/00 - instrument aborting during testing - sent to mfr for svc. 12/18/00 - no problem found by mfr - placed into svc. 2/23/01 - wells not working, test aborting, button freezing - sent to mfr for svc, reprogram flash cards - returned 3/20/01. 3/27/01- experiencing early clot detect- spoke to mfr - will send new tubes, possible tube problems. 5/9/01 - still experiencing early detects - mfr to send replacement hemochron 8000. 5/22/01 - replacement sent back - buttons freezing. 6/1/01 - 2nd replacement received. Second device model # ctor-b (h1006). Purchased aug 1997. 9/26/97 - installed. 3/31/98 - printer broken - repaired. 3/01/01 - results are low and jumpy - sent to mfr, returned 4/16/01 - no problem found. 3/16/01 - loaner screen froze - returned for loaner replacement - received 3/22/01. 5/09/01 - mfr to send new replacement - housing was cracked upon receipt - sent back for another replacement. 5/29/01 - 2nd replacement received.
Patient Sequence No: 1, Text Type: D, B5