JaSECT Safety Committee (July, 2018)

Safety Information

Notes on Using VAVD Devices
There was a case of an emergency stop of cardiopulmonary bypass due to mishandling during
extracorporeal circulation using Vacuum-Assisted Venous Drainage (VAVD). Please reconfirm
the safety measures.

【Case】
A venous reservoir with a positive pressure
relief valve was used, and normal open system
extracorporeal circulation was initiated.
Then, to increase the venous return flow, aclamp was applied to the vacuum-assist line tostart VAVD, but the blood volume in thereservoir continued to decrease. The
perfusionist determined that the position of thevenous cannula was inadequate and asked thesurgeon to check its distal position, but thesituation did not change. As the venous flow
continued to decrease, it was determined thatcardiopulmonary bypass cannot be continued,
and the bypass was stopped. The cause of theproblem was immediately determined, and the
cardiopulmonary bypass was resumed. The
surgery was completed without problems.

32

Correct clamp
position
Wrong clamp
position
Clamp position on the vacuum-assist linein the reported case

【Cause of the occurrence】① Negative pressure was not applied to the venous reservoir due to incorrect clamping ofthe vacuum-assist line.
② Failure to monitor the pressure in the venous reservoir led to the failure to confirm thatpressure in the venous reservoir was positive.

Countermeasures① The Joint Review Committee of Three Japanese Societies* for Vacuum-Assisted Venous
Drainage Extracorporeal Circulation recommends that the following four points should beobserved when implementing extracorporeal circulation with vacuum-assisted venous drainage:
1. Attach a moisture trap to the vacuum-assist line instead of a gas filter.
2. Use a new, sterile vacuum-assist line circuit every time.
3. Install a pressure monitor with a positive pressure alarm and a positive pressure

relief valve to the venous reservoir.
4. Use a dedicated vacuum regulator that can be fine-tuned when implementing
VAVD.

② Take measures such as placing a marking tape on the position of the atmosphere vent line of thevacuum-assist line where the clamp should be applied.
③ When using a venous reservoir that does not have a built-in positive pressure relief valve, attach apositive pressure relief valve manufactured exclusively for the venous reservoir by the manufacturer
to the designed location. In that case, understand the characteristics of the positive pressure reliefvalve before use.

④ Please ensure at each facility to be familiar with the basic operation methods (procedure)
for implementing VAVD and conduct trouble simulations.

VAVD
Vacuum line
connecting port

Positive Pressure ReliefValve【Reference material】

・The pressure at which positive pressure relief valve opens differs depending on the venousreservoirs even with built-in positive pressure relief valves.
［mmHg］

60A

BCD

1000

1500

2000

2500

50
403020100500

3000 ［mL］

Change in internal pressure of various device with respect to suction flow rate
(Release pressure for the positive pressure relief valve)(Survey result by JaSECT Safety Committee, 2017）* The Three Japanese Societies are formed by; The Japanese Association for Thoracic Surgery, The
Japanese Society for Cardiovascular Surgery, and the Japanese Society for Artificial Organs.