Blood Pumps Pressure/Flow/Resistance Brian Schwartz, CCP Perfusion I September 16, 2003
Dec 16, 2015
Blood PumpsPressure/Flow/Resistance
Brian Schwartz, CCP
Perfusion I
September 16, 2003
Blood Pumps
Purpose of Blood Pumps
Ideal Blood Pump
Types of Blood Pumps
Most Commonly Used Pumps
Types of Blood Flow
Other Blood Pumps Used
Development of Blood Pumps
To replace the beating heart during heart surgery
They propel blood and other physiologic fluids throughout the extracorporeal circuit; which includes the patient’s natural circulation as well as the artificial one
The Ideal Blood Pump
Move volumes of blood up to 5.0 L/Min Must be able to pump blood at low
velocities of flow All parts in contact with blood should
have smooth surface Must be possible to dismantle, clean and
sterilize the pump with ease, and the blood handling components must be disposable
The Ideal Blood Pump(continued)
Calibration should be easy, reliable, and reproducible
Pump should be automatically controlled; however, option for manual operation in case of power failure
Must have adjustable stroke volume and pulse rate
FYI
The average human heart can pump up to 30 liters of blood per minute under extreme conditions.
In the operating room setting this is not necessary due to may reasons:– patient is asleep– patient is given muscle relaxants– patient metabolic rate is greatly reduced– patient is cooled during CPB
Types of Blood Pumps
Kinetic Pumps–Centrifugal pumps
Positive Displacement Pumps:–Rotary Pumps–Reciprocating Pumps
Centrifugal Pumps
The pumping action is performed by the addition of kinetic energy to the fluid through the forced rotation of an impeller
Centrifugal Pumps
Designed with impellers arranged with vanes or cones
Centrifugal pumps are magnetically driven and produce a pressure differential as they rotate
It is the pressure differential between the inlet and outlet that causes blood to be propelled
Positive Displacement Pumps
This type of pump moves blood forward by displacing the liquid progressively, from the suction, to the discharge opening of the unit
Positive Displacement Pumps (continued)
Rotary Pumps–Roller Pumps–Screw Pumps
Reciprocating Pumps–Pistons–Bar Compression–Diaphragm
Rotary Pumps
Rotary Pumps–use rollers along flexible tubing to provide
the pumping stroke and give direction to the flow
Archimedean Screw Pumps–a solid helical rotor revolving within a stator
with different pitches so the blood is drawn along the threads
Rotary Pumps (continued)
Multiple Fingers–the direction of flow is produced by a series
of keys that press in sequence against the tubing
Reciprocating Pumps
Pistons–this pump uses motor driven syringes that are
equipped with suitable valves, delivering pulsatile flow
–limited to low output capacity Bar Compression
–blood moves from the alternate compression and expansion of the tube or bulb between a moving bar and a solid back-plate
Reciprocating Pumps (continued)
Diaphragm Pumps–with a flat diaphragm or finger shaped
membrane made of rubber, plastic, or metal, blood is propelled forward
Ventricle Pumps–a compressible chamber mounted in a
casing and are activated by displacement of liquid or gas in the casing
Two Most Common Pumps Today
Roller Pump–Advantages
Occlusive, therefore if power goes out the arterial line won’t act as a venous line
Out put is accurate because it is not dependent of the circuits resistance (including the patients resistance)
–Disadvantages Can cause large amounts of damage to blood
(hemolysis) if over-occluded
Two Most Common Pumps Today (continued)
Centrifugal Pump–Advantages
Reduced hemolysis No cavitation No dangerous inflow/outflow pressures Air gets trapped in pump No need to calibrate
Two Most Common Pumps Today (continued)
Centrifugal Pump–Disadvantages
Causes over-heating Over heating promotes clotting Difficult to de-air If power goes out, arterial line acts like a
venous line
Roller Pump
Two Types of Perfusion
Pulsatile Flow (simulates the human heart)–Decreases peripheral resistance–Increases urinary flow–Better lymph formation–Increases myocardial blood flow–Need 2.3 times more energy to deliver
blood in a pulsatile manner than with non-pulsatile flow
Two Types of Perfusion (continued)
Non-Pulsatile Flow –Simply means continuous flow
Various Opinions on Pulsatile Flow
Advocates–It simulates the beating heart, aiding in
preserving capillary perfusion and cell function
–With the extra energy produced with pulsatile flow, we can avoid the closing down of the capillary beds.
Various Opinions on Pulsatile Flow (continued)
Opponents–Pulsatile flow is a more complex procedure
for minimal benefits–Capillary Critical Closing Pressure: (although
never seen under microscope) The belief that when the pressure in the capillary system goes below a certain point the capillaries will close…reducing the gas exchange between the blood and the tissues
Flow, Pressure and Resistance
Blood Flow: defined as the movement of blood flow through the body, or in our case, the extracorporeal circuit
Pressure: defined as the force vector that is exerted at a 90 degree to that of blood flow
Resistance: the force vector opposite to that of pressure
The Relationship Between Pressure, Flow and Resistance
Flow = Pressure / Resistance
Resistance = Pressure / Flow
Pressure = Flow X Resistance
Laminar Flow
Definition: Referring to blood flow, where all the layers run parallel to the walls of the blood vessels or tube
Reynold’s Number
An equation that enables us to determine whether blood flow is laminar or turbulent
R.N = 2 (fluid density)( average velocity)(r) (fluid viscosity)
If R.N. < 2000 flow is laminar If R.N. > 3000 flow is turbulent If R.N. between 2000 and 3000 flow
unstable
Reynold’s Number (continued)
Blood acts as a Newtonian fluid, one that has a constant viscosity at all velocities
A thixotropic fluid : the viscosity is altered by changing velocities
Viscosity
Another important factor that effects the flow of blood
Viscosity = Shear Stress / Shear Rate
Poiseuille’s Law
Expresses how different variables effect flow. The most notable variable is radius of the vessel or tube.
Flow = (Pressure gradient)(3.14)(radius 4) 8 (viscosity)(length)
Resistance
The main source of resistance is the arterioles. This resistance comes after the pressure source (the heart) giving up peripheral resistance
TPR = MAP/F TPR= Sum of all factors effecting the
resistance to flow
Resistance (continued)
• SVR= PA - PV / Q• PA= MAP• PV= RAP• Q= Flow Rate
• SVR= (MAP-CVP/C.O.) X 80
Pressure
• When the heart contracts and the pressure rises, the highest point is called systolic pressure
• When the heart relaxes and the aortic pressure reaches the lowest point.. this is called diastolic pressure
• Mean arterial pressure = SP/DP
Pressure (continued)
• Because vessels aren’t normally rigid, rather they are flexible, you will see a nice rise in the arterial wave form.
• If the aorta, the most flexible vessel, is rigid, the systolic pressure would rise sharply. (A good diagnostic indicator)
Resistance
The main source of resistance is the arterioles
Viscosity = Shear Stress / Shear Rate
F= (P1-P2) X 3.14 X r4/8L X Viscosity