Laboratory evaluation of the limitations of positive pressure safety valves on hard-shell venous reservoirs

Abstract

Vacuum-assisted venous drainage (VAVD) is a technique used to increase venous return during cardiopulmonary bypass (CPB). However, VAVD has created some new safety concerns. One potential problem is the pressurization of the venous reservoir in the event of vacuum failure. To prevent this overpressurization, a positive pressure release valve (PPRV) is placed on the venous reservoir. The purpose of this study was to determine if there is a difference in the pressurization of venous reservoirs using various PPRVs. The method of this study included evaluation of four different venous reservoirs and their associated PPRVs. Each reservoir was completely sealed, and two roller pumps with 1/4-in tubing were connected to the reservoir suction inlet. The roller pumps were calibrated, and a disposable pressure transducer was used to measure pressure at the venous inlet. Each reservoir was first sealed and then pressurized to test the occlusion of the roller heads. The PPRVs were tested by measuring the venous inlet pressure at a range of suction flow rates from 0-5 L/min. Linear regression analysis was performed to predict the venous inlet pressure from the rate of suction flow for each PPRV. The PPRV in the Baxter, Gish, and Gambro reservoirs maintained a low reservoir pressure (<40 mmHg) even at excessive suction flow rates (3-5 L/min). The PPRV in the Medtronic reservoir allowed excessive pressures (>40 mmHg) even at low flow rates (1-2 L/min). It is recommended that any reservoir used for VAVD be evaluated in a similar manner to determine whether it is safe under the maximal suction and vent flow conditions possible during clinical practice.