Perfusion Tubing: Standardized or Modify?

The lower the prime, the better?  Humm, that sounds like pediatrics but some in the adult sector are having lower primes in achieving higher chances of less transfusion.  I applaud our adult colleagues in trying to do what is best for the patient even if standardized tubing packs have to be modified resulting in higher prices as some would argue. 

Colleagues of ours are saying 3/8 x 3/8 AV loops is all that is needed especially with the new vacuum venous drainage devices in the marketplace.  As one who likes to “stir the water”, why not 5/16” x 3/18” or even 5/16 x 7/16” AV loops?  All these tubing sizes are available clinically from our tubing pack companies.  All you need to say is “get it”.

5/16” tubing was introduced to me by Gary Corneilus, Chief Perfusionis (retiring this summer of 2013) at Frondren-Brown-The Methodist Hospital in Houston, Texas.  It was during one of my many inquisitive talks with him during my perfusion training in 1982 that he educated me in the use of 5/16” tubing during the “good old days”.   As a Physician’s Assistant, I was always taught well by Carl Fasser, PA Program at Baylor College of Medicine during the mid 1970’s in always trying to get the most of any educator for potential help in one’s future.   So there you have it.  I started asking, “why?”.  Those simple questions opened the doors to ask representatives and other perfusion mentors for further educating one’s mind.

We now know that 1/8”, 5/32”, 3/16”, 5/16” and 7/16” tubing are accessible from Saint-Gobain Performance Plastics (formerly Tygon) and for that matter any tubing company as well.  Wow, looking at the possibilities pediatrics, small adults and even regular adults.  I even recall Aaron Hill’s article on 5/8” venous line tubing for very large adult patients. 

That begs the question as to connectors.  Again, one must be innovative as well.  With a little of physical effort, this is attainable after all we have even put 1/4″ on 3/8” connectors and 3/8” tubing on 1/2″ connectors in a pinch.

1/8” fits male lures

5/32” fits 3/16” connectors

3/16” fits 1/4” connectors

5/16” fits 1/4” loose but better on 3/8” connectors

7/16” fits 1/2” connectors

Ron Gorney and I have published in the past the pressure drops of these tubing sizes and recommended venous returns.  Now with vacuum venous drainage devices will there be 7/16” venous lines and 5/16” arterial lines?  I guess time will tell.

Jorge Molina, PA-C, CCP

Tulsa Children’s Hospital