EMERGENCY

DE-AIRING OF THE LEVITRONIX VAD CIRCUIT

PURPOSE
To act as a tool for the ECLS specialist in the removal of air from the Levitronix VAD circuit during an
emergency situation, prior to the perfusionist arrival. The VAD is a closed loop system with no access
points therefore connectors are required to be inserted in order to de-air the circuit. The procedure has
been designed in a sequential manor to ensure a clear understanding and the safe / rapid re-initiation of
support.

POLICY STATEMENT

A perfusionist is required to reinitiate LVAD/RVAD support

Under no circumstance is an ECLS specialist to reinitiate LVAD/RVAD support
The source of air MUST be identified and corrected prior to de-airing the VAD circuit.
Surgical air entrainment (e.g. venous cannula malposition) or venous cannula cracked connector
can
only be corrected by the surgeon, therefore continue to de-air circuit as per policy.
VAD circuit air entrainment requires the primary problem to be corrected (e.g. cracked blood pump or
open IV lines) and then continue to de-air circuit as per policy.
The plasmalyte infusion set must be removed from the circuit
600ml bag must be removed from the circuit

SITE APPLICABILITY
All Levitronix VAD patients within BCCH.

PRACTICE LEVEL/COMPETENCIES
Levitronix VAD circuit de-airing is considered an advanced skill and only those with advanced training in
perfusion and ECLS are to perform this task.

Perfusionist

ECLS Specialist

ECLS Team Leader

EQUIPMENT
Circuit

3/8 Circuit

2 x x Luer lock connector

2 x 3/8 x 3/8 luer lock connector
Pressure bag
Infusion set
Baxter JC7790 straight type blood set
1 L Plasmalyte A
600 ml bag Volunteer Donor
3 tubing clamps
Sterile scissors
2 x Dead ender cap (white)
Large alcohol swabs x 4
Heparin 1,000 iu/ml

ECLS Blue Cart

Drawer
3rd
4th
4th
4th
4th
Hanging ECLS cart
4th
1st
4th
1st and 2nd

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EMERGENCY
DE-AIRING OF THE LEVITRONIX VAD CIRCUIT

PROCEDURE
1.

2.
3.
4.
5.
6.
7.
8.
9.

Clamp the circuit just distal to the pump head (see Fig. 1) Circuit Control Clamp # 3
Stop the Levitronix blood pump (hold to stop red button on console)
Activate an ECLS CODE
Communicate issue to the bedside staff
Identify the source of air (a surgical team may be required)
Clamp the venous line (#2) and the arterial line (#3) close to the cannulas but on the tubing

NOT the wire reinforced cannula section (fig 1.)

Prep the venous line with alcohol swabs, below the clamp
Using the sterile scissors cut the tubing
Insert the 3/8 x 3/8 luer lock connector (or x LL connector for the ) into the circuit
Insert connectors with luer locks orientated vertically to vent air more efficiently

10. Repeat steps 7-9 for the arterial line

Prep the arterial line with alcohol swabs, below the clamp
Using the sterile scissors cut the tubing
Insert the 3/8 x 3/8 luer lock connectors (or x LL connectors for the ) into the circuit
11. Insert 1L plasmalyte A into the pressure bag
Pressurize to 300mmHg
Prime air free the infusion set
Clamp
Hang on circuit
12. Attach the infusion set to the venous line luer lock connector

Unclamp the plasmalyte A infusion set

13. Attach empty 600ml bag to the arterial luer lock connector
14. Remove the Circuit Control Clamp #3 and de-air the circuit
Tip:
Raise venous line luer lock connector above clamp #2 momentarily to de-air
Tap the circuit, starting at the point where the Plasmalyte A enters, holding the de-aired portions
down allowing the air to rise with the fluid flow pathway.
Remove the pump head from its motor and invert, allowing the air to rise to the outlet.
Allow plasmalyte A flow to rinse the circuit, allowing the blood / air / Plasmalyte mixture to vent
rapidly to 600ml bag
15. Once the circuit is de-aired, re-clamp the Circuit Control Clamp #3
16. Remove the plasmalyte A infusion set from the luer lock connector and dead end cap the connector
(make sure connector is de-aired)
17. Remove the 600ml bag from the arterial line and dead end cap the connector (make sure connector is
de-aired)
18. Await perfusionist arrival
Do NOT remove clamps # 1 and # 2

Re-initiation Perfusion Only

Check circuit
Re-prime venous and arterial lines/ cannulas
Initiate LVAD/RVAD support
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#3

#2

EMERGENCY
DE-AIRING OF THE LEVITRONIX VAD CIRCUIT
Note: If patient remains off VAD support for a prolonged period of time consult ECLS Physician and
consider giving a Heparin bolus IV (Heparin 50iu/kg from the 1000iu/ml vial) to the patient.

DOCUMENTATION
Chart event on ECLS flow sheet and PSLS to be recorded

Figure 1.
Document Created: February 2014, V Harris/N Casey
Document Reviewed: March 2015 (V Harris/N Casey)
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EMERGENCY
DE-AIRING OF THE LEVITRONIX VAD CIRCUIT
Review Date: March 2016

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