CCP Anticoagulation & Heparin Management 2

Question 1

A patient on CPB has an ACT of 380 seconds after the initial heparin dose. What is the most appropriate action?

Accepted Answer

Proceed with CPB as the ACT is adequate

Answer

An ACT of 380 seconds is above the minimum threshold of 300–400 seconds required for safe CPB, so the perfusionist may proceed.

Question 2

Which of the following conditions is most likely to cause heparin resistance during cardiac surgery?

Accepted Answer

Antithrombin III deficiency

Answer

Antithrombin III (AT III) deficiency reduces the effectiveness of heparin because heparin exerts its anticoagulant effect by binding to and activating AT III.

Question 3

Fresh frozen plasma (FFP) is administered intraoperatively to a patient with heparin resistance. What is the primary mechanism by which FFP restores heparin responsiveness?

Accepted Answer

Replenishes antithrombin III levels

Answer

FFP contains antithrombin III, restoring the necessary cofactor so that heparin can exert its anticoagulant effect.

Question 4

During CPB, the ACT suddenly drops from 500 to 320 seconds without any change in the patient's condition. What is the most likely cause?

Accepted Answer

Protamine contamination of the circuit

Answer

Protamine contamination of the CPB circuit or priming solution can neutralize circulating heparin, causing an unexpected drop in ACT.

Question 5

What is the recommended initial heparin dose for systemic anticoagulation before cannulation for CPB?

Accepted Answer

300 units/kg

Answer

The standard initial heparin dose for CPB anticoagulation is 300 units/kg to achieve an ACT greater than 400–480 seconds.

(CCP) Certified Clinical Perfusionist Practice Test

(CCP) Certified Clinical Perfusionist Practice Test

CCP Anticoagulation & Heparin Management 2