An evaluation of hard-shell venous reservoir integrated pressure relief valve pressure mitigation performance

Abstract

Introduction: Vacuum assisted venous drainage (VAVD) requires the sealing of the hard-shell venous reservoir, thereby creating circumstances where reservoir pressurization may occur. Manufacturers utilize integrated pressure relief valves (IPRV) to mitigate pressurization risk; however, accidents have been reported even with these devices. We have undertaken a performance evaluation of IPRV’s in a large number of hard-shell venous reservoirs. Methods: Reservoirs were sealed and gas insufflated while measuring reservoir internal pressure. Linear regression models were developed to depict the association between internal pressure and gas inflow rate. External secondary one-way valves (ESOV) were assessed for pressure mitigation performance. An assisted venous drainage survey was circulated to Canadian Clinical Perfusionists. Results: The reservoirs tested were adult ( n = 9, 64%) and pediatric ( n = 5, 36%) designs. Significant variability ( p < 0.001) in internal reservoir pressures (range: 0.04–161.41 mmHg) was observed across the titrated gas inflow rate (0.5–10.0 l/min). The regression models demonstrate excellent predictive performance (SE: 0.008–0.309). ESOV’s reduce the reservoir pressure below that of the IPRV; however, they cannot eliminate reservoir pressurization. The survey showed a majority (91%) of respondents use VAVD, and reservoir pressurization events occur regularly (18%). Conclusions: Significant variability among reservoir’s IPRV to mitigate reservoir pressurization exists. The predictive models are extremely accurate at estimating the internal pressure. ESOV performance limitations moderate their utility as a backup pressure mitigation technique. A significant number of reservoir pressurization events are occurring with the use of VAVD. As a result, standardized communication from manufacturers on the purpose and performance of IPRV is recommended in order to delineate the limitations of these devices.

Extracorporeal Circulation and Venous Hemodynamics: A Literature Review on Physiological Foundations to Clinical Applications

“…The findings underscored the variability of internal reservoir pressures based on different gas inflow rates. Additionally, the study highlighted the limitations of external secondary one-way valves (ESOVs) in mitigating reservoir pressurization events, thus emphasizing the need for improved communication regarding these devices' capabilities and limitations [22].…”