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

Perfusion 2020 November 28
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.

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