ALICE POLKINGHORNE – PERFUSIONIST

What does your typical day consist of?

I get into work in the cardiac theatres at around 7:30 and look to see if I have been allocated a theatre to work in that morning. Operations taking place are often coronary artery bypass grafting (CABG) and valve replacements. I set up the heart lung bypass machine in theatre and get the whole thing ready to put a patient on bypass. This also includes setting up a cell salvage machine which will collect any waste blood from the surgical field and salvages red blood cells which we put back into the patient. I attend a theatre brief with the cardiac surgeon, cardiac anaesthetist and the rest of the theatre team, where we go over the plan for the operation and any co-morbidities the patient has such as kidney failure, diabetes, hypertension etc. These all impact management of the patient on cardiopulmonary bypass which we are responsible for. Set up is completed and the operation starts. The initial part of the operation can last for up to ~45 mins and for this part we aren’t needed unless the patient is unstable and would be potentially needed for emergency cardiopulmonary bypass initiation. Heparin (anticoagulant) is administered to the patient and at this point we come into theatre and the patient is prepared by
the surgeon for bypass. The patient is connected to the bypass circuit and I initiate bypass
whereby all the blood in the patient gets taken from the right atrium and drains into the bypass circuit where it is pumped and oxygenated and sent back to the aorta of the patient. I am responsible for a number of things whilst the patient is supported by bypass including the delivery of a high potassium solution called cardioplegia which arrests the heart. It also includes the management of the patient’s temperature since the patient is often cooled a few degrees or more, blood pressure which we manage with vasopressor administration, blood gas monitoring which we carry out every 20-30 minutes and anticoagulation status as the patient must remain anti-coagulated for the duration of bypass. Once the surgeon has finished the main part of the operation the patient is weaned from bypass whereby the heart is allowed to slowly take over the job of the bypass machine and then bypass is terminated. The patient is then supporting themselves with the aid of the ventilator. The bypass machine is left in a state that bypass could be re-initiated in the event of an emergency. I operate the cell salvage machine and re-infuse any salvaged red blood cells back into the patient. Once the operation is fully complete, I tidy up and clean down the bypass and cell salvage machine and make sure they’re ready for use the next day. Whilst I am training, I must be supervised for 150 cases so my mentor or other qualified perfusionist is sat in theatre with me.

When did you graduate and how did you find the transition into work?

I graduated in July 2019, but I started applying for trainee perfusionist jobs in March 2019 as this is when hospitals generally start advertising. I didn’t get interviews for any trainee perfusionist vacancies until the interview for my current post at Blackpool Victoria Hospital and the interview was in August. I applied for all trainee perfusionist vacancies of which there were quite a few (10-12) and had no interviews for any, other than my current job at which I was successful. I started the job in September 2019.

How has an anatomy degree been beneficial for your current career?

Anatomy is a really useful degree for this course because you need good cardiac anatomy knowledge and you must know generic anatomy of all the organs because they can often be impacted by cardiopulmonary bypass. The MSc has quite an in-depth anatomy module at the beginning and I knew the majority of the content already from my anatomy degree. The anatomy degree also covers other bases such as pharmacology and statistics. A basic understanding of the action of adrenaline and noradrenaline, along with other inotropes and their action on the cardiovascular system, will be really useful in the management of the patient’s blood pressure – I gained a basic understanding of this at some point along the anatomy course. The high pressure nature of the exams and the spotters makes you an attractive candidate since a perfusionist will be placed under high pressure during an emergency situation and, if called in at 2am, you’ll be the only perfusionist so will need to be able to think for yourself, quickly – a skill gained in the spotters.

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