4. In which ways is the initiative creative and innovative?
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Adaptive Extracorporeal Circulation Circuit innovative is different than other Ultrafiltration methods in that it is lesser in operation time and it used for all of Ultrafiltration procedure additional in Hemodialysis and lesser in chance of occurrence in complication.
The first phase of the design is to supply existing equipment within the agency for preparation for the Adaptive Extracorporeal Circulation Circuit is available for all Ultrafiltration procedure. By using the Luer connector attached to the blood inlet and the blood outlet port through a 3 way connector.
As a result, it can use both CUF and MUF, but it has a problem and cannot not be used continuously because of the need to stop the MUF procedure to take blood from the Extracorporeal Circulation to replace where patients have low blood pressure.
The second phase is redesigned using the heart-lung machine blood pumps. And modified by increasing the length of the blood inlet for the blood pump head. The result is usable as MUF and CUF have continued and can take blood from Extracorporeal Circulation at the same time.
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5. Who implemented the initiative and what is the size of the population affected by this initiative?
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Perfusionists of Naresuan University Hospital are using the Adaptive Extracorporeal Circulation Circuit innovative for all methods of Hemodilution and also Hemodialysis for all of the patient to reduce morbidity and mortality in cardiac surgery, which covering patients all of the Lower Northern District about 3 million people as a percentage is 4.6 of the total population.
This innovation can be applied to cardiac surgery patients throughout the world.
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6. How was the strategy implemented and what resources were mobilized?
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For the strategy using SWOT analysis for design, planning, created innovation of ECC available as MUF+CUF, then record the problems and modify to use it, For the resources to be used for innovation consists of Hemoconcentrator 1 pieces, 1 set of Ultrafiltration collection tubing: PVC ¼ inches in diameter, 24 inches in length, 1 pieces of Ultrafiltration collection container:1,000 ml of empty NSS bottle, 1 set of Blood inlet tubing:PVC ¼ inches in diameter, 50 inches in length, 2 pieces of straight connector: 1/4 inch to male connector, 1 set of Blood outlet port: PVC ¼ inches in diameter, 20 inches in length, 1 pieces of 1/2 straight connector with luer, 1 pieces of 3/8 straight connector with luer, 2 pieces of three way connector.
The entire device is a waste material from the Extracorporeal Circulation, except for the Hemoconcentrator can be charged from patients. Almost no cost in invents the Adaptive Extracorporeal Circulation Circuit, just only cost of sterilization.
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7. Who were the stakeholders involved in the design of the initiative and in its implementation?
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For this innovation the stakeholders are Open Heart Surgery Team, which consist of Cardiovascular and Thoracic Surgeons, Perfusionists, Scrub nurse, Anesthesiologist, Anesthesiologist nurse and the most important is Cardiac Patients and their family.
Adaptive Extracorporeal Circulation Circuit to improve service on open heart surgery following Extracorporeal Circulation Circuit, which has been designed to be able with CUF, MUF and Hemodialysis without cutting or replacing the Ultrafiltration circuit. This innovation makes safety by reducing the risk and complications that will occur with the client. They are also able to filter the water and solution and improve customer satisfaction and safety to both service providers and customers. For the cardiac patients has a safety service, no complication and get a good result from pulling out of the blood while the provider has a facilities service, the surgeon has a continued working and overall operative time is faster.
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8. What were the most successful outputs and why was the initiative effective?
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The most successful output of this innovative is to be applied to all Ultrafiltration Procedures (MUF, CUF, Hemodialysis) and to all patients (Infant, Pediatric, Young children, Adolescent, Adult) which are the results of the position of blood inlet and blood outlet we chose, its flexibility for all procedure. It can be used for all patients because of the various sizes of connector with luer for each patient.
Reduced time to change Ultrafiltration Circuit, the incidence of infection from blood and secretions spilled, the incidence of injuries from cutting Ultrafiltration Circuit, the incidence of the Air bubbles in Extracorporeal Circulation Circuit, all of the above are the resulting from we don’t need to change the Ultrafiltration Circuit so we can take the operative procedure by continuously.
The monitoring indicators we use as a basis for monitoring and evaluation of innovative applications to meet the strategy. In case of problems in each step that does not go according to plan, it will have to improve to the goal.
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9. What were the main obstacles encountered and how were they overcome?
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From the use of innovations have not found significant problems and risks, including patients not affected or complications from its use. The problem is only in the second phase showed that the filtration rate of each patient is unstable and cannot be filtered continuously by the need to take blood from Extracorporeal Circulation Circuit to replace it, so it has to use the blood pump to solve the filtration rate.
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