CPB circuit was replaced with the standby primed circuit, ready for re-commencement of CPB if required! Haemostasis was obtained with no related adverse outcomes to the patient.

A proposal was made to make an amendment to the clinical practice and the SOP statement to be amended as follows:

"STOP suction pumps on INITIATION of protamine test dose. This information should be clearly communicated by the Anaesthetist to both Perfusionist and Surgeon. Only cell salvage suction should be utilised from this point".

Challenges:  Initially, there was resistance from the Surgeons as this clinical practice had been in place for many years without incident. Associated adverse outcome literature was also scarce. However, the anecdotal potential for protamine to jeopardise circuit integrity and in the interests of patient safety the SOP proposal was approved.