Shielding the patient from the normalization of deviance through technical rigor, ethical vigilance, and human factors in extracorporeal circuit assembly

Abstract

This article aims to critically analyze the preparation, assembly, and maintenance of the extracorporeal circuit from the perspective of patient safety and the perfusionist's ethical-professional duty. Through a thematic review that integrates clinical evidence and human factors analysis, it is argued that circuit assembly is not a mechanical task but a high-criticality clinical intervention equivalent to the surgical act itself. The development examines how blood-material interaction triggers pathophysiological responses that are amplified by failures in aseptic technique, facilitating biofilm formation and infectious risks. Furthermore, it critically analyzes the "normalization of deviance" and the impact of technological distractions as precursors to latent errors. The study concludes that the implementation of standardized protocols, with the identification of critical steps and the reflective use of checklists, constitutes essential safety barriers. The fundamental contribution of this work lies in proposing a culture of operational excellence where technical method and discipline are consolidated as expressions of ethical commitment, transforming the protocol into a real therapeutic barrier that shields the patient from preventable adverse events in the cardiovascular surgical environment