ecmo

Question 1

what is the half life of Heparin?

Answer 1

1.5 hours

Question 2

Consideration of femoral VA ECMO patients?

Answer 2

Depending on mixing cloud, R Aline might not work for blood gasses, may need to use the pump arterial gas

Question 3

Drugs that bind to ECMO circut

Answer 3

Fentanyl & Propofol

Question 4

Normal Plasmahemoglobin level?

Answer 4

<30

Question 5

IF bladder ( venous) pressure is becoming more negative

Answer 5

Kink, clot, position, preload, agitation, pneumo, tamponade

Question 6

Reasons your delta P may DECREASE

Answer 6

decreased blood viscosity, decreased flow, opening of bridge

Question 7

Heparin on the septic/inflamed patient

Answer 7

may need higher dose b/c of coagulopathy

Question 8

Why don’t they irradiate blood ahead of time?

Answer 8

The K increases more with time post irradiation

Question 8

Why don’t they irradiate blood ahead of time?

Answer 8

The K increases more with time post irradiation

Question 9

Leukoreduced causes what to happen to PRBCs?

Answer 9

PRBCs lose efficacy to 85%

Question 10

What does irradated mean?

Answer 10

donor lymphocytes are inactivated

Question 11

What do you do if all of the sudden your pt isnt oxygenating and CO2 is rising?

Answer 11

check the sweep line for kinks (can try putting it on the tank), is your post oxygenator O2 low too? issue with oxygenator, look for clots, increase in delta P, increase RPMs,

Question 12

Return/arterial pressure increasing

Answer 12

kinks, clots, position (check xray), is pt hypertensive? Sedation? zero lines

Question 13

What to do if air is in the arterial line?

Answer 13

Emergency, stop pump/clamp above air, call for help, emergency vent settings/ escalation of inotropes, walk air to nearest leur connection or open bridge to get air out

Question 14

Normal vs ECMO PT levels

Answer 14

PT normal 12-14 seconds, ECMO 15-16- correct with FFP

Question 15

Normal vs ECMO PTT levels

Answer 15

PTT normal 24-36 seconds, ECMO 60-90. Correct with Heparin

Question 16

PTT affected by ___, influenced by ___

Answer 16

affected by heparin, influenced by PTL/fibrinogen/clotting factors

Question 17

What interferes with Hep U level

Answer 17

High bilirubin, high triglycerides, high plasmahemoglobin. Hep U is not inflienced by PTL or clotting factors

Question 18

What might you need to give after giving factor 7?

Answer 18

FFP because it used up your

Question 19

how does hypothermia affect clotting times?

Answer 19

it delays clotting time and alters PTL function

Question 20

How does bilirubin affect coag labs?

Answer 20

increases PTT and decreases Hep U

Question 21

How does hemolysis affect coag labs?

Answer 21

Decreases PTT and Hep U

Question 22

If Hep U is normal, PTT/ACT are low

Answer 22

check AT3, give FFP

Question 23

If Hep U is normal, PTT/ACT are high

Answer 23

r/o DIC (d-dimer), decrease heparin, give FFP

Question 24

If Hep U is low, and PTT/ACT is low

Answer 24

give heparin bolus/increase gtt

Question 25

If hep U is low, and PTT/ACT high

Answer 25

increase heparin, r/o DIC, give FFP.

Question 26

what should you consider when weaning flows?

Answer 26

Going upon heparin & you may need to wean sweep

Question 27

VA considerations with sweep

Answer 27

never turn it off,

Question 28

What weight gets 1/4" circuit?

Answer 28

<10kg ]

Question 29

name of our 2 heaters

Answer 29

cardioquip and microtemp

Question 30

what color are the pediatric/adult oxygenators?

Answer 30

peds is blue (blue baby), and white is adult

Question 31

how do you clamp roller pump?

Answer 31

VBA

Question 32

On roller pump, where is CRRT access/return?

Answer 32

Idk anymore

Question 33

When restarting from clamped/off cardiohelp..

Answer 33

unclamp slowly, RPMs at least 1500

Question 34

what are the optimal RPMs for cardiohelp to reduce hemolysis

Answer 34

2,000-4,000

Question 35

How late is perfusion usually around until?

Answer 35

4pm

Question 36

what to check before a controlled new cannulation on a neo?

Answer 36

Head ultrasound

Question 37

whats the formula to assess how well oxygenator is working?

Answer 37

your pump FiO2 x 3-5 = post oxygenator PaO2, if this is bad, consider sighing, old oxygenator.

Question 38

To assess your patients lung, can do "cilley" test

Answer 38

go up on their vent FiO2 and see if sats go up

Question 39

what should you assess if seeing multiple venous bubbles

Answer 39

assess site for proline deficiency

Question 40

water heater... refilling..

Answer 40

do it slowly, water is cold

Question 41

Your post oxygenator PaO2 shouldn't be lower then..

Answer 41

150

Question 42

As your diuresis on VA ecmo, your PaO2

Answer 42

may increase as less blood goes through heart, more through pump

Question 43

On Cardiohelp, when accessing arterial side...

Answer 43

flush anything SLOWLY or bubble detector will alarm

Question 44

your patient keeps getting PTL w/o solid gain in PTL level

Answer 44

DIC

Question 45

How do you fix circuit DIC?

Answer 45

change the circuit so you stop consuming factors on y our old clotty circuit, may need a couple changes. Can also do plasmapheresis

Question 46

clamp

Answer 46

off sweep

Question 47

what an air lock in your cardiohelp?

Answer 47

the air in your pump stops forward flow

Question 48

If you need to remove air on arterial side of oxygenator

Answer 48

add saline as you pull air so you don't cavitate

Question 49

on VV ecmo, sats 80s are ok if:

Answer 49

good lactate, UOP adn perfusion

Question 50

VA ecmo, if PaO2 is too high

Answer 50

you may have no CO and LV stun, check echo to see if flows are too high assess need for septostomy

Question 51

any baby with pulm HTN going on VV

Answer 51

R heart gets support when VV ecmo provides oxygen to PAs

Question 52

ratio of sweep/flow when starting ecmo

Answer 52

1:1 unless there is chronic co2 retention

Question 53

signs of cardiac distension

Answer 53

ART line is flat, PaO2 is high, CVP high

Question 54

what happens to CVP when you start VA ecmo

Answer 54

it goes down due to VA steal

Question 55

Ways to improve oxygen delivery (6)

Answer 55

-increase FiO2, increase flow (but not past max flow rate or O2 can worsen), increase hemoglobin, improve native cardiac output, new oxygenator, sedate/paralyze/cool

Question 56

How to change CO2? (3)

Answer 56

Increase sweep, change oxygenator, sigh oxygenator

Question 57

Hgb in VV vs VA patients

Answer 57

VV might be kept higher if there is no native lung function, VV had lower sats

Question 58

250ml NS bag

Answer 58

<10kg

Question 59

500ml NS bag

Answer 59

10-30kg

Question 60

1L bag NS

Answer 60

>30kg

Question 61

What weight gets a blood prime?

Answer 61

<30kg

Question 62

Excessive negative venous pressure can cause

Answer 62

Hemolysis, cavitation, vessel wall damage. If it’s sudden, may just be sucking up against vessel wall- gave fluid, reposition

Question 63

What causes pre oxygenator pressure to increase?

Answer 63

Hypertension, clotting oxygenator, clots or kinds to cannula

Question 64

Where can you NOT administer things with a string or large volume pump?

Answer 64

In the negative side of the circuit. But you can give fluid via push under constant supervision

Question 65

Where should blood and FFP be given if it must be on the circuit?

Answer 65

Into a pre oxygenator pigtail with and IV pump. If more emergent, can give via push on negative limb prepump.

Question 66

Where when needed, do you give platelets and cryo?

Answer 66

Post oxygenator on a pump

Question 67

Where do you give medications on a circuit? Like vanco

Answer 67

Pre oxygenator

Question 68

Where does the prismaflex access and return?

Answer 68

Access on venous limb, first set of pigtails by lab draw. Return to CDI by heparin

Question 69

Venous pressure alarms- warning/alarm/max

Answer 69

-80/-100/-120

Question 70

Pre oxygenator pressures warning/alarm/max

Answer 70

290/300/350

Question 71

Post oxygenator pressures warning/alarm/max

Answer 71

280/290/340

Question 72

Gas pressure warning/alarm

Answer 72

20/40

Question 73

Where should the alarms be on the transonic flow meter?

Answer 73

20% above/below flow target

Question 74

How often should you flush and zero transducers?

Answer 74

Flush q4 Zero q shift

Question 75

The flow probe ONLY transonic.

Answer 75

Should be lubricated. And only repositioned above the bridge of circuit is deforming or signal is deficient

Question 76

What can be plugged in on the ECMO cart?

Answer 76

The transonic and CDI. Nothing else.

Question 77

When your done with heaters…

Answer 77

Don’t empty them! Or they have to go to biomed to be refilled

Question 78

How do you calibrate CDI if the bridge is open?

Answer 78

With the Patient VBG, not pump, because pump is affected by open bridge

Question 79

What do you do if you need to open the bridge?

Answer 79

Perfusion can be paged during daytime hours, otherwise include it in the morning page

Question 80

Minimum quadrox flow for adult/peds

Answer 80

Adult is 0.5LPM Peds 0.2LPM But goal is always 1LPM

Question 81

Minimum sweep/flow on VA patients? (Non cardiac)

Answer 81

0.1 sweep 30% FiO2