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ECMO Flashcards

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1
Q

What is SVo2 synced with?

A

Pump venous gas.

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2
Q

What does the pump arterial gas sync?

A

SAT, HCT, pO2, and PCo2.

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3
Q

What are the S/S related to Hemolysis?

A

Increased PFHgb, tea colored/pink urine or ultrafiltrate, and decreased renal function.

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4
Q

What are the causes of Hemolysis?

A

Sheer stress, extreme negative pressures, and increased clot burden in circuit.

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5
Q

What are the solutions for Hemolysis?

A

-Avoid negative pressures for extended periods.
-Collect PFHgb slowly and at least 1-2 hrs post blood administration.
-Trend PFHgb daily.
-Monitor UOP amount and color.
-Change circuit when indicated.

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6
Q

Hemolysis lab level?

A

> 150 PFHgb

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7
Q

What is the standard range for Anti-XA?

A

0.35 - 0.64

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8
Q

What is the moderate range for Anti-XA?

A

0.21 - 0.40

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9
Q

What is the high range for Anti-XA?

A

0.10 - 0.30

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10
Q

What are the three things that can alter your Anti-XA result?

A

High triglycerides, hyperbilirubinemia, hemolysis.

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11
Q

What are the goal labs for NICU?

A

HCT >35, PLTs >100, INR <1.5, Fibrinogen >150

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12
Q

What are the labs for PICU?

A

HCT >30, PLTS >100, INR <1.5, Fibrinogen >150

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13
Q

What are the labs for CVICU?

A

HCT >25, PLTS >50, INR <2, Fibrinogen >100

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14
Q

Define the CP22 and what it does -

A

Pump head that measures venous pressure (P-In) and pre-oxygenator pressure (P-Out).

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15
Q

Define Oxygenator and what it does -

A

“Lung” of ECMO, min. flow must be 500ml/min, SWEEP can be 0-05 - 14LPM, and it can heat or cool the patient’s blood.

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16
Q

Define the Hemofilter and what it does -

A

“Kidney” of ECMO, min. flow 100ml, min, allows us to SCUF (slow cont. ultrafiltration w/ dialysate). Ineffective for patients >20kg.

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17
Q

What are the arterial flow measures?

A

Maximum flow: 200ml/kg or 7LPM
Minimum flow: 20ml/kg or 0.1LPM

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18
Q

What are the venous flow measures?

A

Maximum flow: 250ml/kg or 7LPM.
Minimum flow: 0.5 LPM

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19
Q

What is the minimum flow required for the shunt?

A

0.1 LPM (100ml)

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20
Q

What are the venous pressure limits?

A

Max: -40
Stop: -100

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21
Q

What are the pre-oxy pressure limits?

A

Max: 300
Stop: 350

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22
Q

What is the post-oxy limit?

23
Q

What are the causes of cannula site bleeding?

Study These Flashcards
A

-Suture issues
-Torque
-Decreased weight
-Cannula malposition

24
Q

What are the solutions to cannula site bleeding?

Study These Flashcards
A

Check the site, CXR, re-suture, pressure dressing, surgicel.

25
What is the gradient and what does it indicate?
The gradient is the difference of your pre-oxy and post-oxy pressures; follow the trend to track clot burden and ineffectiveness.
26
How does one obtain cardiac index?
But inputting the height and weight under the toolbox tab.
27
What is Zero Flow mode?
Pump maintains a specific equilibrium, preventing any retrograde.
28
What is Zero RPMs?
The pump head is no longer spinning, clamp arterial cannula and then venous cannula to prevent retrograde from the patient. Open the bridge.
29
What are the SIGH parameters?
5 LPM over 15 seconds.
30
What should you troubleshoot regarding negative venous return problems?
Patient may need volume. Patient may need sedation. Patient may need to be repositioned. Assess for clots and/or kinks. Assess cannula positions - CXR or ECHO. Assess for tamponade.
31
What should you troubleshoot regarding increased arterial pressure problems?
Patient may need more sedation. Assess for clots in oxygenator. Assess cannula positioning - CXR or ECHO. Re-zero post-oxy pressure line and/or flush line.
32
What are the steps for discontinuing bypass?
-Clamp arterial, then venous, the open bridge. -Turn emergency vent settings on. -If off bypass for >15min, disconnect gas line from Oxy and cut heparin in half, move critical meds to patient, and monitor Anti-Xa/PTT from the pump PRN.
33
What are the steps to resuming bypass?
-Put in zero flow mode. -Close bridge. -Unclamp venous, then arterial. -Slowly increase RPMs. -Resume infusions to ECMO pump -Return to previous vent settings. -Clear bridge w/ normal saline.
34
What are the potential causes for sudden loss of flow?
Clot in either cannula, clot in tubing or CP22 or Oxy. Check for kinks.
35
What are the rest vent settings in NICU?
x24-40, 20-22/5-10, PS 5, Fio2 40%
36
What weight and how many mls are required for the 1/4" circuit?
<15kg and 500ml.
37
What weight and how many mls are required for the 3/8" circuit?
>15kg and 750ml.
38
What is the minimum flow required for the Oxygenator?
0.5 LPM (500ml)
39
What steps need to be taken for a CDH repair?
Position patient r/t defect side. Ensure you are flowing well and discuss anti-coagulation w/ SX. Give TXA an hour before the procedure [runtime: 24hr] to reduce chance of post-op bleeding which is the biggest risk. Make sure the blood products are READY and the ETT is stabilized.
40
What are signs of Oxygenator failure?
Increased gradient and poor Co2 clearance + poor oxygenation. [compare pump venous and pump arterial gases. Sigh oxy and recheck gases.]
41
What is Recirculation?
Blood goes out the arterial/return cannula and gets consumed back by the venous cannula. (only on VV ECMO)
42
What will you see w/ Recirculation?
SVo2 on pump and patient overhead o2 sats will be similar. Blood color will look similar (brighter on the venous side).
43
How do you troubleshoot Recirculation?
-Reposition patient. -Assess sedation. -Check cannula position. -Evaluate volume status. -Check pump venous and re-calibrate SVo2.
44
What are S/S of CNS changes?
Decreased neuro response, full fontanelle, HUS/CT changes, pupil changes, and/or seizures.
45
What are some causes of CNS changes?
Hypoxic event. Hemorrhage. Cerebral edema. Seizures.
46
What are some adjustments for CNS changes?
Neuro exams q1 + HUS/imaging. Monitor and treat seizures. Avoid HTN. Anticoagulation awareness - blood product administration. ECMO support might be adjusted.
47
What are the S/S of Cardiac Tamponade?
Decrease in pulse pressure + increased Po2 and poor perfusion w/ decreased ECMO flow.
48
What are the causes of Cardiac Tamponade?
Pericardial perforation by cannula. Malpositioned CVL/PICC. Occluded chest tube post op.
49
What are S/S of DIC?
Requiring frequent PLT transfusion w/ decreased fibrinogen and increased clotting in the circuit. The only fix is a circuit change.
50
What are S/S of North-South Syndrome?
[Specific to VA ECMO w/ arterial cannula in fem.] Head and face cyanosis w/ adequate truncal and extremity perfusion. Sats will be different on L vs R hand.
51
What is Myocardial Stun?
Reversible myocardial dysfunction (rule out cardiac tamponade).
52
What are the causes of Myocardial Stun?
Hypocalcemia, aortic cannula position, decreased O2 delivery to coronaries. Treatment? If VV consider going to VA.
53
What the process with hep-locking cannulas?
Initially cut 2" away from end [3/8 or 1/4 perfusion adapter w/ female-female + microclave.]; q8 hep flush, 9.6ml.
54

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