Ecmo 2 Flashcards by paige KAHLER

ECMO phone numbers 1/2

5-8070
5-8071

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Extra safety checks (6)

Emergency equipment in drawers, clamps, emergency vent settings, heparin calculation, rapid infuser, o2 tank.

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Name of PICU ECMO medical director

Mark Eikenberry

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Name of the dialysis line

Medcomp

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Bad delta

Doubles or over 40

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Roller pump, when traveling remember to

Remove air cap and hook up rapid infuser

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Flushing transducers

Take off air cap

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When on CRRT, what lab should bedside draw?

Lytes

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istat

Few drops of blood first!

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2 NPs in PICU

Kendel or Stacey

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NICU ECMO medical director

Lia Gravarie

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Risk factor for a failing oxygenator

Sepsis (sometimes they plasmapherese sepsis to remove cytokines/toxins)

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What’s one way to test your oxygenator when you think it’s failing?

Increase the FiO2 and see if post oxy pao2 increased. Do the formula FiO2 x 3-5

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Strange dressing that needs blood to adhere to it

Patch pro

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What can you NOT use on a cannula

Stat seal and secure a port

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Brand name of the DLVV

Avalon

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Who needs irritated blood

<4 mo and immunocompromized. Only blood and platelets get irritated. It means lymphocytes are deactivated

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Syringe blood will have what type of preservative?

Adsol

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Once adsol is removed, how long is it good for?

24hrs. They will remove adsol on patients <4 months

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When you order a cooler, what can BB keep down stairs?

Platelets

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Blood banks phone number

6824

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When to order a cooler (or ask)

Stenting, transport, chest tube, bronch, if anesthesia is present they should be the ones ordering it

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When ordering a cooler how do you activate it?

Sending down the yellow sleep, UST has it

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How is prime blood labeled?

Orange tag

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Cooler considerations if giving 40mls

Ask BB if they should send you a syringe or use a bag you already have. Also use oldest blood in the cooler first!

Notify perfusion on cardiohelp if RPMs exceed

4,000

Istat, how long to warm up to room air in box and not in box?

1hr and 5mins

istat batteries

Get them from lab, recycle with biomed

Date them once warmer, Chem 8, CG8 and CG4 with expiration

Chem8 is good for 2 weeks, CG4/8 2 months

How to prevent reflux if heparin into the line

Don’t open stop cock, set timer for 10 mins as it’s running

One easy way to help an overly negative bladder pressure?

Raise the bed

The other PICU doc (he studders)

Jeff Nowak

When on VV, low sats..

Might need to increase flow if they are super low like 30

Transplant kids when ordering blood

Talk to BB to see if you can use the same donor

When should you put on your rapid infuser?

Travel and procedures

When traveling:

Get rapid infuser in line, name band on clip board, tie up syringes, get cart ready, blood cooler ordered by you or anesthesia, consider transport warmer if long transport, go over checklist

Who removes zip ties?

Perfusion

Tell perfusion if peds oxygenator needs sweep of

Temperature, slowly..

Rewarm slowly

If scuffing ACT must be ——— or heparin level must be ——

ACT 160 or hep gtt 10-12.5

When weaning flows, watch your CDI for what?

May need to wean sweep, watch CO2

Max temp setting

39 degrees

What kind of stop cock needs to be on fluid line?

ECMO on/off stop cock

Anticoagulation during a complication: how many units to give or ACT is <120 120-160 160-200 >200 (Given to failing circuit before complete failure, or not at all. No makeup doses)

<120 give 75u/kg 120-160 50u/kg 160-200 25u/kg >209 none

Update: prime blood should be less then how many days old?

7 days

Adsol doesn’t HAVE to be removed in an emergency

What to do if sweep is .1 and co2 is 30? On VV ECMO.

Call provider to ask to come off ECMO (sweep off)

Centramag for infants under —— kg in CV

15kg

What are the 4 factors of recirculation?

Too high of flow, position of cannula, low intravascular volume (dehydration or pneumo), decreased cardiac output.

Resting ecmo PEEP settings

Might be 10-12, especially if we need the lungs help to oxygenate, higher peep may be necessary during the initial capillary leak phase

Who is at the most risk of developing differential hypoxemia?

A respiratory pt on VA

Lia G

NICU ECMO medical director

Crrt don’t remove more then ? /kg

4/kg/hr

Dopamine and PVR vs Vaso and PVR

Dopa increases, bad in pulm HTN, Vaso decreases

DIC labs: INR,Hep U, PTL, Fibrinogen, plasma hgb, ACT

Higher: INR, plasma hgb, act. Others low

Blood or cristalloud primed circuit is short in what? What do you replace?

Platelets and fibrinogen

How long is a CRRT bag good for?

24 hours from the time the bag is cracked by pharmacy. It will say the time on the label

When starting CRRT, what should you have at the bedside?

Calcium dose, fluid for bonus, consider what their sodium is if going on a clear prime of saline. Make sure ical, Hgb and sodium (for clear) are healthy for patient

Temp for warmer sleeve when doing CRRT

43 degrees

Citrate, once metabolized by the patient Leaves what behind?

Bicarbonate

Pre/post filter replacement

Pre Dilutes out your “dirty” blood so the solvents can actually cross the CRRT membrane. Called “solvent drag”. Example watching the rain pull a leaf down a gutter. Fluid can pull things across.

Post replacement.

Done, because we pulled off the good/bad and the ugly. So we replace it so our electrolytes don’t get too low. So based off labs you may run post replacement fluid. Solution is needed to “replace” and removed “volume” and replenish lost electrolytes

Liver failure in CRRT will cause (if on citrate)

Citrate lock

Heparin dosing when going on CRRT

Will give loading “bolus” dose of heparin (only if your not on ECMO)

Suggestions for CRRT frequent clotting (4)

Maintain higher BFR. Larger catheter. Use pre filter replacement fluid. Rarely, use citrate and heparin

Heater cables, for CRRT. We have gray and blue for which filters

Gray is for HF1000 & HF 1400 Blue is for HF20

CRRT: if you’re having pressure/pod issues

Clean/tape it. Make it do a self test

How long is blood recirculate good for for CRRT?

1hr exactly

If I CRRT circuit is clear primed, how long is it good for? What do you do 30mins prior to putting it on a patient?

Good for 3 days, hit “reprime” with a new bag of NS.

How long is the CRRT battery good for?

0-7mins, expect <5

Who should you make sure if around or at least knows, prior to initiating CRRT?

Any new CRRT circuit tell intensivist

What do you check after AM hospital generator check?

That your heater is still on

When opening bridge on your own, what do you need to do?

Flush out the clot

RPMs changing unprovoked on cardiohelp

Clot

3 factors that increase your bicarbonate

-the citrate in blood products, use of diuretics, NG suction.

Ecmo 2 Flashcards

(75 cards)