ECMO Circuits and Components Flashcards by Briana Lieberman

What are the basic components of all ECMO circuits?

Cannulas
Tubing/Pump boot
Bladder/Reservoir
Blood Pump
Oxygenator 
Heat Exchanger

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Additional Components of an ECMO Circuit

Water heater/cooler
Pressure monitoring Transducers
Circuit Bridge
Blood Monitoring
Air detector

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Where is the pressure monitor?

At bladder

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Where does the heparin go in in the ECMO circuit?

Heparin going in before the membrane

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What are the 3 cannula selection types?

Arterial
Venous
Dual Lumen (VV cannula)

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0-3 kg: Flow

200 cc/kg

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3-10 kg: Flow

150 cc/kg

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10-15 kg: Flow

125 cc/kg

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15-30 kg: Flow

100 cc/kg

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> 30 kg

75 cc/kg

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> 55 kg

65 cc/kg

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V-A ECMO Target Flows

Neonate: 100-150 cc/kg/min
Pediatric: 75-100 cc/kg/min
Adult: 50-75 cc/kg/min

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V-V ECMO Target Flows

Neonate: 100-120 cc/kg/min
Pediatric: 90-100 cc/kg/min
Adult: 75-90 cc/kg/min

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What are the goals of the arterial cannula selection?

Make your surgeon happy
Have a large enough cannula to minimize pressure drop
Minimize shear stress
Maintain laminar flow

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What are the goals of the venous cannula selection?

Make your surgeon happy

Have a large enough venous cannula to gravity drain the amount of blood flow that is required (but small enough to fit)

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Flow with pediatrics is ______ based.

weight (cc/kg)

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Flow with adults is usually ______.

indexed (L/min/m2)

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What is the aim of the arterial cannula?

Utilize the smallest cannula w/ the highest flow rate

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Arterial Cannula: Do not exceed pressure drop greater than what?

> 100 mmHg

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When is the critical velocity reached with arterial cannula?

Reached when laminar flow becomes turbulent (Reynold’s number)

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Higher pressures = higher ________ = hemolysis = BAD

shear stress

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What is the aim of the venous cannula?

Drain the patient with the smallest cannula.

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What should you be aware of the in regard to venous cannula?

Be aware of the cannulation site

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What is the pressure drop for the venous cannula?

-30 to -40 range (pressure-flow curve)

Common Cannulation Sites: Peds V-A

Right internal jugular vein | Right common carotid

Common Cannulation Sites: Peds VV

internal jugular vein

Common Cannulation Sites: Adult V-A

Femoral venous | Femoral arterial

Common Cannulation Sites: Adult V-V

Femoral venous | jugular venous

Jugular cannula allows flow rates exceeding _____ L/min, even reaching ___ L/min for 31 Fr cannulas.

4 L/min; 5 L/min

Origen V-V Cannula Sizing

12 Fr: Children 2-5 kg 15 Fr: Children 4-8 kg 18 Fr; Children 7-12 kg

V-V ECMO: Venous blood is drained through....

a single lumen of the double lumen cannula

V-V ECMO: Arterialized blood is returned......

via the other lumen of the double lumen cannula

ECMO Tubing is made out of....

PVR or Silicone

What are the sizes of ECMO Tubing?

1/4'' 3/8'' 1/2''

Durometer

measure of the hardness of a material. Hardness may be defined as a material's resistance to permanent indentation

Each tubing has ____ x _____(2)

Size x wall thickness Ex. 1/4''x1/8'' 1/4'' x 3/32''

What special tubing is formulated to withstand pump boot stress in roller pumps?

Super Tygon

Walk the raceway every ____ days.

Why do you walk the raceway?

Minimized spallation

Venous Bladders

reservoir

The flow patterns in the _________ (2) are less conducive to clot formation.

Better Bladder

How does the better bladder result in a shorter venous line?

allows active venous drainage without raising the patient on blocks or mattresses resulting in a shorter venous line

Venous drainage of the silicone bladder is increased by....

raising the patient and/or lowering the bladder

Venous drainage of the better bladder in increased by

increasing the negative pressure the pump generated

Oxygenators

Maquet PEds | Cadiohelp

Can you use a regular oxygenator in ECMO?

It will suffice of off label use | Blood is outside; gas is inside the fiber bundle

What was the gold standard until recently?

Medtronic circuit

What are the 3 basic pressure transducer locations?

Pre-oxygenator Post-oxygenator Bladder

What is the purpose of the ECMO Bridge?

Serves to prevent the ECMO circuit from being static when it is necessary to come off ECMO for a period of time; consider it an AV shunt

What kinds of bridges will you see?

No bridge 1/4'' and 3/8'' bridge Luer lock 1/8'' bridge

What must you do to the AV bRidge frequently

Must flash bridge frequently

A-V Bridge can be done with 2 stopcocks and 1/8'' tubing open when needed and .....

Reflush with saline

Going on ECMO (1/4'' x 1/4'' x 1/4'' bridge)

A-B-V Unclamp Arterial Clamp Bridge Unclamp Venous

Coming off ECMO

V-B-A "Very bad accident" Clamp Venous Unclamp Bridge Clamp Arterial

Monitoring Oxygen Kinetics

Arterial Blood gases venous blood gases venous saturations cerebral oximetry

Blood Gas Monitor Examples

Terumo CDI | Maquet BMU 40

NIRS

Near-infrared spectroscopy technology; such that used in pulse oximetry has been used and trusted in the world of medicine for decades; spectroscopic method that uses the near infrared region of the electromagnetic spectrum

What is the infrared spectrum in NIRS?

800 nm to 2500 nm