Lab Values and Drugs

Question 1

For each of the values listed below what is normal and where do we like this
value to be while pt on ECMO. Explain.
PH

Answer 1

7.35-7.45

Question 2

For each of the values listed below what is normal and where do we like this
value to be while pt on ECMO. Explain.
a. PH

Answer 2

35-45

Question 3

PO2

Answer 3

On ECMO - >200

Question 4

Lactate

Answer 4

0.5 - 2

Question 5

NaHCO3

Answer 5

22-28

Question 6

Base deficit

Answer 6

+/- 4

Question 7

Hgb/HCT

Answer 7

12-15 (women) & 13-17 (men)
On ECMO (Adult > 7, Peds > 10)

Question 8

Sodium

Answer 8

135-145

Question 9

Potassium

Answer 9

3.6-5.1

Question 10

Serum calcium

Answer 10

8.9-10.7

Question 11

Ionized Calcium

Answer 11

1.16-1.32

Question 12

Ionized Magnesium

Answer 12

0.46 - 0.64

Question 13

PT

Answer 13

12.3-14.8 s

Question 14

PTT

Answer 14

25-36
On ECMO - 60-80 seconds

Question 15

Anti Xa (AKA Unfractionated Heparin)

Answer 15

On ECMO - 0.3 - 0.7
If bleeding 0.2-0.5

Question 16

Cultures

Answer 16

You want negative cultures! Blood, urine, respiratory.

Question 16

ATIII activity (< 30 days, > 30 days)

Answer 16

< 30 days (44-76 %)
> 30 days (80-120 %)
ATIII binds with heparin to work as an anticoagulant, heparin does
not work by itself.

Question 17

Plasma Hgb

Answer 17

< 12

Question 18

Fibrinogen

Answer 18

200-400

Question 19

INR

Answer 19

<2 (On ECMO < 4.9)

Question 20

Troponin

Answer 20

0-0.4

Question 21

CK

Answer 21

40-350

Question 22

CK mb

Answer 22

0-5

Question 23

ALT

Answer 23

0-40

Question 24

AST

Answer 24

0-95

Question 25

Describe the relationship of these tests to ECMO. a. Head ultrasound - Is this done on all ECMO patients

Answer 25

Neonates and Infants

Question 26

-When is this test done?

Answer 26

Done pre-cannulation and then once a day for the first 3 days, then every other day.

Question 27

-What does this result show?

Answer 27

Intracranial hemorrhage, blood in the ventricles

Question 28

Why is this important to patients on ECMO?

Answer 28

It’s a contraindication for ECMO. If it’s a grade 1-2 then they will keep an eye on it, if its a grade 3 or larger either will DC ECMO or not put patient on ECMO

Question 29

b. Chest x-ray -Is this done on all ECMO patients

Answer 29

Yes

Question 30

When is this test done?

Answer 30

After cannulation and daily/PRN

Question 31

What does this test tell us?

Answer 31

Cannula Placement

Question 32

Discuss the importance of this test.

Answer 32

Misplaced cannulas can cause decreased flows, chugging, recirculation (VV), high negative pressures, high positive pressures.

Question 33

c. Cardiac ECHO -When is this test done?

Answer 33

Adults - during weaning (PRN to confirm cannula placement) Neonates - Pre-ECMO and (PRN to confirm cannula placement)

Question 34

Is this done on all ECMO patients?

Answer 34

Yes

Question 35

What do we learn from this test?

Answer 35

Cardiac function, pulmonary artery pressures.

Question 36

Are the results usually normal or abnormal?

Answer 36

Usually abnormal for VA and normal for VV

Question 37

d. CT Scan -When is it done?

Answer 37

Change in patient status

Question 38

What do we learn from this test

Answer 38

Check for head bleed, abdominal function (with contrast)

Question 39

How does this affect the care of our patient?

Answer 39

Can give immediate answers. Sometimes is not tolerated well by patient. If results are poor, then a conversation may happen to discontinue ECMO.

Question 40

Do all patients have this test?

Answer 40

No, would only need done for a specific change in patient status.

Question 41

e. Fluoroscopy -When is this used?

Answer 41

To place a double-lumen cannula safely.

Question 42

What does this tell the practitioner?

Answer 42

Cannula Placement

Question 43

What patients are most likely to have this done?

Answer 43

VV ECMO

Question 44

f. Cardiac Cath i. When is this done?

Answer 44

If patient has had a STEMI, any patient on ECPR, create balloon septostomy in neonates.

Question 45

Can patients on ECMO go to the Cath Lab?

Answer 45

Yes

Question 46

Describe the information that might come from this tes

Answer 46

Check for coronary blockage.