Study Guide Flashcards
(218 cards)
1
Q
What anticoagulant is used for the neonatal and pediatric patients?
A
Heparin
2
Q
What anticoagulant is a direct thrombin inhibitor?
A
bivalirudin and aragtroban
3
Q
What is the desired range for ACTs?
bolus dose of heparin for Neonate?
pt slightly bleeding?
pt with severe bleeding?
A
180-220 seconds
>300 seconds
160-180 seconds
<150 seconds
4
Q
What factors affect how ACTs are determined?
A
platelet dysfunction
temperature
anemia
coagulation factor deficencies
thrombocytopenia
5
Q
What elements are required for heparin to work?
A
anti-thrombin iii (AT)
6
Q
What test measures the effectiveness of bivalirudin?
A
aPTT
ACT
TEG
7
Q
What does PTT measure?
A
partial thromboplastin time
8
Q
What is a normal PTT?
A
25-36 seconds
9
Q
What range of PTT do we use for ECMO pts?
A
60-80 seconds (will increase if stranding/clots are seen)
10
Q
What are the two pathways in the coagulation cascade?
A
Intrinsic Pathway - activated by foreign body and inflammation (Tissue Factor 12)
Extrinsic Pathway - tissue injury; trauma (Tissue Factor 3 to 7)
both lead to common pathway at Factor 10
11
Q
What test are used to evaluate anticoagulation in neonates?
A
ACT and TEG initially, then Anti-Xa assay and PTT
12
Q
What is the bolus of heparin given to large pediatrics or adults?
A
10,000 units
13
Q
What is the bolus dose of heparin given to an infant or small child?
A
100 units/kg (10,000 units max)
14
Q
Which drug will CRRT affect?
A
heparin
15
Q
What is the reversal agent/antidote for heparin? bivalirudin?
A
protamine
none - time it takes for the kidneys to clear
16
Q
What is the ACT?
A
Activated Clotting Time; whole blood coagulation test
17
Q
What does ACT measure?
A
time it takes for clot to form in whole blood in seconds
18
Q
What device is used to run an ACT?
A
POC Hemochron - Signature Elite
19
Q
Why is the ACT elevated in the prime?
A
only RBCs are used to prime the circuit so there are no clotting factors
20
Q
What anticoagulant does the ACT measure best?
A
heparin
21
Q
What are factors that affect anticoagulation?
A
platelet function, temperature, ATiii Deficiency, Hypotension, Sepsis, Liver Dysfunction, DIC, Body Habitus
22
Q
What is the dose of heparin to place in the adult circuit?
A
0
23
Q
What is the dose of heparin for the neonatal circuit?
A
.2 mls (20 units)
24
Q
What is PRBCs?
A
packed red blood cells
25
When are PRBCs given and why?
Hgb <7 for peds/adults, <10 for neonates
increase Hgb and to increase oxygen carrying capacity
26
What is Cryoprecipitate?
precipitate of thawed FFP; rich in fibrinogen - small volume (good for peds/neonates)
27
When is Cryoprecipitate given and why?
Fibrin <100 mg/dL
increase fibrin to promote clotting
28
What is FFP?
fresh frozen plasma
29
When is FFP given and why?
INR >1.5
pts with a coagulopathy who are bleeding or at risk of bleeding
30
What are Platelets?
manufactured by whole blood and binds to fibrinogen
31
When are Platelets given and why?
Peds/Neonates - <80,000
Adults - do not get platelets unless they are actively bleeding <50,000
help with clotting factors
32
How are blood products given to adults on ECMO?
peripheral IV
33
Where are the blood products given in the neonatal circuit?
Venous Cannula - pigtails/manifold; PRBCs, FFP
Arterial Cannula - bridge; Cryo-, Platelets (pushed manually; 5 cc every 5 mins - flush with saline after given)
34
What is the usual dose or volume of blood products given to small peds/neonates?
10-15 mls/kg (if bleeding, 20 mls/kg)
35
What does it mean to use emergency release blood?
blood that is used is not cross matched with the patient
36
What does blood type mean?
presence or absence of antigens
37
What blood type is the universal donor?
O-
38
What blood type is the universal recipient?
AB+
39
What are the special requirements for infants <4 months with respect to blood?
Initial sample at birth is good for 4 months due to immature liver not making antigens
40
What part of the blood carries the antibodies?
plasma
41
What is thrombocytopenia?
low platelets
42
What factor is given when thrombocytopenia occurs?
heparin; Heparin Induced Thrombocytopenia (HIT)
43
When does RH matter?
women of pregnancy age as well as pregnant woman
44
How long may blood stay in the unit refrigerator?
none; can stay in coolers for 12 hrs
45
What factors may be placed in the refrigerator?
FFP and pRBCs - no platelets
46
Trace blood flow from cannula tip to tip: Cardiohelp Adult
-Venous Drainage Cannula
-Venous Pre-pump/Pre-oxygenator pigtail/CRRT return
-Venous Sat Probe
-Centrifugal Pump
-Connection for Pressure Monitoring Cable
-Post-pump/Pre-oxygenator/VBG pigtail
-De-Airing Membrane/Yellow Cap
-Oxygenator
-Post-Pump/Post-Oxygenator/De-airing pigtail/CRRT draw
-Post-pump/Post-oxygenator/ABG pigtail
-Arterial Flow Probe/Air bubble detector
-Arterial Return Cannula
47
Trace blood flow from cannula tip to tip: Cardiohelp Pediatric
-Venous Drainage Cannula
-Port to Bridge (V)/CRRT return
-Venous Manifold Port
-Venous Sat Probe
-Centrifugal Pump
-Connection for Pressure Monitoring Cable
-Post-pump/Pre-oxygenator/VBG pigtail
-De-airing Membrane/Yellow Cap
-Oxygenator (HLS 5)
-Post-pump/Post-oxygenator/De-airing Pigtail/CRRT draw
-Arterial Manifold
-Arterial Flow Probe/Air bubble detector
-Port to Bridge (A)
-Arterial Return Cannula
48
Trace blood flow from cannula tip to tip: Rotaflow Adult
-Venous Drainage Cannula
-Venous Sat Probe
-Pre-pump/Pre-oxygenator/CRRT return pigtail
-Centrifugal Pump
-Post-pump/Pre-oxygenator/VBG pigtail
-De-Airing Membrane/Yellow Cap
-Oxygenator
-Post-pump/Post-Oxygenator/De-airing port/CRRT draw
-Post-pump/Post-oxygenator pigtail/ABG
-Spectrum Arterial Sat Probe
-Spectrum Arterial Flow Probe
-Arterial Return Cannula
49
Trace blood flow from cannula tip to tip: Neonatal Circuit
-Venous Drainage Cannula
-Venous Sat Probe
-Venous Manifold
-Port to Bridge (V)/CRRT return
-Venous Pressure Line (DLP)
-Infusion Ports x2
-Centrifugal Pump
-Post-pump/Pre-oxygenator Pressure Line
-Oxygenator
-De-Airing Membrane/Yellow Cap
-Post-Pump/Post-Oxygenator Pressure Line/CRRT draw
-Arterial Manifold
-Spectrum Arterial Sat Probe
-Port to Bridge (A)
-Spectrum Arterial Flow Probe
-Arterial Return Cannula
50
What is different about the neonatal circuit from the adult Rotaflow and Cardiohelp Circuit?
manifold
bridge
more venous pigtails (infusion ports)
size of oxygenator
size of tubing
51
Function/Location Arterial and Venous Sat Probes:
CardioHelp
RotaFlow
Neonatal Circuit
CardioHelp:
venous: pre-pump/pre-oxygenator; Hgb/Hct/SvO2
arterial: post-oxygenator near the post-oxygenator pigtail
Rotaflow:
venous: external probe on the venous side of the circuit; SvO2 (Spectrum Monitor)
arterial: external probe on the arterial side of the circuit; SaO2, Hgb, Hct (Spectrum Monitor)
Neonatal:
venous: external probe placed proximal to the pt; SvO2 (Spectrum Monitor)
arterial: external probe placed proximal to the pt; SaO2, Hgb, Hct (Spectrum Monitor)
52
Function/Location Pigtails:
Adults CardioHelp: 4 (venous line, post-pump/pre-oxygenator, de-airing/CRRT draw, post-pump/post-oxygenator pigtail)
Pediatric CardioHelp: 2 (post-pump/pre-oxygenator, de-airing pigtail (post-pump/post-oxygenator)
Neonates: 2 (venous pigtails for meds)
53
Function/Location Venous Pressure:
measures pressure from patient
Adult & Pediatric CardioHelp: internal reading pre-pump
Neonatal Circuit: DLP, just past venous bridge port
54
Function/Location Pre-Oxygenator Pressure:
measures pressure of the oxygenator
Adult and Pediatric CardioHelp: internal sensor - post-pump/pre-oxygenator
Neonatal Circuit: DLP connected to post-pump/pre-oxygenator port (Y'd with post-pump/post-oxygenator port)
55
Function/Location Post-Oxygenator Pressure:
measures pressure from return cannula/tubing, and the patient
Adult & Pediatric CardioHelp: internal sensor near post-pump/post-oxygenator port
Neonatal Circuit: DLP connected to post-pump/post-oxygenator/de-airing port (Y'd with pre-oxygenator port)
56
Function/Location Oxygenator:
- oxygenates blood
- gas exchange to blow off CO2
- heat exchanger between circuit and heater/cooler
57
Function/Location Rotaflow Centrifugal Pump:
- pulls blood from patient and pushes blood into the oxygenator
- pre-oxygenator
58
Function/Location CardioHelp Centrifugal Pump:
- pulls blood from patient and pushes into the oxygenator
- pre-oxygenator - attached/one-unit
59
Function/Location of Bridge:
Neonatal Circuit: venous side placed between the manifold and venous pressure line; arterial side is placed proximal to the pt
60
Where is the blood flow measured in the neonatal circuit?
Spectrum Monitor flow probe proximal to the pt on the arterial side
61
Where is blood flow measured in the CardioHelp circuit?
flow probe proximal to the patient on the arterial side
62
Where is blood flow measured in the adult Rotaflow circuit?
- Spectrum Monitor flow probe proximal to the patient on the arterial side
- needs additional paste to pump head directly out of pump (not accurate with <1L flow)
63
Where is the blood flow measured in the LifeSPARC circuit?
flow probe proximal to the patient on the arterial side
64
Where is the blood flow measured in the Centrimag circuit?
flow probe proximal to the patient on the arterial side
65
What is the difference between the CardioHelp and Rotaflow centrifugal pump?
CardioHelp has 4 channels for blood flow and the Rotaflow is a single outlet resting on a sapphire pin
66
How does the Centrimag compare to other pumps?
full magnet levitation with no bearings or seals
67
How does the LifeSPARC compare to other pumps?
magnetically levitated with Single Point Ruby pivot bearing
68
What is an oxygenator failure?
inability for gas exchange or oxygenation with increased sweep
69
What parameters do you evaluate everyday to determine how well the oxygenator is working?
Delta P
SvO2 (VA ECMO)
SpO2 (VV ECMO)
70
What would you see on a patients blood gas that might make you think the oxygenatory is failing?
PaO2 <50
acidosis
71
What physical things do you check on the circuit to determine the functional status of the oxygenator?
the oxygenator itself for clots
gas outlet
72
What factors might cause an oxygenator to fail?
Clots
Air
Power Failure
Occluded Gas Outlet
73
What might the gas exhaust look like in a failing oxygenator?
- little/no exhaust
- pink/red condensation
74
What lab values would you see with a failing oxygenator?
Plasma Free Hgb increased
poor post-oxygenator gases
acidosis
poor patient gases
75
Minimum/Maximum Sweep: Neonatal Quadrox
.1L
3L
76
Minimum/Maximum Sweep: Pediatric Quadrox
.1L
5.6L
77
Minimum/Maximum Sweep: Small Adult Quadrox & 5.0 CardioHelp
.25L
10L
78
Minimum/Maximum Sweep: Adult Quadrox & 7.0 CardioHelp
.25L
14L
79
Minimum/Maximum Sweep: Neonatal Euroset
.1L
3L
80
Minimum/Maximum Sweep: Nautilus Smart ECMO Oxygenator
.25L
21L
81
Minimum/Maximum Blood Flow: Neonatal Quadrox
.2L
1.5L
82
Minimum/Maximum Blood Flow: Pediatric Quadrox
.2L
2.8L
83
Minimum/Maximum Blood Flow: 5.0 CardioHelp
0.5L
5L
84
Minimum/Maximum Blood Flow: Adult Quadrox & 7.0 CardioHelp
.5L
7L
85
Minimum/Maximum Blood Flow: Neonatal Euroset
.2L
1.5L
86
Minimum/Maximum Blood Flow: Nautilus Smart ECMO Oxygenator
.5L
7L
87
What is an indicator of clot formation within your circuit?
- Increase in Delta P
- Increase in Venous Pressures if clots are in the venous side of the circuit
- Increase in Arterial Pressure if clots in arterial side of circuit
- unable to draw/flush pigtails
- dark spots in circuit/oxygenator
88
What does venous pressure indicate in your patient and the circuit?
Decrease in Volume Status; chugging - increase in venous pressure
Kink, tubing/cannula positioning, Clots
89
What does recirculation mean?
oxygenated blood from the return cannula goes back into the drainage cannula; occurs only in V-V ECMO
90
How do you fix recirculation?
reposition cannulas
decrease flows
91
What factors affect recirculation?
cannula positioning
increased pump flow
92
How do you determine if a patient is ready to be weaned off of V-V ECMO?
- successful treatment of the underyling disease
- improved blood gases with less support
93
How do you determine if a patient is ready to be weaned off of V-A ECMO?
- EF of 30%
- improved hemodynamics/cardiac function
- weaning of support meds
- underlying issue treated/recovered
94
How do you test a patient to see if they're ready to be weaned off ECMO?
V-A:
peds/neonates: several clamp out trials
adults: low flow trial at 1L/Zero Flow as well as sweep around 1-2
V-V: cap the oxygenator (12 hrs peds; 24 hrs adults)
95
How do you wean off of V-V ECMO? V-A ECMO?
V-V: only wean sweep; do not change flows
V-A: decrease flow as well as sweep
96
What are potential air traps in the Oxygenator?
top of the oxygenator; de-airing pigtail, de-airing membrane
97
What are the potential air traps in the ECMO Circuit Cannulas?
clamp out patient and get air to the oxygenator or closest pigtails/port
98
What are potential air traps in the Centrifugal Pump Head?
clamp out patient, and flush the cannulas with volume to push air to oxygenator or closest pigtail/port
99
What is Hemolysis?
destruction of RBC
100
What factors cause hemolysis to occur in the ECMO circuit?
- clots
- turbulent flow from increased resistance
- high/low temperature
- acidosis
101
What lab test is drawn to evaluate the degree of hemolysis?
Plasma Free Hgb
102
How do you treat your circuit when hemolysis occurs?
Check for clots
Check for kinks in tubing
Pre-membrane pressure <300 mmHg
Add albumin during priming
Limit negative venous pressure
103
What is the normal range for Plasma Free Hgb?
<12 ; >50 mg/dL = hemolysis
104
Normal Value pH:
7.35-7.45
105
Normal Value PaCO2:
Normal Value pt on ECMO:
35-45
106
Normal Value PaO2:
Normal Value pt on ECMO:
80-100
>200
107
Normal Value Lactate:
0.5-2
108
Normal Value Bicarb:
22-28
109
Normal Value Base Deficit:
+/- 4 from 0
110
Normal Value Hgb:
Normal Value pt on ECMO:
12-15 - women
13-17 - men
adults >7, neonates >10
111
Normal Value Hct:
3x your hgb
112
Normal Value Sodium:
135-145
113
Normal Value Potassium:
Normal Value pt on ECMO:
3.6-5.1
3-5
114
Normal Value Serum Calcium:
8.9-10.7
115
Normal Value Ionized Calcium:
1.16-1.32
116
Normal Value Ionized Magnesium:
.46-.64
117
Normal Value PT:
12.3-14.8 seconds
118
Normal Value aPTT:
Normal Value pt on ECMO:
25-36 seconds
60-80 seconds
119
Normal Value Anti Xa:
.3-.7
if bleeding .2-.25
120
Normal Value ATIII activity:
<30 days
>30 days
44-76%
80-120%
121
Normal Value Plasma Free Hgb:
Normal Value pt on ECMO:
<12
< 50
122
Normal Value Fibrinogen:
200-400 mg/dL
123
Normal Value INR:
Normal Value pt on ECMO:
<2
124
Normal Value Troponin:
0-0.4
125
Normal Value CK:
40-350
126
Normal Value CK mb:
0-5
127
Normal Value ALT:
0-40
128
Normal Value AST:
0-95
129
When do we get a head ultrasound?
pre-cannulation of neonates to rule out possible ICH
130
How often do we get head ultrasounds?
daily for the first three days than every other day
131
What do head ultrasounds tell us and why is it important?
ICH and it's important because it’s a contraindication for cannulation; grade 3 or higher
132
When are chest x-rays done on ECMO patients?
post cannulation and daily/PRN
133
Why are chest x-rays important with ECMO Patients?
to ensure placement of cannulas
134
When are cardiac ECHOs done for adults? neonates?
during weaning to check native cardiac function - ramp down; PRN to confirm cannula placement
pre-cannulation to rule out cyanotic congenital heart disease
135
What supplies do you take from the cannulation cart for an adult being cannulated for V-A ECMO?
Dilators (pikA, sorin)
Venous Cannulas
Arterial Cannulas
Reperfusion cannula
7” tubing
Male to Male adaptor
Sterile Utensils
Sutures
136
What supplies do you take from the cannulation cart for an adult being cannulated for V-V ECMO?
Dilators (venous)
Venous Cannula(s)
Sterile Utensils
Sutures
137
What is a reperfusion cannula?
a cannula placed on the same side as the arterial cannula to perfuse the lower limb with oxygenated blood
138
When is a reperfusion cannula used?
V-A ECMO
139
Why is a reperfusion cannula used?
to provide blood flow to the lower limb of the side the arterial cannula is placed; prevent the lower limb from dying
140
What is Cardiac Output?
quantity of blood pumped by the heart in L/min
141
What is Cardiac Index?
cardiac output from the left ventricle in one minute to BSA
142
What is BSA?
body surface area
143
CO=
native heart function; used to assess ECMO flow
Heart Rate (HR) x Stroke Volume (SV)
CI x BSA
144
CI=
Cardiac Output/BSA
145
What does Viscosity mean?
thickness of a fluid
146
How does viscosity affect ECMO flow?
an increase in viscosity increases resistance which decreases flow
147
What does afterload mean?
- the amount of resistance the heart has to overcome to open the aortic valve and pump blood out (SVR)
- afterload reflects pts BP (increase BP, decrease flows), afterload also affected by by cannula size
148
What does preload mean?
the force that stretches the cardiac muscle prior to contraction; filling pressure of the heart during diastole (LVEDP)
149
What happens to ECMO flow with increased preload:
increase flow due to more volume; negative pressure would become less negative
150
What happens to ECMO flow with decreased preload:
decrease in flow due to less volume; chugging occurs
151
What happens to ECMO flow when afterload increases:
decrease in flow and an increase in post-oxygenator pressure
152
What happens to ECMO flow when afterload decreases:
flows increase and post-oxygenator pressure decreases
153
What is the priming volume for the Rotaflow pump?
32 mls
154
What is the priming volume for the Centrimag pump?
31 mls
155
Oxygen Content (CaO2)=
(Hgb x 1.34 x SaO2) + (PaO2 x 0.0031)
Most important variables- Hgb and SaO2
156
Oxygen Delivery (DO2)=
CaO2 x CO
157
What is the best indicator of oxygen delivery on V-A ECMO?
SvO2
158
What is the best indicator of oxygen delivery on V-V ECMO?
patient gases, SpO2
159
What influences oxygen delivery on V-V ECMO?
- patients lungs due to blood flowing through the patients native lungs
- recirculation - not delivering O2
- Hgb
- CO
- FiO2
160
What influences oxygen delivery on V-A ECMO?
- Hgb
- CO
- FiO2
- Increase Flow
161
What pressures are monitored on a neonatal/pediatric circuit?
Venous Pressure - monitors patient, tubing positioning/kinks
Pre-Oxygenator - monitors oxygenator/clot formation
Post-Oxygenator - monitors afterload/oxygenator, tubing positioning/kinks
162
What pressures are monitored on the CardioHelp circuit?
Venous Pressure - monitors patient (preload dependent)/tubing positioning - kinks
Pre-Oxygenator Pressure - pressure of the oxygenator - clot formation
Post Oxygenator Pressure - monitors patient and oxygenator - afterload sensitive
Delta P - difference in post-oxygenator pressure minus pre-oxygenator pressure; reflects increased resistance of the oxygenator
163
What pressures are monitored in the adult Rotaflow circuit?
With Quadrox none
With Nautilus - pre and post oxygenator pressures
164
What parameters are monitored by the venous probe on the CardioHelp?
Hgb
Hct
SvO2
Temperature
165
What parameters are monitored by the Spectrum Monitor?
Venous Probe:
SvO2
Arterial probe:
SaO2
Hgb
Hct
Flow probe:
Blood flow/air bubbles
166
What does Zero Flow mode do on the CardioHelp?
turns the RPMs to 0 which allows us to check the patients native heart function and is a safety feature for backflow prevention
167
What is the most common complication in ECLS?
bleeding due to anticoagulation
168
List 4 reasons you might emergently remove a patient from ECMO:
air embolism/clots
membrane oxygenator failure
tubing rupture
centrifugal pump head failure
Excessive bleeding
ICH
Accidental Decannulation
169
List 5 causes of circuit air entrainment:
- high negative pressures from kinked tubing
- cutdown/central cannulation with high negative pressures can pull air in around the sutures
- air from central lines (NO PRESSURE BAGS)
- oxygenator membrane rupture if exhaust port is blocked causing air to go into the blood
- venous pigtail on negative pressure side/drawing labs
- cracked tubing/circuit parts
- patient accidentally decannulates
170
What is recirculation?
oxygenated blood gets drained back into the venous drainage cannula
171
4 factors that affect recirculation:
- close proximity of cannulas
- poor cardiac output
- high ECMO flows
- hypovolemia
172
What is the major limiting factor for ECLS blood flow?
Decreased preload
173
If your PCO2 is high, what do you do to the sweep gas?
increase sweep gas
Adults - .5-1L
Neonates - .1L
Peds - .2-.5L
174
What is measured by the Hemochron Signature Elite?
ACT
175
How is a parameter "armed" for the CardioHelp?
activate the chain link by selecting each parameter
176
How do you prep the CardioHelp circuit for the surgeon?
- clamp closes to the oxygenator w/ tubing clamps
- clamp the reservoir w/ white clamps
- disconnect the reservoir w/ quick connects
- hand the circuit to the surgeon sterile
- instruct to clamp and cut the circuit
177
What are signs of cardiac tamponade on V-A ECMO?
- flows would decrease due to decrease venous return - chugging
- increased venous pressure (more negative) due to decrease venous return to the heart
- pt hypotensive
- decrease pulsatility
178
What are signs of a tension pneumothorax on V-V ECMO?
- Decreased lung compliance
- Decrease SpO2
- Decreased flows
- Increased venous pressure (more negative)
179
What parameters do you inspect when doing your circuit checks?
RPMs
blood flow
venous pressure
pre-oxygenator
post-oxygenator
Delta P
SvO2
SaO2
Hgb
Hct
Temperature
Sweep
FiO2
180
Which screen on the CardioHelp allows you to store your lab values?
Press the folder button with either the SvO2, Hgb, or Hct
181
What device is used for CRRT?
NxStage
182
What line is clamped on the Centrimag when changing the pump to another external drive?
Venous and Arterial Lines closest to patient
183
What is the minimum RPMs to be sure of forward flow in Centrimag, CardioHelp, and Rotaflow Pumps?
1700 - to prevent stagnant blood which could cause clotting and backflow
184
List 4 blood products your patients may recieve:
pRBC
FFP
Platelets
Cryoprecipitate
185
When is Crystalloid, Albumin (5%, 25%) and blood products transfused?
- low flows due to hypovolemia; chugging, increased venous pressure
- no pressure bags
186
Normal cultures:
Negative
187
What do we learn from ECHOs?
Cardiac function
Pulmonary artery pressures
188
When do we perform a CT Scan?
Change in patient status
189
What do we learn from CT Scans?
Check for head bleed, abdominal function (w/ contrast)
190
How does a CT scan affect the care of our patient?
Sometimes not tolerated by patient; if poor results then conversation with family to end ECMO
191
When do we go to Fluoroscopy?
To place a double lumen cannula safely
192
What does fluoroscopy tell us?
Cannula placement
193
What patients are most likely to have fluoroscopy?
VV ECMO pts
194
When is a cardiac cath done?
Pt had a STEMI, any ECPR, check for coronary blockage
195
What is the most common bacterial pneumonia?
Streptococcus
196
Maximum weight for ECMO
VV ECMO - <50 BMI
VA ECMO - <40 BMI
197
Minimum weight for ECMO
2 kg
198
What is the minimum gestational age for ECMO?
>34 weeks
199
What tests must be obtained before going on ECMO for neonates?
Head ultrasound
Cardiac echo
Metabolic screening
Basic labs/cultures/chest xray
200
How do I assist in setting up the circuit?
- Plug in the pump
- Plug in gas lines/make sure oxygen is hooked up and on
- water for heater/cooler
- go through pre-initiation checklist
201
What side of the neck is prepared for neonate?
Right
202
What do you check to confirm your circuit is ready?
Check the pre-initiation checklist
203
Normal flow for neonate on ECMO?
100-150 mls/kg
204
Fluid removed during hemofiltration occurs due to
The pressure gradient
205
Heparin dosages may need to be altered when CVVH is added into the system because
Dialysis filter absorbs the heparin
206
Signs and symptoms of oxygenator failure
Increased Pre-Membrane pressure
Increase in Delta P
Decreased O2 and CO2 exchange
Hematuria
Blood leak from gas outlet
207
The ultimate goal of ECLS is
Maximize oxygen delivery
208
What variable actions could you take to increase oxygen delivery?
Increase flows
Increase Hgb
Increase FiO2
209
How is the change of sweep assessed?
ABGs
210
How often do you sigh?
Q2
211
How often do you chart?
Q1 unless a significant event occurs
212
How often do you flush pigtails?
Q4; issues with clotting - Q2
213
Where are primed circuits stored in the hospital?
OR - outside OR 21
NeoMart
ECMO room 531 in ChOR
CSICU - outside of 134
214
How is pRBC/FFP given in Neonates?
Venous infusion ports w/ syringe pump
215
How is platelets/cryo given with neonates?
Arterial side of the bridge
manually given; 5 cc every 5 mins until all is given then flush
216
ECMO improves oxygen delivery by which mechanisms?
- stabilizing of hemoglobin saturations
- taking over at least 60% of the blood flow through functioning membrane lung, away from the sick native lungs
- stabilizing by taking over at least 60% of the cardiac output through the ECMO pump
217
Membrane failure can be characterized by raising pump CO2 levels because of:
alteration in membrane surface area caused by fibrin formation
218
What items will your perfusionist need when they arrive with the circuit?
- cannulation cart
- heparin - 100 IU/kg
- clamps
- pre-initial check list
