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ECMO - peds > Circuits and Components > Flashcards

Circuits and Components Flashcards

1
Q

What 3 pressures do you measure in an ECMO circuit

A

pre oxygenator pressure
post oxygenator pressure
venous inlet (negative pressure)

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2
Q

better bladder – talk about it

A

the venous “reservoir” of an ECMO circuit
a ridged exterior tube with an inner cylastic membrane - outflow is connected to a roller pump, can keep the inner cylastic membrane expanded will create negative pressure sucking blood from the pts atrium (kinda like a centrifugal pump)
you keep a pressure manometer on that outer membrane, “bladder pressure (negative inlet pressure)” set the point to right before cavitation.

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3
Q

how does drainage work with ECMO?

A

kinetic assisted venous drainage, siphoning it out

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4
Q

what shunt may be in the ECMO circuit

A

an arterial venous shunt, with a CDI usually unit
arterial - high pressure
venous - low pressure

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5
Q

Never use what kind of caps in an ECMO circuit?

A

vented caps for transducers, bc they can suck air into the circuit easily

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6
Q

Where do you put heparin in, in an ECMO circuit?

A

pre oxygenator, to avoid clots in the oxygenator.
not before the centrifugal pump bc it can have too much negative pressure and suck in the whole syringe of heparin on accident
neonates - the majority of places still do heparinize for ECMO
use an ACT test 160-220sec

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7
Q

What ACTs are you looking for on ECMO?

A

160 (180)-220 sec

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8
Q

Where do you put the flow probe on an ECMO circuit?

A

After the bridge before the patient so you are totally sure that flow is going to the patient

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9
Q

whats the protocol for the bridge in the ECMO circuit?

A

you keep it clamped the whole time you are on ECMO
who ever is sitting ECMO will have to unclamp and clamp the bridge every 7 minutes to ensure no clots are forming.

sometimes there is a bridge made with two male-male stopcocks filled with saline and you dont have to unclamp all the time. but if you want to test if the patient is ready to come off of ECMO you open them up.

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10
Q

3 cannula selection types for ECMO?

A

Arterial
Venous
Dual Lumen (V-V Cannula)

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11
Q

0-3 flow?

A

200 cc/kg

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12
Q

3-10kg flow?

A

150 cc/kg

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13
Q

10-15 kg flow?

A

125 cc/kg

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14
Q

15-30 kg flow?

A

100 cc/kg

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15
Q

> 30 kg flow?

A

75 cc/kg

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16
Q

> 55 kg flow?

A

65 cc/kg

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17
Q

Will you use vacuum is ECMO?

A

NO

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18
Q

If you pressurize the VR in a normal CPB circuit with vacuum - what happens?

A

the venous line is the least compilable so if the VR is over pressurized the pressure will shoot everything right up the venous line directly into the RA
make sure the relief pop-off valve is OPEN

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19
Q

V-A ECMO

Neonate cc/kg/min??

A

100-150 cc/kg/min

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20
Q

V-A ECMO

Ped cc/kg/min?

A

75-100 cc/kg/min

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21
Q

V-A ECMO

Adult cc/kg/min?

A

50-75 cc/kg/min

22
Q

V-V ECMO

Neonate cc/kg/min??

A

100-120 cc/kg/min

23
Q

V-V ECMO

Ped cc/kg/min?

A

90-100 cc/kg/min

24
Q

V-V ECMO

Adult cc/kg/min?

A

75-90 cc/kg/min

25
Q

Cannulation choices – Flow with Pediatric is what related?

A

weight related (cc/kg)

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

26
Q

Cannulation choices – Flow with Adults is related to what?

A

usually indexed (L/min/m2)

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

27
Q

Arterial ECMO cannulation
aim?
critical velocity of pressure drop????

A

Aim: utilize the smallest cannula w/ the highest flow rate
Do NOT exceed pressure drop > 100 mmHg
Critical velocity is reached when laminar flow becomes turbulent (Reynolds #)
Higher pressures = higher sheer stress = hemolysis = bad

28
Q

Avalon V-V ECMO

A

MOST used cannula?
4-5 LPM
31 FRENCH

29
Q

Venous ECMO cannula
aim?
pressure drop?

A

Aim: drain the patient with the smallest cannula
Be aware of the cannulation site
Pressure drop is in the -30 to -40 range

30
Q

Veno-Arterial PEDS ECMO (V-A) cannulation sites?

A

Right Internal Jugular Vein

Right Common Carotid

31
Q

Veno-Venous PED ECMO (V-V) cannulation sites?

A

Internal Jugular Vein alone

32
Q

Veno-Arterial Adults ECMO (V-A) cannulation sites?

A

Femoral Venous

Femoral Arterial

33
Q

Veno-Venous Adults ECMO (V-V) cannulation sites?

A

Femoral Venous

Jugular Venous

34
Q

What is the tubing in an ECMO race way made of?

A

Super Tygon Tubing

The race way is about 5 feet long so that you can walk the race every 5-7 days so the tubing in the raceway when it is getting worn out you can just move it down

35
Q

The Origen V-V Cannula

12 Fr for children what wt?

A

2-5 Kg

36
Q

The Origen V-V Cannula

15 Fr for children what wt?

A

4-8 Kg

37
Q

The Origen V-V Cannula

18 Fr for children what wt?

A

7-12 Kg

38
Q

Veno-Venous ECMO

Venous blood is drained through what and arterialized blood returned where? (special kind of cannula)

A

through a single lumen of a double lumen cannula

Arterialized blood is returned via the other lumen

39
Q

V-V Canuula Size and ?Patient Weight Range
?F 2-5 kg
?F 4-8 kg
?F 7-12 kg

A

12F
15F
18F

40
Q

Poiseuille’s Law:

A 
=  ΔP  x  π r4/L x V x 8 
ΔP:pressure difference or gradient 
r:radius of tube 
L:length of tube 
V: viscosity of the fluid 
8:constant of proportionality 
*If you double the length, blood flow is cut in ½ 
*If you double the viscosity, blood flow is cut in half
41
Q

ECMO tubing
material?
standard sizes?
how do the sizes come?

A

PVC or Silicone, Special tubing (Super Tygon)
Standard sizes are ¼”, 3/8”, and ½”
Durometer-measure of the hardness of a material.
Hardness may be defined as a material’s resistance to permanent indentation.
Each has size x wall thickness (1/4” x 1/8” or ¼” x 3/32”)

42
Q

Super Tygon Special tubing is formulated to do what?

A

is formulated to withstand pump boot stress in roller pumps

Can walk the raceway every 7 days,Minimizes spalation

43
Q 
Boot vs SV/Revolution
3/16” ?cc
¼” ?cc
3/8” ?cc
½” ?cc
A 
7cc (x100 = 700cc MAZ)
13cc (x100=1300cc MAX)
27cc (x100=cc MAX)
45cc (x100-cc MAX)
* Do NOT exceed 100 rpm’s for maximum tubing flows
44
Q

Going on ECMO?

A

A-B-V

unclamp arterial, move it to the bridge, unclamp venous

45
Q

Coming off ECMO?

A

V-B-A (very bad accident)

clamp venous, unclamp bridge use that clamp to clamp the arterial line

46
Q

Kids can get inter-cranial bleeds when in what oxygen state?

A

hypoxic

acidosis —> inter-cranial bleeding —>strokes

47
Q

Can any oxygenator work for ECMO?

A

Any oxygenator will suffice for off label use

Blood outside-Gas inside the fiber bundle

48
Q 
Quadrox Adult Specifications
BF rate?
total prime volume?
SA?
material oxygen membrane?
A

0.5-7 LPM
250ml
1.8m2
polymethylpentene

49
Q

The ECMO bridge?

A

The 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 A-V shunt
Can be done with 2 stopcocks and 1/8” tubing open when needed and reflush with saline

you’ll see–
No bridge
¼” and 3/8” bridge
Luer lock 1/8” bridge

50
Q

ECMO monitoring?

A

Arterial Blood gases
Venous Blood gases
Venous Saturations
Cerebral Oximetry

51
Q

NIRS on ECMO?

nanometers?

A

Near-infrared spectroscopy (NIRS) technology, such as that used in pulse oximetry, has been used and trusted in the world of medicine for decades.
Near-infrared spectroscopy (NIRS) is a spectroscopic method that uses the near-infrared region of the electromagnetic spectrum
(from about 800 nm to 2500 nm)

ECMO - peds (3 decks)

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