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ECMO > ecmo > Flashcards

ecmo Flashcards

1
Q

what is the half life of Heparin?

A

1.5 hours

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2
Q

Consideration of femoral VA ECMO patients?

A

Depending on mixing cloud, R Aline might not work for blood gasses, may need to use the pump arterial gas

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3
Q

Drugs that bind to ECMO circut

A

Fentanyl & Propofol

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4
Q

Normal Plasmahemoglobin level?

A

<30

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5
Q

IF bladder ( venous) pressure is becoming more negative

A

Kink, clot, position, preload, agitation, pneumo, tamponade

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6
Q

Reasons your delta P may DECREASE

A

decreased blood viscosity, decreased flow, opening of bridge

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7
Q

Heparin on the septic/inflamed patient

A

may need higher dose b/c of coagulopathy

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8
Q

Why don’t they irradiate blood ahead of time?

A

The K increases more with time post irradiation

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8
Q

Why don’t they irradiate blood ahead of time?

A

The K increases more with time post irradiation

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9
Q

Leukoreduced causes what to happen to PRBCs?

A

PRBCs lose efficacy to 85%

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10
Q

What does irradated mean?

A

donor lymphocytes are inactivated

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11
Q

What do you do if all of the sudden your pt isnt oxygenating and CO2 is rising?

A

check the sweep line for kinks (can try putting it on the tank), is your post oxygenator O2 low too? issue with oxygenator, look for clots, increase in delta P, increase RPMs,

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12
Q

Return/arterial pressure increasing

A

kinks, clots, position (check xray), is pt hypertensive? Sedation? zero lines

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13
Q

What to do if air is in the arterial line?

A

Emergency, stop pump/clamp above air, call for help, emergency vent settings/ escalation of inotropes, walk air to nearest leur connection or open bridge to get air out

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14
Q

Normal vs ECMO PT levels

A

PT normal 12-14 seconds, ECMO 15-16- correct with FFP

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15
Q

Normal vs ECMO PTT levels

A

PTT normal 24-36 seconds, ECMO 60-90. Correct with Heparin

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16
Q

PTT affected by ___, influenced by ___

A

affected by heparin, influenced by PTL/fibrinogen/clotting factors

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17
Q

What interferes with Hep U level

A

High bilirubin, high triglycerides, high plasmahemoglobin. Hep U is not inflienced by PTL or clotting factors

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18
Q

What might you need to give after giving factor 7?

A

FFP because it used up your

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19
Q

how does hypothermia affect clotting times?

A

it delays clotting time and alters PTL function

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20
Q

How does bilirubin affect coag labs?

A

increases PTT and decreases Hep U

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21
Q

How does hemolysis affect coag labs?

A

Decreases PTT and Hep U

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22
Q

If Hep U is normal, PTT/ACT are low

A

check AT3, give FFP

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23
Q

If Hep U is normal, PTT/ACT are high

A

r/o DIC (d-dimer), decrease heparin, give FFP

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24
Q

If Hep U is low, and PTT/ACT is low

A

give heparin bolus/increase gtt

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25
Q

If hep U is low, and PTT/ACT high

A

increase heparin, r/o DIC, give FFP.

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26
Q

what should you consider when weaning flows?

A

Going upon heparin & you may need to wean sweep

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27
Q

VA considerations with sweep

A

never turn it off,

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28
Q

What weight gets 1/4” circuit?

A

<10kg ]

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29
Q

name of our 2 heaters

A

cardioquip and microtemp

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30
Q

what color are the pediatric/adult oxygenators?

A

peds is blue (blue baby), and white is adult

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31
Q

how do you clamp roller pump?

A

VBA

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32
Q

On roller pump, where is CRRT access/return?

A

Idk anymore

33
Q

When restarting from clamped/off cardiohelp..

A

unclamp slowly, RPMs at least 1500

34
Q

what are the optimal RPMs for cardiohelp to reduce hemolysis

A

2,000-4,000

35
Q

How late is perfusion usually around until?

A

4pm

36
Q

what to check before a controlled new cannulation on a neo?

A

Head ultrasound

37
Q

whats the formula to assess how well oxygenator is working?

A

your pump FiO2 x 3-5 = post oxygenator PaO2, if this is bad, consider sighing, old oxygenator.

38
Q

To assess your patients lung, can do “cilley” test

A

go up on their vent FiO2 and see if sats go up

39
Q

what should you assess if seeing multiple venous bubbles

A

assess site for proline deficiency

40
Q

water heater… refilling..

A

do it slowly, water is cold

41
Q

Your post oxygenator PaO2 shouldn’t be lower then..

A

150

42
Q

As your diuresis on VA ecmo, your PaO2

A

may increase as less blood goes through heart, more through pump

43
Q

On Cardiohelp, when accessing arterial side…

A

flush anything SLOWLY or bubble detector will alarm

44
Q

your patient keeps getting PTL w/o solid gain in PTL level

A

DIC

45
Q

How do you fix circuit DIC?

A

change the circuit so you stop consuming factors on y our old clotty circuit, may need a couple changes. Can also do plasmapheresis

46
Q

clamp

A

off sweep

47
Q

what an air lock in your cardiohelp?

A

the air in your pump stops forward flow

48
Q

If you need to remove air on arterial side of oxygenator

A

add saline as you pull air so you don’t cavitate

49
Q

on VV ecmo, sats 80s are ok if:

A

good lactate, UOP adn perfusion

50
Q

VA ecmo, if PaO2 is too high

A

you may have no CO and LV stun, check echo to see if flows are too high assess need for septostomy

51
Q

any baby with pulm HTN going on VV

A

R heart gets support when VV ecmo provides oxygen to PAs

52
Q

ratio of sweep/flow when starting ecmo

A

1:1 unless there is chronic co2 retention

53
Q

signs of cardiac distension

A

ART line is flat, PaO2 is high, CVP high

54
Q

what happens to CVP when you start VA ecmo

A

it goes down due to VA steal

55
Q

Ways to improve oxygen delivery (6)

A

-increase FiO2, increase flow (but not past max flow rate or O2 can worsen), increase hemoglobin, improve native cardiac output, new oxygenator, sedate/paralyze/cool

56
Q

How to change CO2? (3)

A

Increase sweep, change oxygenator, sigh oxygenator

57
Q

Hgb in VV vs VA patients

A

VV might be kept higher if there is no native lung function, VV had lower sats

58
Q

250ml NS bag

A

<10kg

59
Q

500ml NS bag

A

10-30kg

60
Q

1L bag NS

A

> 30kg

61
Q

What weight gets a blood prime?

A

<30kg

62
Q

Excessive negative venous pressure can cause

A

Hemolysis, cavitation, vessel wall damage. If it’s sudden, may just be sucking up against vessel wall- gave fluid, reposition

63
Q

What causes pre oxygenator pressure to increase?

A

Hypertension, clotting oxygenator, clots or kinds to cannula

64
Q

Where can you NOT administer things with a string or large volume pump?

A

In the negative side of the circuit. But you can give fluid via push under constant supervision

65
Q

Where should blood and FFP be given if it must be on the circuit?

A

Into a pre oxygenator pigtail with and IV pump. If more emergent, can give via push on negative limb prepump.

66
Q

Where when needed, do you give platelets and cryo?

A

Post oxygenator on a pump

67
Q

Where do you give medications on a circuit? Like vanco

A

Pre oxygenator

68
Q

Where does the prismaflex access and return?

A

Access on venous limb, first set of pigtails by lab draw. Return to CDI by heparin

69
Q

Venous pressure alarms- warning/alarm/max

A

-80/-100/-120

70
Q

Pre oxygenator pressures warning/alarm/max

A

290/300/350

71
Q

Post oxygenator pressures warning/alarm/max

A

280/290/340

72
Q

Gas pressure warning/alarm

A

20/40

73
Q

Where should the alarms be on the transonic flow meter?

A

20% above/below flow target

74
Q

How often should you flush and zero transducers?

A

Flush q4
Zero q shift

75
Q

The flow probe ONLY transonic.

A

Should be lubricated. And only repositioned above the bridge of circuit is deforming or signal is deficient

76
Q

What can be plugged in on the ECMO cart?

A

The transonic and CDI. Nothing else.

77
Q

When your done with heaters…

A

Don’t empty them! Or they have to go to biomed to be refilled

78
Q

How do you calibrate CDI if the bridge is open?

A

With the Patient VBG, not pump, because pump is affected by open bridge

79
Q

What do you do if you need to open the bridge?

A

Perfusion can be paged during daytime hours, otherwise include it in the morning page

80
Q

Minimum quadrox flow for adult/peds

A

Adult is 0.5LPM
Peds 0.2LPM
But goal is always 1LPM

81
Q

Minimum sweep/flow on VA patients? (Non cardiac)

A

0.1 sweep
30% FiO2

ECMO (3 decks)

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