Ecmo 2 Flashcards
ECMO phone numbers 1/2
5-8070
5-8071
Extra safety checks (6)
Emergency equipment in drawers, clamps, emergency vent settings, heparin calculation, rapid infuser, o2 tank.
Name of PICU ECMO medical director
Mark Eikenberry
Name of the dialysis line
Medcomp
Bad delta
Doubles or over 40
Roller pump, when traveling remember to
Remove air cap and hook up rapid infuser
Flushing transducers
Take off air cap
When on CRRT, what lab should bedside draw?
Lytes
istat
Few drops of blood first!
2 NPs in PICU
Kendel or Stacey
NICU ECMO medical director
Lia Gravarie
Risk factor for a failing oxygenator
Sepsis (sometimes they plasmapherese sepsis to remove cytokines/toxins)
What’s one way to test your oxygenator when you think it’s failing?
Increase the FiO2 and see if post oxy pao2 increased. Do the formula FiO2 x 3-5
Strange dressing that needs blood to adhere to it
Patch pro
What can you NOT use on a cannula
Stat seal and secure a port
Brand name of the DLVV
Avalon
Who needs irritated blood
<4 mo and immunocompromized. Only blood and platelets get irritated. It means lymphocytes are deactivated
Syringe blood will have what type of preservative?
Adsol
Once adsol is removed, how long is it good for?
24hrs. They will remove adsol on patients <4 months
When you order a cooler, what can BB keep down stairs?
Platelets
Blood banks phone number
6824
When to order a cooler (or ask)
Stenting, transport, chest tube, bronch, if anesthesia is present they should be the ones ordering it
When ordering a cooler how do you activate it?
Sending down the yellow sleep, UST has it
How is prime blood labeled?
Orange tag
Cooler considerations if giving 40mls
Ask BB if they should send you a syringe or use a bag you already have. Also use oldest blood in the cooler first!
Notify perfusion on cardiohelp if RPMs exceed
4,000
Istat, how long to warm up to room air in box and not in box?
1hr and 5mins
istat batteries
Get them from lab, recycle with biomed
Date them once warmer, Chem 8, CG8 and CG4 with expiration
Chem8 is good for 2 weeks, CG4/8 2 months
How to prevent reflux if heparin into the line
Don’t open stop cock, set timer for 10 mins as it’s running
One easy way to help an overly negative bladder pressure?
Raise the bed
The other PICU doc (he studders)
Jeff Nowak
When on VV, low sats..
Might need to increase flow if they are super low like 30
Transplant kids when ordering blood
Talk to BB to see if you can use the same donor
When should you put on your rapid infuser?
Travel and procedures
When traveling:
Get rapid infuser in line, name band on clip board, tie up syringes, get cart ready, blood cooler ordered by you or anesthesia, consider transport warmer if long transport, go over checklist
Who removes zip ties?
Perfusion
Tell perfusion if peds oxygenator needs sweep of
7L
Temperature, slowly..
Rewarm slowly
If scuffing ACT must be ——— or heparin level must be ——
ACT 160 or hep gtt 10-12.5
When weaning flows, watch your CDI for what?
May need to wean sweep, watch CO2
Max temp setting
39 degrees
What kind of stop cock needs to be on fluid line?
ECMO on/off stop cock
Anticoagulation during a complication: how many units to give or ACT is
<120
120-160
160-200
>200
(Given to failing circuit before complete failure, or not at all. No makeup doses)
<120 give 75u/kg
120-160 50u/kg
160-200 25u/kg
>209 none
Update: prime blood should be less then how many days old?
7 days
Adsol doesn’t HAVE to be removed in an emergency
What to do if sweep is .1 and co2 is 30? On VV ECMO.
Call provider to ask to come off ECMO (sweep off)
Centramag for infants under —— kg in CV
15kg
What are the 4 factors of recirculation?
Too high of flow, position of cannula, low intravascular volume (dehydration or pneumo), decreased cardiac output.
Resting ecmo PEEP settings
Might be 10-12, especially if we need the lungs help to oxygenate, higher peep may be necessary during the initial capillary leak phase
Who is at the most risk of developing differential hypoxemia?
A respiratory pt on VA
Lia G
NICU ECMO medical director
Crrt don’t remove more then ? /kg
4/kg/hr
Dopamine and PVR vs Vaso and PVR
Dopa increases, bad in pulm HTN, Vaso decreases
DIC labs: INR,Hep U, PTL, Fibrinogen, plasma hgb, ACT
Higher: INR, plasma hgb, act. Others low
Blood or cristalloud primed circuit is short in what? What do you replace?
Platelets and fibrinogen
How long is a CRRT bag good for?
24 hours from the time the bag is cracked by pharmacy. It will say the time on the label
When starting CRRT, what should you have at the bedside?
Calcium dose, fluid for bonus, consider what their sodium is if going on a clear prime of saline. Make sure ical, Hgb and sodium (for clear) are healthy for patient
Temp for warmer sleeve when doing CRRT
43 degrees
Citrate, once metabolized by the patient Leaves what behind?
Bicarbonate
Pre/post filter replacement
Pre Dilutes out your “dirty” blood so the solvents can actually cross the CRRT membrane. Called “solvent drag”. Example watching the rain pull a leaf down a gutter. Fluid can pull things across.
Post replacement.
Done, because we pulled off the good/bad and the ugly. So we replace it so our electrolytes don’t get too low. So based off labs you may run post replacement fluid.
Solution is needed to “replace” and removed “volume” and replenish lost electrolytes
Liver failure in CRRT will cause (if on citrate)
Citrate lock
Heparin dosing when going on CRRT
Will give loading “bolus” dose of heparin (only if your not on ECMO)
Suggestions for CRRT frequent clotting (4)
Maintain higher BFR. Larger catheter. Use pre filter replacement fluid. Rarely, use citrate and heparin
Heater cables, for CRRT. We have gray and blue for which filters
Gray is for HF1000 & HF 1400
Blue is for HF20
CRRT: if you’re having pressure/pod issues
Clean/tape it. Make it do a self test
How long is blood recirculate good for for CRRT?
1hr exactly
If I CRRT circuit is clear primed, how long is it good for? What do you do 30mins prior to putting it on a patient?
Good for 3 days, hit “reprime” with a new bag of NS.
How long is the CRRT battery good for?
0-7mins, expect <5
Who should you make sure if around or at least knows, prior to initiating CRRT?
Any new CRRT circuit tell intensivist
What do you check after AM hospital generator check?
That your heater is still on
When opening bridge on your own, what do you need to do?
Flush out the clot
RPMs changing unprovoked on cardiohelp
Clot
3 factors that increase your bicarbonate
-the citrate in blood products, use of diuretics, NG suction.
