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1 > ECMO Circuits and Components > Flashcards

ECMO Circuits and Components Flashcards

1
Q

What are the basic components of all ECMO circuits?

A 
Cannulas
Tubing/Pump boot
Bladder/Reservoir
Blood Pump
Oxygenator 
Heat Exchanger
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2
Q

Additional Components of an ECMO Circuit

A 
Water heater/cooler
Pressure monitoring Transducers
Circuit Bridge
Blood Monitoring
Air detector
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3
Q

Where is the pressure monitor?

A

At bladder

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4
Q

Where does the heparin go in in the ECMO circuit?

A

Heparin going in before the membrane

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5
Q

What are the 3 cannula selection types?

A

Arterial
Venous
Dual Lumen (VV cannula)

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6
Q

0-3 kg: Flow

A

200 cc/kg

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7
Q

3-10 kg: Flow

A

150 cc/kg

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8
Q

10-15 kg: Flow

A

125 cc/kg

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9
Q

15-30 kg: Flow

A

100 cc/kg

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10
Q

> 30 kg

A

75 cc/kg

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11
Q

> 55 kg

A

65 cc/kg

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12
Q

V-A ECMO Target Flows

A

Neonate: 100-150 cc/kg/min
Pediatric: 75-100 cc/kg/min
Adult: 50-75 cc/kg/min

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13
Q

V-V ECMO Target Flows

A

Neonate: 100-120 cc/kg/min
Pediatric: 90-100 cc/kg/min
Adult: 75-90 cc/kg/min

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14
Q

What are the goals of the arterial cannula selection?

A

Make your surgeon happy
Have a large enough cannula to minimize pressure drop
Minimize shear stress
Maintain laminar flow

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15
Q

What are the goals of the venous cannula selection?

A

Make your surgeon happy

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

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16
Q

Flow with pediatrics is ______ based.

A

weight (cc/kg)

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17
Q

Flow with adults is usually ______.

A

indexed (L/min/m2)

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18
Q

What is the aim of the arterial cannula?

A

Utilize the smallest cannula w/ the highest flow rate

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19
Q

Arterial Cannula: Do not exceed pressure drop greater than what?

A

> 100 mmHg

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20
Q

When is the critical velocity reached with arterial cannula?

A

Reached when laminar flow becomes turbulent (Reynold’s number)

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21
Q

Higher pressures = higher ________ = hemolysis = BAD

A

shear stress

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22
Q

What is the aim of the venous cannula?

A

Drain the patient with the smallest cannula.

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23
Q

What should you be aware of the in regard to venous cannula?

A

Be aware of the cannulation site

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24
Q

What is the pressure drop for the venous cannula?

A

-30 to -40 range (pressure-flow curve)

25
Q

Common Cannulation Sites: Peds V-A

A

Right internal jugular vein

Right common carotid

26
Q

Common Cannulation Sites: Peds VV

A

internal jugular vein

27
Q

Common Cannulation Sites: Adult V-A

A

Femoral venous

Femoral arterial

28
Q

Common Cannulation Sites: Adult V-V

A

Femoral venous

jugular venous

29
Q

Jugular cannula allows flow rates exceeding _____ L/min, even reaching ___ L/min for 31 Fr cannulas.

A

4 L/min; 5 L/min

30
Q

Origen V-V Cannula Sizing

A

12 Fr: Children 2-5 kg
15 Fr: Children 4-8 kg
18 Fr; Children 7-12 kg

31
Q

V-V ECMO: Venous blood is drained through….

A

a single lumen of the double lumen cannula

32
Q

V-V ECMO: Arterialized blood is returned……

A

via the other lumen of the double lumen cannula

33
Q

ECMO Tubing is made out of….

A

PVR or Silicone

34
Q

What are the sizes of ECMO Tubing?

A

1/4’’ 3/8’’ 1/2’’

35
Q

Durometer

A

measure of the hardness of a material. Hardness may be defined as a material’s resistance to permanent indentation

36
Q

Each tubing has ____ x _____(2)

A

Size x wall thickness
Ex. 1/4’‘x1/8’’
1/4’’ x 3/32’’

37
Q

What special tubing is formulated to withstand pump boot stress in roller pumps?

A

Super Tygon

38
Q

Walk the raceway every ____ days.

39
Q

Why do you walk the raceway?

A

Minimized spallation

40
Q

Venous Bladders

41
Q

The flow patterns in the _________ (2) are less conducive to clot formation.

A

Better Bladder

42
Q

How does the better bladder result in a shorter venous line?

A

allows active venous drainage without raising the patient on blocks or mattresses resulting in a shorter venous line

43
Q

Venous drainage of the silicone bladder is increased by….

A

raising the patient and/or lowering the bladder

44
Q

Venous drainage of the better bladder in increased by

A

increasing the negative pressure the pump generated

45
Q

Oxygenators

A

Maquet PEds

Cadiohelp

46
Q

Can you use a regular oxygenator in ECMO?

A

It will suffice of off label use

Blood is outside; gas is inside the fiber bundle

47
Q

What was the gold standard until recently?

A

Medtronic circuit

48
Q

What are the 3 basic pressure transducer locations?

A

Pre-oxygenator
Post-oxygenator
Bladder

49
Q

What is the purpose of the ECMO Bridge?

A

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 AV shunt

50
Q

What kinds of bridges will you see?

A

No bridge
1/4’’ and 3/8’’ bridge
Luer lock 1/8’’ bridge

51
Q

What must you do to the AV bRidge frequently

A

Must flash bridge frequently

52
Q

A-V Bridge can be done with 2 stopcocks and 1/8’’ tubing open when needed and …..

A

Reflush with saline

53
Q

Going on ECMO (1/4’’ x 1/4’’ x 1/4’’ bridge)

A

A-B-V
Unclamp Arterial
Clamp Bridge
Unclamp Venous

54
Q

Coming off ECMO

A

V-B-A “Very bad accident”
Clamp Venous
Unclamp Bridge
Clamp Arterial

55
Q

Monitoring Oxygen Kinetics

A

Arterial Blood gases
venous blood gases
venous saturations
cerebral oximetry

56
Q

Blood Gas Monitor Examples

A

Terumo CDI

Maquet BMU 40

57
Q

NIRS

A

Near-infrared spectroscopy technology; such that used in pulse oximetry has been used and trusted in the world of medicine for decades; spectroscopic method that uses the near infrared region of the electromagnetic spectrum

58
Q

What is the infrared spectrum in NIRS?

A

800 nm to 2500 nm

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