Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Ecmo > Equipment > Flashcards

Equipment Flashcards

1
Q

Trace the flow of blood through your circuit from cannula tip to cannula tip
Cardiohelp adult

A

1) venous cannula
2) pre pump/ pre oxygenator/ CRRT- return pigtail
3) venous sat probe (HB, HCT, venous temp)
4) cardiohelp centrifugal pump
5) connection for pressure monitoring cable - post pump/pre oxygenator/VBG pigtail
6) yellow de-airing cap
7) oxygenator 7.0
8) post pump/post oxygenator/de-airing/CRRT pull pigtail
9) post pump/ post oxygenator/ABG pigtail
10) flow probe & bubble detector
11) Arterial cannula

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Trace the flow of blood through your circuit from cannula tip to cannula tip
Cardiohelp (pediatric)

A

1) venous cannula
2) bridge (venous side) & CRRT return
3) venous manifold port
4) venous sat probe (HB, HCT, venous temp)
5) cardiohelp centrifugal pump
6) connection for black monitoring cable - post-pump/pre oxygenator/VBG pigtail
7) yellow de-airing cap
8) post pump/ post oxygenator/ de-airing pigtail
9) post pump/ post oxygenator Arterial manifold port
10) flow probe & bubble detector
11) bridge (Arterial side)
12) Arterial cannula

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Trace the flow of blood through your circuit from cannula tip to cannula tip
Rotaflow adult circuit with Spectrum

A

1) venous cannula
2) venous sat probe (Svo2)
3) pre pump/ pre oxygenator/ CRRT return pigtail
4) Rotaflow centrifugal pump
5) post pump/ pre oxygenator/ VBG pigtail
6) yellow de-airing cap
7) oxygenator
8) post pump/post oxygenator/ABG pigtail
9) spectrum Arterial sat probe (HCT, HB)
10) spectrum flow probe
11) Arterial cannula

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the difference about the neonatal circuit from the adult Rotaflow and Cardiohelp circuit?

A

Bridge, more venous pigtails, mainfold

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the function of and location within the circuit of the following
Arterial and venous sat probes

A

Cardiohelp venous- pre pump on the mounted center
Cardiohelp Arterial- post oxygenator near the pigtail for ABG access
Rotaflow venous (Spectrum monitor)- external probe near venous cannula
Rotaflow Arterial (Spectrum monitor)- external probe near Arterial cannula
Neonatal venous (Spectrum Monitor)- External probe placed proximal to the patient from the recirculation line from the manifold

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the function of and location within the circuit of the following
Pig tail

A

Adult Cardiohelp- 4 (venous line, post pump/pre oxygenator, post pump/ pre oxygenator/de-airing, post pump/post oxygenator/ABG
Pediatric Cardiohelp- 2 (post pump/pre oxygenator and post pump/post oxygenator/de-airing)
Neonatal circuit- 2 (venous med infusion)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the function of and location within the circuit of the following
Venous pressure

A

Adult and pediatric Cardiohelp- internal reading pre pump
Neonatal circuit- on a red box connected right after the bridge (when comparing position to the patient)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the function of and location within the circuit of the following
Pre Oxygenator Pressure

A

Adult and pediatric Cardiohelp-internal post pump/ pre oxygenator
Neonatal circuit-on a red box connected to the post pump/pre oxygenator port (Y’d in with the post oxygenator pressure)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the function of and location within the circuit of the following
Post oxygenator pressure

A

Adult and pediatric Cardiohelp-internal near the post pump/post oxygenator pigtail
Neonatal circuit- on a red box connected to the post pump/post oxygenator port (Y’d in with the pre oxygenator pressure)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the function of and location within the circuit of the following
Oxygenator

A

Oxygenates the blood, removes CO2, also acts as the heat exchanger between the circuit and heater/cooler
Placed post pump

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the function of and location within the circuit of the following
Rotaflow Centrifugal Pump

A

Pre oxygenator, pushed blood into oxygenator

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the function of and location within the circuit of the following
Cardiohelp Centrifugal Pump

A

One unit with the oxygenator (still technically pre oxygenator within the circuit)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the function of and location within the circuit of the following
Bridge in neonatal and pediatric Cardiohelp circuit

A

Neonatal- venous side is placed between the manifold recirculation line and the venous pressure line, Arterial side is proximal to the patient

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Is there a bubble detector in the neonatal circuit?

A

No, not in the true sense. Spectrum Monitor does have the ability to track emboli

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Where is the blood flow measured in the neonatal circuit?

A

Spectrum monitor flow probe proximal to the patient on the Arterial side

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Where is blood flow measured in the cardiohelp circuit?

A

Flow probe proximal to the patient on the Arterial side

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Where is blood flow measured in the adult Rotaflow circuit?

A

Spectrum monitor flow probe proximal to the patient on the Arterial side

Needs addition of paste to the pump head directly out of the pump

(Not accurate for flows less than 1 liter), does not account for flows lost in shunts within the circuit (bridges and manifold)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Where is blood flow measured in the LifeSPARC circuit?

A

Flow probe proximal to the patient on the Arterial side

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Where is the blood flow measured in the Centrimag circuit?

A

Flow probe proximal to the patient on the Arterial side

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is the difference between the cardiohelp and Rotaflow centrifugal pump?
How does the Centrimag compare to the other pumps? How does the LifeSPARC compare to the other pumps?

A

Cardiohelp is one unit with an oxygenator, has internal measurements, and uses four channels to disperse the blood throughout the oxygenator.
The Rotaflow is a single outlet, resting on a sapphire pin.
The Centrimag is full magnetic levitation (no bearing). The bearing is a place for clot to form and an area where temperature can increase, causing hemolysis.
The LifeSPARC has a single point ruby bearing with a 16 ml priming volume and is why it needs higher RPMs to reach the same amount of flows as others

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Describe oxygenator failure

A

Decreased gas exchange, unable to add oxygen or remove CO2 even with an increased sweep

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What parameters do you evaluate everyday to determine how well the oxygenator is working?

A

Delta P & venous saturation ( for VA ECMO)
For VV ECMO you would look at the patients saturation.
Recirculation can cause an increased venous saturation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What would you see on a patient’s blood gas that might make you think failure?

A

PaO2 < 50, acidosis, PCO2 that high

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What physical things do you check on the circuit to determine the functional status of the oxygenator?

A

Check for clots, check the gas line

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What factors might cause an oxygenator to fail?

A

Clots, condensation in the oxygenator, occluded gas exhaust causing increased gas pressures on the membrane.
Sighing the membrane is done to expel the condensation from the oxygenator

26
Q

What might the gas exhaust look like in a failing oxygenator?

A

If it is pink/red condensation

27
Q

What might you see in lab values in a failing oxygenator

A

High plasma free hemoglobin, poor ABG (pump and patient), decreased patient SpO2

28
Q

Minimum and maximum sweep for
Neonatal Quadrox

A

0.1- 3 L/min

29
Q

Minimum and maximum sweep for
Pediatric Quadrox

A

0.1- 5.6 L/min

30
Q

Minimum and maximum sweep for
Small adult Quadrox & 5.0 Cardiohelp

A

0.25- 10 L/min

31
Q

Minimum and maximum sweep for
Adult Quadrox & 7.0 Cardiohelp

A

0.25- 14 L/min

32
Q

Minimum and maximum sweep for
Neonatal Euroset

A

0.1- 3 L/min

33
Q

Minimum and maximum sweep for
Nautilus ECMO smart oxygenator

A

0.25-14 L/min

(This pump actually has a recommended sweep flow range of 0.25-21 L/min, but we will accept twice the blood flow range for continuity)

34
Q

What is the minimum and maximum blood flow
Neonatal Quadrox

A

0.2-1.5 L/min

35
Q

What is the minimum and maximum blood flow
Pediatric Quadrox

A

0.2-2.8 L/min

36
Q

What is the minimum and maximum blood flow
Small adult Quadrox & 5.0 Cardiohelp

A

0.5-5.0 L/min

37
Q

What is the minimum and maximum blood flow
Adult Quadrox & 7.0 Cardiohelp

A

0.5-7.0 L/min

38
Q

What is the minimum and maximum blood flow
Neonatal Euroset

A

0.2-1.5 L/min

39
Q

What is the minimum and maximum blood flow
Nautilus ECMO smart oxygenator

A

0.5-7.0 L/min

40
Q

What is an indicator of a clot formation within your circuit?

A

Dark spots in the circuit, increase in Delta P, increase in venous pressure and chugging (if clot is in venous cannula), increased Arterial pressures if in the Arterial cannula, unable to flush/draw from pigtails

41
Q

What does venous pressure tell you about your patient and the circuit?

A

An increased venous pressure (chugging) indicates that the patient is hypovolemic. Could also indicate misplacement in the cannula (try decreasing flows and the flowing back up)

42
Q

Describe the phenomenon of recirculation?

A

When drainage and return cannulas are too close together they will recirculate the blood throughout the circuit and not deliver it to the patient

43
Q

What mode is recirculation most likely to be seen in

A

VV ECMO

44
Q

How do you resolve the problem of recirculation

A

Reposition cannulas, decrease flows. Most of the time you will be asked to decrease flows first because of the repositioning of cannulas is risky

45
Q

What are factors affecting recirculation?

A

Increased blood flow, cannula position

46
Q

How do you determine if a patient is ready to be weaned from ECMO
VV ECMO

A

Improved blood gases with less support. Underlying issue treated/recovered

47
Q

How do you determine if a patient is ready to be from ECMO
VA ECMO

A

Improved cardiac function, hemodynamics, EF of 30%
Weaning off supporting meds.
Underlying issue (treated/recovered)

48
Q

How is a patient tested to see if he is ready to be weaned from ECMO

A

VA- peds/neos are several clamp out trials, adults will do a low flow trial at 1 liter or will utilize zero flow mode momentarily (under the direction of a physician) as well as a sweep around 1-2 with 50%ish Fio2

VV- cap the oxygenators (Peds/Neos - 12 hours, Adults 24 hours). Draw periodic patient ABGs

49
Q

Describe how the patient is weaned from VV ECMO

A

Only wean the sweep. Don’t change the flows.
Adults off sweep for 24 hours+, pediatrics is 12 hours+

50
Q

Describe how the patient is weaned in VA ECMO

A

Will wean the flows as well as the sweep

51
Q

Why are weaning procedures different?

A

VV ECMO supports the pulmonary system. Need to wean based on lung function

VA ECMO supports the cardiac system. Need to wean based on cardiac function.

52
Q

What are potential air traps in the ECMO circuit
Oxygenator

A

Top of the oxygenator, remove air with de-airing membrane and pigtail

53
Q

What are potential air traps in the ECMO circuit
Cannula

A

At the connecters, remove air at the nearest pigtail

54
Q

What are potential air traps in the ECMO circuit
Centrifugal head

A

With enough air, will stop forward flow. Remove air at nearest pigtail

55
Q

TRICK QUESTION. When assessing a patient’s oxygenation status on VA ECMO which of the following is the best indicator of adequacy of oxygenation?

A

pre membrane saturation

56
Q

Define Hemolysis

A

When blood cells rupture

57
Q

What factors in the circuit can cause hemolysis

A

Turbulent flow, increased heat caused by the pump, high pressures due to increased resistance (small cannulas, clot in oxygenator), severe acidosis (making changes to that quickly)

58
Q

What lab test is drawn to evaluate degree of hemolysis?

A

Plasma Free Hemoglobin

59
Q

How do you treat your circuit? For Hemolysis

A

Check for clots, kinks in tubing, pre-membrane pressure < 300 mmHg, possibly add albumin to the prime, limit negative venous pressure

60
Q

What is the normal range for this specific test? Plasma free hemoglobin

A

< 12 mg/dL (when > 50 mg/dL, discussion to change circuit begins, can cause renal impairment)

Ecmo (7 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions