Equipment Flashcards
Trace the flow of blood through your circuit from cannula tip to cannula tip
Cardiohelp adult
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
Trace the flow of blood through your circuit from cannula tip to cannula tip
Cardiohelp (pediatric)
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
Trace the flow of blood through your circuit from cannula tip to cannula tip
Rotaflow adult circuit with Spectrum
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
What is the difference about the neonatal circuit from the adult Rotaflow and Cardiohelp circuit?
Bridge, more venous pigtails, mainfold
What is the function of and location within the circuit of the following
Arterial and venous sat probes
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
What is the function of and location within the circuit of the following
Pig tail
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)
What is the function of and location within the circuit of the following
Venous pressure
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)
What is the function of and location within the circuit of the following
Pre Oxygenator Pressure
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)
What is the function of and location within the circuit of the following
Post oxygenator pressure
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)
What is the function of and location within the circuit of the following
Oxygenator
Oxygenates the blood, removes CO2, also acts as the heat exchanger between the circuit and heater/cooler
Placed post pump
What is the function of and location within the circuit of the following
Rotaflow Centrifugal Pump
Pre oxygenator, pushed blood into oxygenator
What is the function of and location within the circuit of the following
Cardiohelp Centrifugal Pump
One unit with the oxygenator (still technically pre oxygenator within the circuit)
What is the function of and location within the circuit of the following
Bridge in neonatal and pediatric Cardiohelp circuit
Neonatal- venous side is placed between the manifold recirculation line and the venous pressure line, Arterial side is proximal to the patient
Is there a bubble detector in the neonatal circuit?
No, not in the true sense. Spectrum Monitor does have the ability to track emboli
Where is the blood flow measured in the neonatal circuit?
Spectrum monitor flow probe proximal to the patient on the Arterial side
Where is blood flow measured in the cardiohelp circuit?
Flow probe proximal to the patient on the Arterial side
Where is blood flow measured in the adult Rotaflow circuit?
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)
Where is blood flow measured in the LifeSPARC circuit?
Flow probe proximal to the patient on the Arterial side
Where is the blood flow measured in the Centrimag circuit?
Flow probe proximal to the patient on the Arterial side
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?
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
Describe oxygenator failure
Decreased gas exchange, unable to add oxygen or remove CO2 even with an increased sweep
What parameters do you evaluate everyday to determine how well the oxygenator is working?
Delta P & venous saturation ( for VA ECMO)
For VV ECMO you would look at the patients saturation.
Recirculation can cause an increased venous saturation
What would you see on a patient’s blood gas that might make you think failure?
PaO2 < 50, acidosis, PCO2 that high
What physical things do you check on the circuit to determine the functional status of the oxygenator?
Check for clots, check the gas line
What factors might cause an oxygenator to fail?
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
What might the gas exhaust look like in a failing oxygenator?
If it is pink/red condensation
What might you see in lab values in a failing oxygenator
High plasma free hemoglobin, poor ABG (pump and patient), decreased patient SpO2
Minimum and maximum sweep for
Neonatal Quadrox
0.1- 3 L/min
Minimum and maximum sweep for
Pediatric Quadrox
0.1- 5.6 L/min
Minimum and maximum sweep for
Small adult Quadrox & 5.0 Cardiohelp
0.25- 10 L/min
Minimum and maximum sweep for
Adult Quadrox & 7.0 Cardiohelp
0.25- 14 L/min
Minimum and maximum sweep for
Neonatal Euroset
0.1- 3 L/min
Minimum and maximum sweep for
Nautilus ECMO smart oxygenator
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)
What is the minimum and maximum blood flow
Neonatal Quadrox
0.2-1.5 L/min
What is the minimum and maximum blood flow
Pediatric Quadrox
0.2-2.8 L/min
What is the minimum and maximum blood flow
Small adult Quadrox & 5.0 Cardiohelp
0.5-5.0 L/min
What is the minimum and maximum blood flow
Adult Quadrox & 7.0 Cardiohelp
0.5-7.0 L/min
What is the minimum and maximum blood flow
Neonatal Euroset
0.2-1.5 L/min
What is the minimum and maximum blood flow
Nautilus ECMO smart oxygenator
0.5-7.0 L/min
What is an indicator of a clot formation within your circuit?
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
What does venous pressure tell you about your patient and the circuit?
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)
Describe the phenomenon of recirculation?
When drainage and return cannulas are too close together they will recirculate the blood throughout the circuit and not deliver it to the patient
What mode is recirculation most likely to be seen in
VV ECMO
How do you resolve the problem of recirculation
Reposition cannulas, decrease flows. Most of the time you will be asked to decrease flows first because of the repositioning of cannulas is risky
What are factors affecting recirculation?
Increased blood flow, cannula position
How do you determine if a patient is ready to be weaned from ECMO
VV ECMO
Improved blood gases with less support. Underlying issue treated/recovered
How do you determine if a patient is ready to be from ECMO
VA ECMO
Improved cardiac function, hemodynamics, EF of 30%
Weaning off supporting meds.
Underlying issue (treated/recovered)
How is a patient tested to see if he is ready to be weaned from ECMO
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
Describe how the patient is weaned from VV ECMO
Only wean the sweep. Don’t change the flows.
Adults off sweep for 24 hours+, pediatrics is 12 hours+
Describe how the patient is weaned in VA ECMO
Will wean the flows as well as the sweep
Why are weaning procedures different?
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.
What are potential air traps in the ECMO circuit
Oxygenator
Top of the oxygenator, remove air with de-airing membrane and pigtail
What are potential air traps in the ECMO circuit
Cannula
At the connecters, remove air at the nearest pigtail
What are potential air traps in the ECMO circuit
Centrifugal head
With enough air, will stop forward flow. Remove air at nearest pigtail
TRICK QUESTION. When assessing a patient’s oxygenation status on VA ECMO which of the following is the best indicator of adequacy of oxygenation?
pre membrane saturation
Define Hemolysis
When blood cells rupture
What factors in the circuit can cause hemolysis
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)
What lab test is drawn to evaluate degree of hemolysis?
Plasma Free Hemoglobin
How do you treat your circuit? For Hemolysis
Check for clots, kinks in tubing, pre-membrane pressure < 300 mmHg, possibly add albumin to the prime, limit negative venous pressure
What is the normal range for this specific test? Plasma free hemoglobin
< 12 mg/dL (when > 50 mg/dL, discussion to change circuit begins, can cause renal impairment)
