Equipment Flashcards
Trace the flow of blood through your circuit from cannula tip to cannula tip.
a. 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
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 Pressure Monitoring Cable
- Post-pump/Pre-oxygenator/VBG Pigtail
7 - Yellow De-Airing Cap
8 - Oxygenator (5.0)
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
Rotaflow Adult Circuit with Spectrum
1 - Venous Cannula
2 - Venous Spectrum 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 - Post-pump/Post-oxygenator/De-airing/CRRT-Pull Pigtail
8 - Post-pump/Post-oxygenator/ABG Pigtail
9 - Spectrum Arterial Sat Probe (Hct, Hb)
10 - Spectrum Flow Probe
11 - Arterial Cannula
Neonatal Circuit with Spectrum
1 - Venous Cannula
2 - Venous Spectrum Sat Probe
3 - Venous Manifold Port
4 - Bridge (Venous Side) & CRRT Return
5 - Pre-pump/Pre-oxy Venous Pressure Line (to DLP Red Box)
6 - 2 Pre-pump/Pre-oxygenator Pigtail for Med Infusions
7 - Rotaflow Centrifugal Pump
8 - Pre-Oxygenator Pressure Line (to DLP Red Box)
9 - Oxygenator
10 - Yellow De-Airing Cap
11 - Post-Oxygenator Arterial Pressure Line (to DLP Red Box) &
CRRT-Pull Access
12 - Post-pump/Post-oxygenator Arterial Manifold Port
13 - Spectrum Arterial Sat Probe (Hct, Hb)
14 - Bridge (Arterial Side) & Platelet Infusion Access
15 - Spectrum Flow Probe
16 - Arterial Cannula
What is different about the neonatal circuit from the adult Rotaflow and
CardioHelp Circuit
Bridge, more venous pigtails, manifold.
What is the function of and location within the circuit of the following:
a. Arterial and venous sat probes
Cardiohelp Venous = Pre-pump on the mounted sensor.
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 manifold.
Pig Tail
Adult Cardiohelp = 4 (venous line, post-pump/pre-oxy, postpump/post-oxy/de-airing, post-pump/post-oxy/ABG).
Pediatric Cardiohelp = 2 (Post-pump/pre-oxy & post-pump/postoxy/de-airing)
Neonatal Circuit = 2 (venous med infusions)
Venous Pressure
Adult & Pediatric Cardiohelp = Internal reading pre-pump.
Neonatal Circuit = On a red box connected right after the bridge
(when comparing position to the patient).
Pre oxygenator pressure
Adult & Pediatric Cardiohelp = Internal post-pump/pre-oxygenator
Neonatal Circuit = On a red box connected to the post-pump/preoxygenator port (Y’d in with the post-oxygenator pressure).
Post oxygenator pressure
Adult & Pediatric Cardiohelp = Internal near the post-pump/postoxygenator/ABG pigtail.
Neonatal Circuit = On a red box connected to the post-pump/postoxygenator port (Y’d in with the pre-oxygenator pressure)
Oxygenator
Oxygenates the blood, removes CO2, also acts as the heat
exchanger between the circuit and heater/cooler.
Placed post pump.
Rotaflow Centrifugal Pump
Pre-oxygenator, pushed blood into oxygenator.
CardioHelp Centrifugal Pump
One unit with the oxygenator (still technically pre-oxygenator within
the circuit).
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 & manifold).
Where is the 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 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 need higher RPMs to reach
the same amounts of flows as the others.
Describe oxygenator failure?
Decreased gas exchange. Unable to add oxygen or remove CO2 even with an
increased sweep.
What parameters do you evaluate every day to determine how well the
oxygenator is working?
Delta P & Venous Saturation (for VA ECMO).
For VV ECMO you would look at the patient’s 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 is 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?
High plasma free hemoglobin, poor ABG (pump & patient),
decreased patient SpO2.
What is the minimum and maximum sweep for
a. Neonatal Quadrox
0.1 - 3 L/min
What is the minimum and maximum sweep for Pediatric Quadrox
0.1 - 5.6 L/min
What is the minimum and maximum sweep for Small Adult Quadrox & 5.0 CardioHelp
0.25 - 10 L/min
What is the minimum and maximum sweep for Adult Quadrox & 7.0 CardioHe
0.25 - 14 L/min
What is the minimum and maximum sweep for Neonatal Euroset
0.1 - 3 L/min
What is the 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 the 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/m
What is the minimum and maximum blood flow Nautilus ECMO Smart Oxygenator
0.5 - 7.0 L/min
What is an indicator of 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
some and then flowing back up).
Describe the phenomena 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 this most likely to be seen in?
VV ECMO
How do you resolve this problem?
Reposition cannulas, decrease flows. Most of the time you will be
asked to decrease flows first because 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
a. VV ECMO
Improved blood gasses with less support. Underlying issue
treated/recovered.
Improved blood gasses with less support. Underlying issue
treated/recovered.
Improved cardiac function, hemodynamics, EF of 30%, weaning of
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 is this procedure 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?
a. 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 connectors, 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 the nearest
pigtail.
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 cause this?
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?
Check for clots, kinks in tubing, pre-membrane pressure <300
mmHg, possibly add albumin to prime, limit negative venous pressure.
What is the normal range for this specific test?
< 12 mg/dL (when > 50 mg/dL, discussion to change circuit begins,
can cause renal impairment)
