Lab Values and Drugs Flashcards
For each of the values listed below what is normal and where do we like this
value to be while pt on ECMO. Explain.
PH
7.35-7.45
For each of the values listed below what is normal and where do we like this
value to be while pt on ECMO. Explain.
a. PH
35-45
PO2
On ECMO - >200
Lactate
0.5 - 2
NaHCO3
22-28
Base deficit
+/- 4
Hgb/HCT
12-15 (women) & 13-17 (men)
On ECMO (Adult > 7, Peds > 10)
Sodium
135-145
Potassium
3.6-5.1
Serum calcium
8.9-10.7
Ionized Calcium
1.16-1.32
Ionized Magnesium
0.46 - 0.64
PT
12.3-14.8 s
PTT
25-36
On ECMO - 60-80 seconds
Anti Xa (AKA Unfractionated Heparin)
On ECMO - 0.3 - 0.7
If bleeding 0.2-0.5
Cultures
You want negative cultures! Blood, urine, respiratory.
ATIII activity (< 30 days, > 30 days)
< 30 days (44-76 %)
> 30 days (80-120 %)
ATIII binds with heparin to work as an anticoagulant, heparin does
not work by itself.
Plasma Hgb
< 12
Fibrinogen
200-400
INR
<2 (On ECMO < 4.9)
Troponin
0-0.4
CK
40-350
CK mb
0-5
ALT
0-40
AST
0-95
Describe the relationship of these tests to ECMO.
a. Head ultrasound
- Is this done on all ECMO patients
Neonates and Infants
-When is this test done?
Done pre-cannulation and then once a day for the first 3
days, then every other day.
-What does this result show?
Intracranial hemorrhage, blood in the ventricles
Why is this important to patients on ECMO?
It’s a contraindication for ECMO. If it’s a grade 1-2 then they
will keep an eye on it, if its a grade 3 or larger either will DC ECMO or
not put patient on ECMO
b. Chest x-ray
-Is this done on all ECMO patients
Yes
When is this test done?
After cannulation and daily/PRN
What does this test tell us?
Cannula Placement
Discuss the importance of this test.
Misplaced cannulas can cause decreased flows, chugging,
recirculation (VV), high negative pressures, high positive pressures.
c. Cardiac ECHO
-When is this test done?
Adults - during weaning (PRN to confirm cannula placement)
Neonates - Pre-ECMO and (PRN to confirm cannula
placement)
Is this done on all ECMO patients?
Yes
What do we learn from this test?
Cardiac function, pulmonary artery pressures.
Are the results usually normal or abnormal?
Usually abnormal for VA and normal for VV
d. CT Scan
-When is it done?
Change in patient status
What do we learn from this test
Check for head bleed, abdominal function (with contrast)
How does this affect the care of our patient?
Can give immediate answers. Sometimes is not tolerated
well by patient. If results are poor, then a conversation may happen
to discontinue ECMO.
Do all patients have this test?
No, would only need done for a specific change in patient
status.
e. Fluoroscopy
-When is this used?
To place a double-lumen cannula safely.
What does this tell the practitioner?
Cannula Placement
What patients are most likely to have this done?
VV ECMO
f. Cardiac Cath
i. When is this done?
If patient has had a STEMI, any patient on ECPR, create
balloon septostomy in neonates.
Can patients on ECMO go to the Cath Lab?
Yes
Describe the information that might come from this tes
Check for coronary blockage.
