Patient Management ECMO FINAL

Question 1

Describe initiation of VA-ECMO ?

Answer 1

• Incremental over 10 minutes.
• Wean Inotropes QUICKLY
• Reduce ventilator settings QUICKLY to rest settings.

Question 2

Describe initiation of VV-ECMO ?

Answer 2

• Incremental over 15 minutes.
• Wean Inotropes SLOWLY
• Reduce ventilator settings SLOWLY to rest settings.

Question 3

ACT for an Uncomplicated term baby ?

Answer 3

200 - 240 sec

Question 4

ACT for an Uncomplicated Pre-term baby ?

Answer 4

180 - 220 sec

Question 5

ACT for a surgical patient ?

Answer 5

160 - 180 sec

Once hemostasis is achieved, increase parameters

Question 6

Heparin drip ?

Answer 6

100 u / mL

Question 7

How much blood does the Hemochron ACT machine require ?

Answer 7

0.4 mL sample

Question 8

Heparin needed to cannulate ?

Answer 8

100 u / Kg

Question 9

Heparin needed to initiate ECMO ?

Answer 9

ACT > 200

Question 10

Heparin GTT to start ?

Answer 10

50 u/Kg/hr

Question 11

If ACT is not adequate, what should we do?

Answer 11

Bolus if necessary (1/2 previous hours dose)

Question 12

What may decrease ACT?

Answer 12

Platelets.

Monitor ACT frequently if were administering platelets.

Question 13

Fluid management ?

Answer 13

Total all fluids should equal 80-100 mL/Kg/Day

Measure all intake and output

Question 14

Minntech Minifilter

Answer 14

• 13 mL prime volume
• ACT port > Bladder
• IV pump to filtrate port
• Dial in your hourly loss
• Adjust pump flow to account for shunt

Question 15

Hemofiltration: Exchange Transfusion ?

Answer 15

Take out your blood component pushes

Question 16

Hemofiltration: Zero Balance ?

Answer 16

Take out the total of everything going in (GTT and push)

Question 17

Hemofiltration:

Negative Balance ?

Answer 17

Take out zero balance + XmL more

Do Not factor in whats coming out via chest tubes, urine, ect.

Question 18

Practice Slide 22

Answer 18

Practice Slide 22

Question 19

Algorithm for blood component administration ?

Answer 19

• PRBC
• FFP
• Albumin
• Platelets
• Cryoprecipitate

Question 20

Standing orders for: HCT

Answer 20

> 40%

10 mL/Kg

Question 21

Standing orders for: Platelets

Answer 21

> 100 K

1 unit for more than 20K below

1/2 unit for less than 20K below

Question 22

Standing orders for: Fibrinogen

Answer 22

> 100 K

Give 1 unit of Cryo
About 10 mL

Question 23

Standing orders for: Fluid to maintain flow

Answer 23

10 mL/Kg

Question 24

Platelet count is 68K, how will you manage this ?

Answer 24

Give 1 unit of FFP

Question 25

Platelet count is 90K, how will you manage this ?

Answer 25

Give 1/2 unit of FFP

Question 26

HCT is 48, how will you manage this ?

Answer 26

PRBCs

10 mL/Kg

Question 27

Fibrinogen is 70K, how will you manage this ?

Answer 27

Give 1 unit of Cryo

About 10 mL

Question 28

Antibiotic Management ?

Answer 28

• Broad spectrum antibiotic for the first 2 -3 days.
• Blood cultures every day
• Emphasize sterile technique

Question 29

Charting considerations ?

Answer 29

• Hourly values
• PRN notes
• Hourly, Shift, & total fluid balance
• Pre-Shift Checklist

Question 30

How can you tell that our patient on VA-ECMO is improving ?

Answer 30

• Improved gas exchange at lower oxygenator settings
• Improved gas exchange at lower pump flow settings.
• Reversal or closure of PDA shunt
• Improved lung fields on X-Ray
• Improvement with Tidal Volumes and Compliance

Question 31

How can you tell that our patient on VV-ECMO is improving ?

Answer 31

Same as VA-ECMO but. .

PaO2 improvement is more subtle

Question 32

Trial Off for VA-ECMO ?

Answer 32

• Increase Vent settings
• Move Inotropes from circuit to patient.
• Turn Off oxygenator sweep gas
• Clamp cannulas & Flow through bridge
• Check patient & circuit ACT Q20 min.
• Flash cannulas Q20 min.
• Check SvO2 to assess patient during flash

Question 33

Trial Off for VV-ECMO ?

Answer 33

• Increase vent settings
• Turn off oxygenator sweep gas
• Check ACT Q60 min
• Check SvO2 to assess patient continuously