Patient Management ECMO FINAL Flashcards
Describe initiation of VA-ECMO ?
- Incremental over 10 minutes.
- Wean Inotropes QUICKLY
- Reduce ventilator settings QUICKLY to rest settings.
Describe initiation of VV-ECMO ?
- Incremental over 15 minutes.
- Wean Inotropes SLOWLY
- Reduce ventilator settings SLOWLY to rest settings.
ACT for an Uncomplicated term baby ?
200 - 240 sec
ACT for an Uncomplicated Pre-term baby ?
180 - 220 sec
ACT for a surgical patient ?
160 - 180 sec
Once hemostasis is achieved, increase parameters
Heparin drip ?
100 u / mL
How much blood does the Hemochron ACT machine require ?
0.4 mL sample
Heparin needed to cannulate ?
100 u / Kg
Heparin needed to initiate ECMO ?
ACT > 200
Heparin GTT to start ?
50 u/Kg/hr
If ACT is not adequate, what should we do?
Bolus if necessary (1/2 previous hours dose)
What may decrease ACT?
Platelets.
Monitor ACT frequently if were administering platelets.
Fluid management ?
Total all fluids should equal 80-100 mL/Kg/Day
Measure all intake and output
Minntech Minifilter
- 13 mL prime volume
- ACT port > Bladder
- IV pump to filtrate port
- Dial in your hourly loss
- Adjust pump flow to account for shunt
Hemofiltration: Exchange Transfusion ?
Take out your blood component pushes
Hemofiltration: Zero Balance ?
Take out the total of everything going in (GTT and push)
Hemofiltration:
Negative Balance ?
Take out zero balance + XmL more
Do Not factor in whats coming out via chest tubes, urine, ect.
Practice Slide 22
Practice Slide 22
Algorithm for blood component administration ?
- PRBC
- FFP
- Albumin
- Platelets
- Cryoprecipitate
Standing orders for: HCT
> 40%
10 mL/Kg
Standing orders for: Platelets
> 100 K
1 unit for more than 20K below
1/2 unit for less than 20K below
Standing orders for: Fibrinogen
> 100 K
Give 1 unit of Cryo
About 10 mL
Standing orders for: Fluid to maintain flow
10 mL/Kg
Platelet count is 68K, how will you manage this ?
Give 1 unit of FFP
Platelet count is 90K, how will you manage this ?
Give 1/2 unit of FFP
HCT is 48, how will you manage this ?
PRBCs
10 mL/Kg
Fibrinogen is 70K, how will you manage this ?
Give 1 unit of Cryo
About 10 mL
Antibiotic Management ?
- Broad spectrum antibiotic for the first 2 -3 days.
- Blood cultures every day
- Emphasize sterile technique
Charting considerations ?
- Hourly values
- PRN notes
- Hourly, Shift, & total fluid balance
- Pre-Shift Checklist
How can you tell that our patient on VA-ECMO is improving ?
- 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
How can you tell that our patient on VV-ECMO is improving ?
Same as VA-ECMO but. .
PaO2 improvement is more subtle
Trial Off for VA-ECMO ?
- 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
Trial Off for VV-ECMO ?
- Increase vent settings
- Turn off oxygenator sweep gas
- Check ACT Q60 min
- Check SvO2 to assess patient continuously
