ECMO Management for Specialists
Study online at https://quizlet.com/_e1jij0
Pros: Experts on ECMO circuit flow dynamics and ad-
vanced trouble shooting
ECMO Staffing model - Perfusion model
Cons: Lacks patient care knowledge and understanding of
ICU concepts
Pros: Experts on acute patient care and advanced ICU
concepts
ECMO Staffing model - ECMO Specialist model
Cons: Lacks Experience with ECMO advanced trouble
shooting
maintains integrity of the ECMO circuit
Titrate ECMO
-Flows
-Sweep
Role of the ECMO Specialist -FdO2
monitor for ECMO complications
intervenes during ECMO emergencies
Assists with 'day to day' patient clinical decision making
role of bedside nurse assessment, monitoring, and documentation
DO NOT LEAVE THE ROOM
Responsible for:
-IVP Medications
Roles during ECMO bedside insertion - Bedside RN -Titration of drips
-Vent
-Defibrillation/ACLS
Speaking with MDS/NPs
, ECMO Management for Specialists
Study online at https://quizlet.com/_e1jij0
Delegation
Obtaining the insertion cart
Builds and primes ECMO CIRCUIT
Assisting MDs with cannula placement
Roles during ECMO bedside insertion - ECMO Specialist
Hands off ECMO lines
Notifying Bedside RN when to give Heparin and dose
Initiates ECMO therapy
Prep well
-OR style not ICU style
-Cannula infections are devastating
Full body drape
Prep and drape
-Wires are long and can get contaminated easy
-use femoral drape (Cath lab, Blue towels, ect.)
Use bedside table under drape at the foot of the bed
-Open all sterile kits before beginning procedure
encourage use of ultrasound
-Easier to identify correct vessel
-Can also confirm cannula is correct place
Vascular Access use Pik-A and Pik-V kits for initial access
use micropuncture kit for distal perfusion catheter access
two or more person procedure
Serial Dilation
, ECMO Management for Specialists
Study online at https://quizlet.com/_e1jij0
Observe for good "wire skills"
-Keep the wire straight a all times (two person job)
-floss the wire (move it back and forth)
-Do not kink the wire
-may need a super stiff or Amplatz wire
Adequate Dilation
-advance and rotate freely
-multiple passes
Minimize potential for bleeding
- Enlarge skin incision as you go (Avoid excessive dissec-
tion)
Should be easy if proper dilated
do not allow cannula and dilator to "uncouple"
place at correct depth
Placement of cannula - Err on the side of placing femoral cannula too deep
- can estimate by measuring from insertion sire to
xiphoid
Flush cannula periodically if there are delays on placing
cannula
DO NOT TAKE HANDS OFF CANNULA UNTIL IT IS SE-
CURED!!!
-weight of tubing can pull it out
Securing cannula -if arterial cannula the ECMO flows will push it out
Place tight purse string stitch around cannula site
-Extreme caution not to damage or puncture cannula
Study online at https://quizlet.com/_e1jij0
Pros: Experts on ECMO circuit flow dynamics and ad-
vanced trouble shooting
ECMO Staffing model - Perfusion model
Cons: Lacks patient care knowledge and understanding of
ICU concepts
Pros: Experts on acute patient care and advanced ICU
concepts
ECMO Staffing model - ECMO Specialist model
Cons: Lacks Experience with ECMO advanced trouble
shooting
maintains integrity of the ECMO circuit
Titrate ECMO
-Flows
-Sweep
Role of the ECMO Specialist -FdO2
monitor for ECMO complications
intervenes during ECMO emergencies
Assists with 'day to day' patient clinical decision making
role of bedside nurse assessment, monitoring, and documentation
DO NOT LEAVE THE ROOM
Responsible for:
-IVP Medications
Roles during ECMO bedside insertion - Bedside RN -Titration of drips
-Vent
-Defibrillation/ACLS
Speaking with MDS/NPs
, ECMO Management for Specialists
Study online at https://quizlet.com/_e1jij0
Delegation
Obtaining the insertion cart
Builds and primes ECMO CIRCUIT
Assisting MDs with cannula placement
Roles during ECMO bedside insertion - ECMO Specialist
Hands off ECMO lines
Notifying Bedside RN when to give Heparin and dose
Initiates ECMO therapy
Prep well
-OR style not ICU style
-Cannula infections are devastating
Full body drape
Prep and drape
-Wires are long and can get contaminated easy
-use femoral drape (Cath lab, Blue towels, ect.)
Use bedside table under drape at the foot of the bed
-Open all sterile kits before beginning procedure
encourage use of ultrasound
-Easier to identify correct vessel
-Can also confirm cannula is correct place
Vascular Access use Pik-A and Pik-V kits for initial access
use micropuncture kit for distal perfusion catheter access
two or more person procedure
Serial Dilation
, ECMO Management for Specialists
Study online at https://quizlet.com/_e1jij0
Observe for good "wire skills"
-Keep the wire straight a all times (two person job)
-floss the wire (move it back and forth)
-Do not kink the wire
-may need a super stiff or Amplatz wire
Adequate Dilation
-advance and rotate freely
-multiple passes
Minimize potential for bleeding
- Enlarge skin incision as you go (Avoid excessive dissec-
tion)
Should be easy if proper dilated
do not allow cannula and dilator to "uncouple"
place at correct depth
Placement of cannula - Err on the side of placing femoral cannula too deep
- can estimate by measuring from insertion sire to
xiphoid
Flush cannula periodically if there are delays on placing
cannula
DO NOT TAKE HANDS OFF CANNULA UNTIL IT IS SE-
CURED!!!
-weight of tubing can pull it out
Securing cannula -if arterial cannula the ECMO flows will push it out
Place tight purse string stitch around cannula site
-Extreme caution not to damage or puncture cannula
