ECMO Drugs
Bolus dose of heparin when going on ECMO?
100 units/kg
What does it mean when “- -“ is displayed on the centrimag?
Blood flowing backwards
A double lumen VV catheter has two drainage ports in the ____ and ___ , and one reinfusion port directed at the ___
SVC and RA, reinfusion port directed at the RA
Once the bridge has been opened, how frequently does it need to be flashed?
Q30 minutes
What drugs are contained in the ECMO drug box
-Mannitol
-Sodium Bicarb
-25% Albumin
-Calcium Chloride
-Heparin
-Thrombate
-Ancef
Causes of lack of return?
Hypovolemia, Kinks in circuit, Cannula malposition, Inadequate cannula size
Sign of profound cardiac dysfunction and inability to adequately eject blood from the left ventricle?
How is it treated?
Pulmonary edema/hemorrhage
treatment = atrial septostomy to relieve pulmonary venous congestion
Which direction should you handcrank a roller pump?
Counter-clockwise
Once ACT is 300 or less, initiate heparin gtt at ____units/kg/hr for patients less than 1 year or ____units/kg/hr for patients greater than a year
less than 1 year: 25 units/kg/hr
greater than 1 year: 20 units/kg/hr
What are factors that affect recirculation?
Pump flow, right atrial size, cannula position, cardiac output
Name 3 pieces of information to provide when paging code ecmo
1. room
2. patient weight
3. cardiac/non cardiac
Name 5 aspects of ECMO safety checks
•2 large clamps
•Pump alarms on and appropriate
•No lanyards
•No scissors
•Cannulas secured to bed
•Dressing check
•Review ECMO orders & parameters
•Hand crank on roller pump
•Back up console/pump head on Centrimag
•Volume
•Wheels locked
•No trip hazards
•Connections secure
Heparin acts by accelerating the action of ____
Antithrombin
Signs of oxygenator failure (3):
Increased pre membrane pressure, decreased oxygen and carbon dioxide transfer, blood leak from the egress
Best measure of adequate systemic perfusion
venous sat > 70%
What blood products should ECMO patients have on hand in blood bank at all times?
2 units PRBC's 2units plts
A dangerous, potentially lethal, immunologically mediated adverse drug reaction to unfractionated heparin
Heparin Induced Thrombocytopenia
alternative drugs: argatroban or Bivalirudin
Describe the steps you would take after recognizing your patient has accidentally decannulated
Clamp (VBA)
apply pressure
Staff assist
Emergency vent settings
Call Code ECMO
Code patient
How should you troubleshoot chattering?
reduce rpm’s, give volume, reposition cannulas, check for kinks
What blood product do you anticipate using to treat significant bleeding associated with a fibrinogen of 100?
Cryoprecipitate