Assessment
When should the patient assessment for mobility readiness be performed?
Every day during rounds!
Name when and with whom the time out should be performed
Right before every session with PT/OT, RN, ES and patient all involved.
True or False: A surgeon must be in house in order to do ECMO mobility
False. They have to be notified and ok the order, but do not need to be in house
Who is responsible for updating the activity order each day?
CTICU (usually APP)
Presence of this automatically means bedrest for your patient
Femoral Impella
Femoral IABP
LAVA transeptal cannula
Open chest
Name two different ways to assess cannula location
1. Xray/KUB
2. external cannula measurement/marking
Your patient trips on their own cannula and begins to fall and the cannula came out. What is your first action?
CLAMP! The PT/OT and RN will deal with the patient. If any cannula has come out, clamp the circuit!
What do you need to chart after a mobility session?
ECMO vitals, pre-mobility circuit check, completion of the time out checklist, and what activity was performed. If any complications occurred and degree of additional ECMO support required.
Minimum number of sutures on any cannula and DPC
5 per cannula, 2 per DPC
Monitoring vitals is vital. Which monitor do you use?
The big one! MX400 or MP30
True or False: Almost all ECMO mobility studies show that complications and emergencies are extremely rare when done with care and teamwork.
True!
Name two places you will find the time out form
Orange laminated sheet on carts and on uwecls.com and in the policy
The policy states patients with a certain level thrombocytopenia should not mobilize. What is that level?
Platelets less than 50k
Presence of this requires Respiratory Therapy to be involved.
Why should DPCs be given extra careful consideration when mobilizing
What might you anticipate doing for your ARDS patient on VV to help mobilize better?
Increase the sweep!
What does the policy say about oozy cannula sites?
No active (uncontrolled with bedside stich or topical hemostatic agent) cannula site bleeding ***acceptable level of bleeding determined based on patient’s baseline level***
These are the minimum support staff needed for hallway ambulation
Physical or Occupational Therapist
ECMO Specilaist
Bedside RN
Wheelchair follower (tech, RN, family member
What is the delineation between major and minor cannula site bleeding?
Major is 3 or more PRBCs or surgical intervention. Minor is less than 3 or need for hemostatic agent/new stitch
There are 5 steps in the mobility progression. Name them
1. Active or active assisted ROM hip flexion to 90degrees/bed in chair position 2. Dangle edge of bed (supported and/or unsupported) 3. Stand/March in place 4. Sit in chair 5. Ambulate