What is it? What are my responsibilities as baby nurse? ECMO What is it? What are my responsibilities as baby nurse?

ECMO Circuit

ECMO What is ECMO? Extracorporeal Membrane Oxygenation Used to treat a neonate with severe respiratory failure or septic shock when all conventional treatments have been unsuccessful Also used to treat children with a failing heart. ECMO used in CICU Also used to treat children with respiratory failure or septic shock in the PICU EXIT to ECMO

Gives the lungs and heart a chance to rest and recover ECMO Gives the lungs and heart a chance to rest and recover

How does it work??? Typically a neonate is cannulated through the neck (in the CICU they may be cannulated through the chest). The venous cannula drains blood from the jugular vein The blood flows through the tubing into the roller pump head. Then flows into the membrane oxygenator (which acts like the lungs) Gas exchange occurs in the membrane and it does such a good job we have to bleed CO2 back into circuit. Blood flows through a heater to be re-warmed before returning to patient.

How does it work?? Cont. The blood returns to the patient by the arterial cannula into the carotid artery. The patient always has his blood volume. The circuit has extra blood that was used set it up. Heparin is running through the circuit to keep it from clotting.

As beside RN what do I do? Assessments- neuro check every 2-4 hours. HC once a shift. Cap all peripheral IV’s and irrigate Q shift and PRN. Maintain replogle patency. I&O every 4-8-12 hours and compare with specialist’s I&O. Monitor for seizures. Hand bag per doctor’s order Most IV meds are given via circuit by specialist

As a bedside RN what do I do? Cont. Note: IV fluids are given via circuit. Cardiac support drugs are give to patient Do not change CVC cap while on ECMO No heel sticks, venipunctures, or IM injections ECMO cannula site care every 4 hours. ½ strength peroxide and sterile water Cleanse site with cotton-tip applicator Apply betadine ointment to site Cover with sterile gauze- Do not tape

As a bedside RN what do I do? Cont. Measure cannulas with specialist No weights You will never be left alone at the circuit. A specialist must be there at all times.

Emergency When a patient needs to come off ECMO emergently an increase in his support will be required (increasing vent settings) One main thing to always remember is VBA. VERY BAD ACCIDENT Clamp venous cannula, open bridge, and clamp arterial cannula. Must be done in that order.

Do not hesitate to ask a question!!!