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

ECMO Circuit

ECMOWhat is ECMO?Extracorporeal Membrane OxygenationUsed to treat a neonate with severe respiratory failure or septic shock when all conventional treatments have been unsuccessfulAlso used to treat children with a failing heart. ECMO used in CICUAlso used to treat children with respiratory failure or septic shock in the PICUEXIT to ECMO

ECMOGives 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 veinThe 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 IVs and irrigate Q shift and PRN.Maintain replogle patency.I&O every 4-8-12 hours and compare with specialists I&O.Monitor for seizures.Hand bag per doctors orderMost 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 patientDo not change CVC cap while on ECMONo heel sticks, venipunctures, or IM injectionsECMO cannula site care every 4 hours. strength peroxide and sterile waterCleanse site with cotton-tip applicatorApply betadine ointment to siteCover with sterile gauze- Do not tape

As a bedside RN what do I do? Cont.Measure cannulas with specialistNo weightsYou will never be left alone at the circuit. A specialist must be there at all times.

EmergencyWhen 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 ACCIDENTClamp venous cannula, open bridge, and clamp arterial cannula. Must be done in that order.

Do not hesitate to ask a question!!!