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ECMO LAYOUT

The document outlines the use of Extra Corporeal Membrane Oxygenation (ECMO) for prolonged pulmonary and circulatory support, detailing types (VV and VA ECMO), indications, and contraindications. It also covers nursing considerations such as hemodynamics, anticoagulation, ventilator and renal management, as well as complications associated with ECMO. Key nursing interventions include monitoring vital parameters, managing anticoagulation, and addressing potential complications like bleeding and thromboembolism.

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Ann Merlin Jobin
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8 views4 pages

ECMO LAYOUT

The document outlines the use of Extra Corporeal Membrane Oxygenation (ECMO) for prolonged pulmonary and circulatory support, detailing types (VV and VA ECMO), indications, and contraindications. It also covers nursing considerations such as hemodynamics, anticoagulation, ventilator and renal management, as well as complications associated with ECMO. Key nursing interventions include monitoring vital parameters, managing anticoagulation, and addressing potential complications like bleeding and thromboembolism.

Uploaded by

Ann Merlin Jobin
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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PLAN B

STEP 1: Review of circulatory system

STEP 2: Introduction Extra Corporeal Membrane Oxygenation


(ECMO) provides prolonged pulmonary and/or circulatory
support by removing venous blood, pumping it across an
artificial lung (oxygenator or membrane lung) for gas exchange,
& returning it to the pt.

TYPES INDICATIONS
 VV ECMO
 VA ECMO CONTRA INDICATIONS
 VV:Refractory
hypoxemia/mixed
respiratory failure  Uncontrolled bleeding
 VA:Pulmonary&  Poor prognosis from
Circulatory support (VA) primary condition
cardiac arrest,
overdose, massive PE,
cardiogenic shock

STEP 3: CANNULATION

VV ECMO: Major veins are cannulated to


VA ECMO: Major veins (drainage) and
drain and return blood to the body.
arteries (return) are cannulated.
• Right or left common femoral vein
• Inferior vena cava or right atrium
(drainage) and right internal jugular
(drainage) to right femoral artery
vein (return/infusion)
(return/infusion)
PLAN A

STEP 4: Nursing Considerations

 Hemodynamics

 Target parameters by continuous venous oximetry.


 If oxygenation drops below the target range, consider increasing blood flow,
intravascular volume, or hemoglobin concentration
 Decreasing patient’s temperature
 Left ventricular output may worsen with VA ECMO; inotropes
 Monitor central venous pressure and fluid status.

 Anticoagulation

 Continuous IV infusion of unfractionated heparin


 An activated clotting time (ACT) of 180 to 210 seconds.
 Reduce the ACT target
 Monitor platelet counts and maintain level above 50,000/mL.
 Monitor hemoglobin and maintain level within normal range.
 Ventilator management

 Adjust ventilator settings


 Typical ventilator settings are FiO2 less than 50%, positive end expiratory pressure
(PEEP) at 5 cm H2O, tidal volume at 4 mL/kg, respiratory rate at 2 to 5 breaths per
minute, and plateau pressure maintained less than 20 cm H2O
 Perform strict pulmonary hygiene

 Renal management

 Diuretics are often administered to reduce fluid overload.


 Ultrafiltration can be added to the ECMO circuit
 Oliguric and polyuric phases of acute tubular necrosis are common on ECMO
 Continuous renal replacement therapy (CRRT) may be required.
 Use RASS (Richmond Agitation-Sedation Scale)

 Hospital Acquired Pressure Ulcer

 Pressure relief specialised mattresses


 Dressing over bony prominences (mepilex)
 Nutritional support
 Use of skin moisturizers

STEP 5: Complications

 Bleeding
 Thromboembolism
 Cannulation-related complications
 Hemolysis
 Heparin-induced thrombocytopenia
 Oxygenator failure
 Pump failure

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