RNs running ECMO on adult patients

Advanced Practice Columnist / Guide · Jul 17, 2012

RN's do run ECLS at our institution with the Mechanical Circulatory Support team on call for higher level troubleshooting. The intensity of the workload (more frequent assessments, labs) make it justifiable to have 2 nurses assigned to the patient each shift.

BigCliffCCRN · Jan 5, 2014

I agree with this comment. ICU is ICU is ICU. although miracles do happen and most people respond well to the treatments we provide, not everyone makes it. Plus, its more fun and interesting to deal with more machines, have more under your belt and develop more skills and use your brain more, there is only so much you can learn about turning someone and cleaning them, day after day. How about learning new things and making yourself indispensable, thats how I feel. Just an opinion. :)

BigCliffCCRN · Jan 5, 2014

Absolutely!

armyicurn · Jan 5, 2014

I agree with this comment. ICU is ICU is ICU. although miracles do happen and most people respond well to the treatments we provide, not everyone makes it. Plus, its more fun and interesting to deal with more machines, have more under your belt and develop more skills and use your brain more, there is only so much you can learn about turning someone and cleaning them, day after day. How about learning new things and making yourself indispensable, thats how I feel. Just an opinion. :)

Well said brother! We are is the same wavelength !

Chad Collins · Jan 6, 2014

Look at it this way every new skill you add to your tool bag will net you more money at you next job. As nurses we always have to look forward for increase in pay and to do that we have to become more valuable to future employers. I work a cardiac PCU floor and I recently got trained and certified for Aquaphoresis ( kind of mini dialysis for CHF patients) I don't get any more money now but when i move out of state end of the year my next employer will take all skills into consideration. Good luck

nowplayingjc · Aug 17, 2014

Just sharing an ECMO article I wrote. Cheers!

I am an ECMO nurse. I work with a machine that helps patients who have 80% chance of dying. In a critical care environment, they are considered as one of our most precious patients, if not the most. I got trained for this, and I must admit that it took me a while before I gained the confidence in calling myself an ECMO nurse.

I'm an ECMO nurse. It's winter, so it's the busiest time of the year for us. I'm exhausted, but I love my job, so I need to suck it up. Let me just tell you more about what I do. This is not a ***** rant!

I am an ECMO nurse. You tell me that I only sit on my bum and do ACT every 2 hours, but you really don't have any clue, do you? I don't value doing the ACT itself, but the numbers that I get from it. I adjust the heparin infusion because I always want to get the balance between my circuit not clotting and the patient not bleeding his brains out. It is always a fine line, but we thread it carefully because we know the consequence of a very deranged ACT.

I am an ECMO nurse. I come with my flash light and I look for fibrins all the time. I search for newly formed strands and make sure that all existing ones are not getting any bigger. If the clot is in post oxygenator line, my anxiety level is high, for I know that if it dislodges, it goes directly to the patient, and the result won't be very good especially if it's a VA circuit.

I am an ECMO nurse. I send blood tests every 6 hours, and I correct whatever I can. If the hematocrit is low, I give my patient a unit or two of RBC. If the platelet is low, I make sure that I adjust the heparin infusion before giving a bag of platelets. All these things affect the smooth run of my circuit, and the worst thing that could happen is the machine just going to a full stop.

I am an ECMO nurse. I deal with plasma hemoglobin all the time. When it's high, I check for other signs of hemolysis like the urine turning pink. I don't want to be that random ECMO nurse who gets a high plasma hb after it has been normal for many days. It's either there's a big clot that suddenly appeared or I just forgot to remove the smart site before taking the sample. Either way, I still do my post oxygenator blood gas just to make sure that the oxygenator is still working well.

I am an ECMO nurse. Though I treat my circuit like a fragile baby, my priority will always be the patient. I work with you to keep this patient alive and to make him better. His hemodynamics, his sedation, and everything you do to the patient will affect my circuit in one way or another. So please tell me if you'll do something. I'm not trying to be difficult: the patient is alive because of this machine, so I just want our patient to stay alive.

I am an ECMO nurse. I don't mind working with junior staff. Everybody would have to start somewhere, isn't it? But if you give me 2 of them, with 2 circuits, and a filter, too, my stress augments together with the work; babysitting can be more challenging than keeping the circuits running. He doesn't need to be highly skilled and overly knowledgable; he just needs to have good planning skills, can act fast in an emergency situation, and most important of all, he needs to have the basic common sense. It's sad sometimes that common sense is not very common.

I am an ECMO nurse. I know you have done ECMO before, but there is a reason why you don't do it now. So if I'm not in the bedspace, please don't manipulate the bed and go up and down without me supervising it. It is my name beside that ECMO circuit, and it is my registration that is on the line if something nasty happens. You probably know what you are doing, but please let's respect each other's role.

I am an ECMO nurse. I know you haven't had an exposure with ECMOs before, and I'm glad that you sometimes admit it. If I call for a registrar and you don't know what to do, I'll explain to you what's happening and I'll give you some suggestions on what we can do. If I tell you that we have been having suckdown events because the patent is not properly sedated, please don't order to give 500ml Albumin to an already fluid overloaded patient. You are making the situation worst and you are not solving the problem. One note for you: Fluids don't always solve suckdown events. Trust me, I learnt it the hard way.

I am an ECMO nurse. I sometimes do a 12-your shift without any break just because there's no other ECMO nurse in the hospital. I try not to drink heaps of water, for I know that going to the toilet will be a mission especially if there is an unstable circuit. I get offered a urine bottle sometimes by my lovely colleagues, but I don't think I'd go as low as that. I would rather run as fast as I can, and do the deed in less than a minute, than to wee in the same room where I work. There are just principles that you can't give up even in the tightest of situations.

I could rant more and sound like a overtly cocky nurse, but I am tired, so I'll end it here. It could be ugly and extremely stressful sometimes doing what we do, but looking at all the post ECMO patients make it all worth it. The little child could start playing with his classmates who sent him well wishes when he was very ill, and the teenager could continue university and marry his beautiful girlfriend who was at his bedside when he was literally on the edge of dying. And so on with the greatest success stories in my career. It's a very challenging role, I must say, and it all started when I finally was able to call myself an ECMO nurse.

nowplayingjc · Aug 17, 2014

Just out of curiosity, how much do you get paid extra for running an ECMO circuit?

Biffbradford · Aug 18, 2014

How much do perfusionists make compared to ICU RNs. You want me to do their job too? Show me the money.

Bluebolt · Aug 18, 2014

Yeah, what Biff said. I like a challenge and learning new things, but I don't do charity for the hospital.

Llhook · Jul 22, 2015

Hi Ghillbert,

I can understand perhaps in your experience that an ECMO is just like a VAD.

But as a BSN that went on to get my MS and CCP, I have to disagrees with your statement. VADs and ECMOs are not remotely the same.

I run a variety of VADs and ECMOs. From biVADs, HeartMate2, impellas, Syncardia TAHs, and using a cardiohelp for picking up ECMO/VAD patients.

Each curcuit, machine, and (obviously patient) is different. The insertion process and discussion and decision of which to use is quite complex. How can you say a post partem heart failure patient on a syncardia or heartmate2 that will go home with the device is anything like an ARDS ECMO patient?

I understand that while you watch them and chart every hour, it may feel the same. However, I've been in the room when RNs have described an ECMO/VAD as "just like dialysis".

Statements like "ECMO and VADs are the same" or it's just like IABP or dialysis show a major lack of understanding

CABGpatch_RN, BSN · Jul 25, 2015

I don't think the original poster was questioning whether or not an RN should run ECLS or ever intimated that ECLS and a VAD, for example, are similar in technology and management.

What I read was ...do I take sole responsibility for managing an ECLS patient with next to no training and after having had minimal hands-on experience in the management of an ECLS patient.

My answer is an unwavering 100% NO.

As another commenter stated there are ECLS guidelines that need to be followed that include indepth individual and facility training. Extracorporeal Life Support Organization - ECMO and ECLS > Resources > Guidelines

I think it puts an RN's license on the line (and you know that facility will not back you up) and borders on practicing outside the standard of care established by the ELSO (link above).

I have always been the first in line to learn something new and have been fortunate to have the opportunity to work in a facility that promotes learning and supports the time it takes to do so properly. I have also worked in the facility that believes and RN is instantly considered competent to be the only heart nurse on the unit after having one 8 hour class, attended an open heart in the OR, observed a take-back, and then had two take-backs of their own with "support." At this facility, sometimes this nurse had 1 -2 years total nursing experience and not necessarily in the ICU. No no no no no. I would never want this person near me or a loved one, nor would I want to be a patient at that facility for any reason.

That's my take for what it's worth (14 year RN in high-volume, high-acuity, well-known CTICU).

uwtrauma1 · Mar 17, 2016

I am an RN in the CVICU at a large academic medical center in the Midwest. We as RNs are trained and competent to manage ECMO, CentriMag, VADS, Impellas, Tandam Heart, and TAH on our patients. Sometimes our patients are 2:1 but we have all had proper training and no RN takes a patient with one of these devices until they feel comfortable.