Toxic flu H1N1 hospitalizes nurse for months -54 days on ECMO - page 2

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  1. by   dudette10
    Don't mean to derail, but I have to ask about BMs and nutrition while on ECMO. Anybody care to explain? TIA.
  2. by   NurseQT
    Wow... This article could have been written about my older brother! His story was almost exactly the same except he didn't have a fever, he had an unrelenting cough and was sent home from the clinic twice before being admitted. He was placed on a vent and two days later was started on ECMO and transferred to larger hospital 4 hours away. Sadly his story didn't have a happy ending, a week after he was placed on ECMO he developed a secondary infection that the MDs could not pinpoint and he went into multi-organ failure. He passed away in Feb. Last year was the first time he hadn't gotten his annual flu shot in years...
  3. by   Here.I.Stand
    How horrible. I'm so very sorry for your loss!!

    Quote from NurseQT
    Wow... This article could have been written about my older brother! His story was almost exactly the same except he didn't have a fever, he had an unrelenting cough and was sent home from the clinic twice before being admitted. He was placed on a vent and two days later was started on ECMO and transferred to larger hospital 4 hours away. Sadly his story didn't have a happy ending, a week after he was placed on ECMO he developed a secondary infection that the MDs could not pinpoint and he went into multi-organ failure. He passed away in Feb. Last year was the first time he hadn't gotten his annual flu shot in years...
  4. by   meanmaryjean
    Quote from dudette10
    Don't mean to derail, but I have to ask about BMs and nutrition while on ECMO. Anybody care to explain? TIA.
    In the PICU- we do not feed our ECMO patients- they are on TPN. And as for BMs- well, it takes three people to change a diaper when it's an ECMO patient sometimes! One person to mash down the mattress enough to get under it, on to clean and one to hold the cannulae. Our patients are under heavy sedation and usually neuromuscular blockade during the entire run.
  5. by   Here.I.Stand
    Quote from dudette10
    Don't mean to derail, but I have to ask about BMs and nutrition while on ECMO. Anybody care to explain? TIA.
    Disclaimer--I have had exactly 2 patients on ECMO during my career, so I am not the most experienced in this area. Both of them were at a hospital I worked at years ago. I have not seen anyone on it at my current hospital. I am not ECMO trained myself (yet); I was the regular RN, and with one pt I had a perfusionist and for the other I had an ECMO-trained RN with me. From what I understand it is used a lot more in peds than it is in adults because adults typically don't have good outcomes. It's kind of a last-ditch effort.

    If the pt had a BM, we were able to logroll him with a CVTS physician present. We just couldn't position the pt side-to-side or otherwise let them move. My one was paralyzed and deeply sedated...the other I can't remember. I can't remember offhand if we paralyzed all of the ECMO pts or just the ones who tried to move around even w/ sedation. I think we might have had them positioned in reverse Trendelenberg so that they weren't completely flat, although we couldn't raise the HOB. The pts were tubefed, just like any ICU pt who's intubated and can't take PO nutrition.
  6. by   hopebewild
    um....... at my hospital we routinely walk our long term waiting for a heart or lung ECMO pt.s and we have had many that were there for MONTHS way more than 58 days lol. the youngest one we have walked on ECMO was four.

    the expected to be short term ECMO patients however are kept sedated. risk vs reward
  7. by   ECMO54days
    Hello all,

    Well it's me!! ECMO girl 54days.

    I have read all of your comments and I appreciate all thoughts and questions.
    To answer some of the burning questions and concerns expressed here:

    -Yes I did have AWESOME AWESOME nursing and medical care or else I would not be here today. (that an a helpful hand from the man upstairs)I was so hypoxic that turning and repostioning was not an option for quite some time. My ARDS was so severe, hence ECMO for 54days, those of you who have cared for ECMO understand that this is abnormally long. I was sedated and paralyized fin exess of 8 weeks.
    Also this wound was NOT on a normal pressure point it was right in the center of my back, so my best guess is either linen was bawled up under neath me, or a needle cap etc. I was a perfect set up for this as I was hypoxic, low albumin, protein, malnurished to a degree. AND I had NO OTHER AREAS OF BREAKDOWN- on my head, elbows, coccyx, or heals.

    - ECMO is really a last ditch effort for ARDS. It is NOT something you would want your family or yourself to be on as an adult. Mortality is usually >90%. Once ECMO is established usually vent setting can be downgraded..not so in my case, I remained on pressure controlled ventilation, 100% FIo2, peep of 25, 40 ppm nitric oxide, AND 100% flow on ECMO for some time(YIKES)

    -this is a therapy common in the pediatric population, but in adults not so much and outcomes usually not so successful and if they are pts usually have many complications (IE kidney failure, liver failure, clots, or major CNS event, bleeding,ischemic limbs etc.

    -Yes many PRE op lung transplants are on a type of ECMO called Nuvo lung which enables them to be up and mobile in the hopes of increasing strength and overall constitution so that post op they do better. Difference is this: underlying cause of hypoxia is much different than in acute ARDS. they usually have one cannulation site in right IJ using Avalon catheter (that has 2 ports) which is much smaller than the larger cannula utilized here and they are NOT cannulated in the groins. ECMO in my case was very similar to heart lung bypass utilized in open heart surgery.

    I endurred quite the ordeal, but I am happy to report I returned to work fulltime (I am also an RN) in September- 5 months following discharge from a 4 1/2 month hospital stay.
    I continue with therapy and ongoing strengthening.
    My wound was offically closed and healed in January- 1 yr after the start of this nightmare. (WIHTOUT surgery I may add)
    I have been let with some residual pulmonary fibrosis, but considering were I was I am grateful and am now oxygen free

    Life is great.
    Thanks again for all the interest

    T
  8. by   JustBeachyNurse
    Quote from ECMO54days
    Hello all,

    Well it's me!! ECMO girl 54days.

    I have read all of your comments and I appreciate all thoughts and questions.
    To answer some of the burning questions and concerns expressed here:

    -Yes I did have AWESOME AWESOME nursing and medical care or else I would not be here today. (that an a helpful hand from the man upstairs)I was so hypoxic that turning and repostioning was not an option for quite some time. My ARDS was so severe, hence ECMO for 54days, those of you who have cared for ECMO understand that this is abnormally long. I was sedated and paralyized fin exess of 8 weeks.
    Also this wound was NOT on a normal pressure point it was right in the center of my back, so my best guess is either linen was bawled up under neath me, or a needle cap etc. I was a perfect set up for this as I was hypoxic, low albumin, protein, malnurished to a degree. AND I had NO OTHER AREAS OF BREAKDOWN- on my head, elbows, coccyx, or heals.

    - ECMO is really a last ditch effort for ARDS. It is NOT something you would want your family or yourself to be on as an adult. Mortality is usually >90%. Once ECMO is established usually vent setting can be downgraded..not so in my case, I remained on pressure controlled ventilation, 100% FIo2, peep of 25, 40 ppm nitric oxide, AND 100% flow on ECMO for some time(YIKES)

    -this is a therapy common in the pediatric population, but in adults not so much and outcomes usually not so successful and if they are pts usually have many complications (IE kidney failure, liver failure, clots, or major CNS event, bleeding,ischemic limbs etc.

    -Yes many PRE op lung transplants are on a type of ECMO called Nuvo lung which enables them to be up and mobile in the hopes of increasing strength and overall constitution so that post op they do better. Difference is this: underlying cause of hypoxia is much different than in acute ARDS. they usually have one cannulation site in right IJ using Avalon catheter (that has 2 ports) which is much smaller than the larger cannula utilized here and they are NOT cannulated in the groins. ECMO in my case was very similar to heart lung bypass utilized in open heart surgery.

    I endurred quite the ordeal, but I am happy to report I returned to work fulltime (I am also an RN) in September- 5 months following discharge from a 4 1/2 month hospital stay.
    I continue with therapy and ongoing strengthening.
    My wound was offically closed and healed in January- 1 yr after the start of this nightmare. (WIHTOUT surgery I may add)
    I have been let with some residual pulmonary fibrosis, but considering were I was I am grateful and am now oxygen free

    Life is great.
    Thanks again for all the interest

    T
    Wow. Returned to work less than six months post discharge you must have had an excellent care team straight through plus wonderful support from family and colleagues. Thank you for taking the time to share your experience. I would not be surprised if it was a cap that initiated the pressure sore as I've seen that happen first hand sadly enough
  9. by   annie.rn
    Incredible! Thanks for the post :-)
  10. by   ECMO54days
    Thx for the kind words
    yes I had great care but I also worked
    extremely hard
    i had critical illness myopathy from all
    the steroids sedation and immobility
    i essentially was paralyzed
    couldn't move my limbs stand walk sit
    or anything
    it was the hardest most painful process
    atill not 100 % in terms of strength but
    I'm still working on it
    but I was determined
  11. by   JustBeachyNurse
    I spent a week intubated on a vent with high dose steroids and heavy sedation from status asthmaticus. I couldn't sit up or barely swallow. I had to learn how to sit up and walk. I can't imagine over two months sedated. Still five months is still very impressive and shows your dedication towards recovery and wellness as well as hard work on your rehabilitation regime. One day at a time, one foot in front of the other and the strength will come to diminish the deconditioning. You are here talking with us and I am thankful you are here to share. Best wishes as you continue to get stronger
  12. by   Here.I.Stand
    Thank you so much for sharing, and for explaining typical ECMO vs. the Nuvo Lung. I actually hadn't heard of that before. I've taken care of lots of pre-op heart transplants on LVADs which the can be home with, but no Nuvo Lungs.

    I saw the comment about ambulating on ECMO and was like "huh???" The last ARDS pt I had had a P/F ratio worthy of ECMO, but it was decided against (trying to be somewhat vague). She was prone for...26, 27 hrs? (Talk about pressure ulcers!) 100% FiO2, 20 of PEEP, max Flolan, and SpO2 still dropped to 60% within seconds of flipping supine.

    And just thinking back to my other ECMO pts....they weren't walking.

    Anyway, thank you again for sharing with us! I was amazed when I read the story, and now in awe to hear all of the details!
  13. by   NurseStorm
    Quote from meanmaryjean
    Not sure about adult ECMO, but in the peds ICU, our ECMO patients cannot be 'turned'. We place them on pressure reduction surfaces, and every hour or two wiggle our hands beneath them to reduce pressure, but because of our patient's size relative to the size of the cannulas, turning could dislodge the catheter tip from their teeny tiny SVC/RAs.
    54 days on ECMO - all I can say is wow!
    Yes thank you for explaining this, we do not do ECMO and I did not realize they cannot be turned.

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