ECMO - page 5

I have been an ECMO R.N. for three years working side by side with another R.N.( one runs the pump the other doing pt. care) Now the PICU is training Respiratory Therapists to manage the pump. Does... Read More

  1. by   NotReady4PrimeTime
    I spoke to the medical director of our ECLS program yesterday and he's very pleased that we're going to be able to help. He suggeeted that I also send you a copy of our policy and procedure for ECLS, something I'll consider after I see how many pages it is! I still have to track down the order sheets, and I'll look at the P&P tonight. Watch your PMs.
  2. by   Polednice
    Woooooow!!! I can't even express, how excited I feel about it all!!.. and thankful!!... I'm already going through some guidelines for ECMO I've found on the net, nursing care standards included!! And it all has just intensified the feeling our team has a lot ..a lot..a lot to learn!!
  3. by   NotReady4PrimeTime
    I'm going to talk to the program supervisor and see if he has all the documents as files on his computer. If he does, then I'll connect you up with him and he can send all the stuff to you. He's getting things ready to run another training session for new specialists, so he should have everything handy...
  4. by   Polednice
    Oh, that would be wondeful of you!!... I am speechless...or I would be repeating myself... but still: Thank you!!

    I did some serious search and found ECLS Guidelines of Great Ormond Street Hospital in the UK..and quantities of ECMO articles on Medscape and PubMed... well, as I wrote before, plenty to learn!!!
  5. by   Polednice
    By the way, this is my department, the whole building it is... so sorry I have no pictures from inside our ward!...it belongs to the General Teaching Hospital in Prague.http://kardiochirurgie.lf1.cuni.cz/
  6. by   NotReady4PrimeTime
    It looks like a very well-preserved and historic building. I wish Canada would pay attention to its historical architectural gems. Instead we tear them down and replace them with glass boxes.

    The hospital where I work is continually expanding and adding on wings and annexes. The one closest to completion right now is the Mazankowski Alberta Heart Institute, which will house the entire cardiovascular program with the exception of our unit and the pediatric cardiology inpatient unit. The Mazankowski is to the left of the photo; it's the rounded glass part and the red-brown section with all the angles. Our unit is on the third floor of the lighter brick building, about where the shadow of the Maz hits it. The building in the foreground on the right is the new gastrointestinal research building. The Univesrtiy of Alberta Schools of Medicine, Dentistry and Nursing are all housed within the confines of the building somewhere.
  7. by   Polednice
    Hurray!!!...having another ECMO under my care!!!!!..another opportunity to learn...having our perfusionist present I can discuss the matter with him!!..this time the patient is sedated, forunately!!
  8. by   NotReady4PrimeTime
    Okay. That's a little bit of an interesting reaction! Good for you, bad for the patient...
  9. by   Polednice
    Well, I really didn't mean it like being glad... not for the patient, for sure!!...anyway, there's an improvement seen by this one, his antikoagulation is looked at much closely. Perfusionists alone have felt the need of better management and came up with a regular check of ATC, and aPTT.
  10. by   Polednice
    ..as another ECMO appeared in our ward, more colleagues of mine see the necessity of some standards. So, we decided to join our efforts, already putting together material related. And since yesterday, perfusionists are supporting us, too, coming up with their comments.

    However, as the greatest problem now we see the care of the cannules. As with the previous patient, also with this one, bleeding along the cannules is troubling us. The blood loss can be considerable in a few days, and the frequent change of the bandages is no good for the patient, too, even if performed as aseptic as possible. We've tried many types of the bandaging material, Kaltostat included, but all are consumed in four or five hours...even the stitches added do not help.

    I'm feeling very stupid to ask a piece of advice in such an obvious matter, but still, you are far more experienced... How can we keep the cannules "clean" with the patient being so heavily heparinised?
  11. by   NotReady4PrimeTime
    We run into the same problem at times. When the patient is really bleeding from the cannulation sites, we usually try to disturb the site as little as possible, meaning that we reinforce the dressing as needed rather than changing it. If you have any kind of clot forming at the site, pulling the dressing off is only going to cause the bleeding to continue. So even though it's really ugly to look at and the risk of infection is higher, we choose to leave it. We put absorbant pads with waterproof backing under the head and neck or whichever site we have that's bleeding and change it frequently. Sometimes we have the surgeon come back and put a couple of stitches in to tighten up the exit site. Oh, and once I had a patient on ECMO who had two art lines, and the surgeon decided that we really needed to discontinue the femoral one... couldn't wait. I told him that he would have to come and remove the line, then apply the necessary pressure to the site because I simply didn't have the time. I got the whole group of fellows who took turns. Wow!! (The patient ended up dying that night, but not due to bleeding...)
  12. by   elizabells
    We once had an ATTENDING who wanted to pull an ECMO baby's umbilical arterial line (because we really don't like to leave them in more than a week) and start a peripheral art line. Thank GOODNESS the ECMO fellow talked him out of it. I don't know WHAT he was thinking.
  13. by   Polednice
    So as I see it, generally we do the same thing, like adding more layers of absorbent dressing (mostly SurgiPads) and not removing the blood clots sticking to the stitches, just sending some tiny samples to microbiology lab.

    Actually, yesterday they managed to stop the bleeding by administering adrenalin and trimecain into the tissue surrounding the cannules... no blood appeared in more than 10 hours after this procedure. Do you use this technique with your patients, too??

    And for the compress after decannulation (All of our ECMO cannules were inserted into femoral vessels, A and V.)... with the previous patient, the one with PAH, we used FemoStop system and it worked pretty well. But otherwise, our surgeons are taking turns in compressing the site, as well... with us moving the patient's bed up and down according to the docs' statures. But it depends on the severity of the bleeding... we might transport our patients to the theatre if necessary or they perform the operation right in our ward. (This being a perfect occasion, when you become three nurses in one: ICU, theatre and anestesiology!!...after one such a shift my shoes fell apart from all the running!!)

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