Diary of An ECMO Nurse

[nowplayingjc]

​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.

[RNdynamic]

May want to transition to something else if you overidentify that much.

[Nurse SMS, MSN, RN]

Thank you for sharing this aspect of your job with us. I found it interesting!

[brattygrl]

Nothing but respect from me to you!

[HouTx, BSN, MSN, EdD]

Are you in the US? Just wondering because of your (mid August) statement that "It's Winter".

[OhioCCRN, MSN, NP]

Thank you for what you do in running that crazy machine that keeps our patients alive!

[LadyFree28, BSN, LPN, RN]

Thank you for what you do in running that crazy machine that keeps our patients alive!

Hope to be in your shoes someday!

[anon456, BSN, RN]

I work alongside ECMO nurses but I have never been brave enough to do more than peer in from outside the room and try my best to stay out of the way. It's all advanced science to me, with a very sick child at the center of it all. I have the utmost respect for what you do.

[la_chica_suerte85, BSN, RN]

That is so fascinating. My last med-surg instructor is a PICU nurse and she kept mentioning something ECMO-this, ECMO-that and I'm thinking, "What?" So, I looked it up and . It is so tremendously fascinating. Thank you for sharing a bit on what it's like to deal with such a complex and amazing life sustaining machine.