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ECMO - Will We Have Sufficient Capacity for the Fall/Winter Flu Season?

Disasters   (60,325 Views 144 Comments)
by indigo girl indigo girl (New Member) New Member

indigo girl works as a visiting nurse.

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You are reading page 4 of ECMO - Will We Have Sufficient Capacity for the Fall/Winter Flu Season?. If you want to start from the beginning Go to First Page.

NotReady4PrimeTime has 23 years experience as a RN and works as a RN, CNCCP(C).

16 Articles; 71,082 Visitors; 7,339 Posts

Jan, it really is astonishing how much more quickly support can be initiated percutaneously. I was used to looonnng cannulations and when we went to perc, it really was as easy and fast as popping in an IABP. Quite incredible.

The biggest challenge for us with perc cannulation will be the size of our patients. We've put babies as small as 2.4 kg on and we've had to cannulate transthoracically a few times as well. One little guy we were considering ECPR for had a previous cardiac repair and when they attempted a surgical right neck cannulation they discovered the vessels were thromboses, so they dissected his left neck and were preparing the cannulae when they achieved ROSC. The other part of that challenge will be the skill of the ICU fellows with line placement. One of our current ones has a dismal track record with placing even single lumen CVCs. Fortunately our intensivists can be on the unit in a very short time from receiving the call, so there is some hope.

All this talk of ECMO is really making me think about applying for the training we have coming in October. I'd almost made the decision to forego it...

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ghillbert has 20 years experience and works as a ACNP-BC, CCRN.

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Yes, you should do it if you have the opportunity. Taking the course (I did the Alfred one back in 2002) really gave me a much better understanding of everything related to it (even though I thought I already knew a lot!). It's very interesting. We certainly didn't let fellows cannulate though, only the attending intensivists. The course there for those who will be cannulating includes animal model training.

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NotReady4PrimeTime has 23 years experience as a RN and works as a RN, CNCCP(C).

16 Articles; 71,082 Visitors; 7,339 Posts

Sadly it isn't so much a case of my tossing my hat into the ring and being given the training. There's a selection process and although I'm exceedingly qualified I might not be part of the charmed circle. I missed the cut once already (after a personality conflict with the nursing coordinator over a safety issue on the unit).

Anyway, check this story form the Edmonton Journal Breaking News feature:

EDMONTON - Alberta doctors who treat patients with the H1N1 virus may be paid up to $518 an hour under a proposed “physician financial support program” from the province and the Alberta Medical Association...

http://www.edmontonjournal.com/health/Alberta+doctors+treat+H1N1+patients+paid/1910150/story.html

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indigo girl works as a visiting nurse.

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http://www.edmontonjournal.com/health/Alberta+doctors+treat+H1N1+patients+paid/1910150/story.html

Alberta doctors who treat patients with the H1N1 virus may be paid up to $518 an hour under a proposed “physician financial support program” from the province and the Alberta Medical Association.

Physicians who opt to work with patients with H1N1 would be paid $518.45 an hour during night shifts, $403.24 an hour during evenings and weekends and $259.23 an hour during weekday shifts, AMA President Dr. Noel Grisdale told members in a letter.

The proposed pay rates would apply if a state of public health emergency was declared.

The province and the AMA are also considering a program that would provide a guaranteed income for physicians unable to work because of illness as a result of treating pandemic patients.

Let me get this straight.

They are going to pay the doctors this outrageous sum to see, probably only for a few minutes each, patients with swine flu. But, the nurse who will spend 8 to 16 hours with these patients gets only the regular hourly rate.

What is the compensation for the nurse who gets swine flu? You know what they will say?

No way to prove it happened on the job. You could have been infected in the community. That is exactly what they said about that healthy, athletic nurse that died of swine flu in California.

Not only that, you, the nurse get only a surgical mask or procedure mask to protect you from these poor patients who may be coughing, puking and pooping. That's what we are seeing. Oh wait, you get to use a face shield with it.

Who was that nurse from Canada that spoke to the IOM in Washington last week favoring the surgical mask. I remember her saying, well you are going to catch the flu in the community anyway. Thanks a bunch, Bonnie, whoever you are for going to bat for nurses.

And here I was trying to get sleepy enough to go to bed, janfrn...

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NotReady4PrimeTime has 23 years experience as a RN and works as a RN, CNCCP(C).

16 Articles; 71,082 Visitors; 7,339 Posts

Sorry, hon. I didn't mean to keep you up all night.

I've just scoured the print edition of this paper and the item didn't appear. I was just so coked by this idiocy that I could hardly wait to bang out a letter to the editor asking just those questions. I've already given a heads-up to my union. Did we learn nothing from SARS?

This Bonnie person you mentioned... is that Bonnie Rogers who sat on the OH&S committee examining PPE requirements? *Going into defensive mode* She isn't a Canadian... http://www8.nationalacademies.org/cp/committeeview.aspx?key=49116

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indigo girl works as a visiting nurse.

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Sorry, hon. I didn't mean to keep you up all night.

I've just scoured the print edition of this paper and the item didn't appear. I was just so coked by this idiocy that I could hardly wait to bang out a letter to the editor asking just those questions. I've already given a heads-up to my union. Did we learn nothing from SARS?

This Bonnie person you mentioned... is that Bonnie Rogers who sat on the OH&S committee examining PPE requirements? *Going into defensive mode* She isn't a Canadian... http://www8.nationalacademies.org/cp/committeeview.aspx?key=49116

I am very sorry about that, janfrn. I probably missed her credentials being announced. It was a sensory overloading experience to listen to two days of testimony and opinions. I got it into my head that she was Canadian for some reason, perhaps because she mentioned colleagues felled by SARS. But, yes, she's the one. I see now that she is in the US.

When I heard her say, matter of factly that the nurses were going to be infected in the community anyway, I wanted to choke her. Come on, Bonnie! Is this any reason to deny them the better protecting mask on the job where they will be in direct contact with confirmed cases? What study did she do or read proving the surgical mask is just as efficacious as the N95?

The Australians at the meeting were openly skeptical of the downplaying of severity of this pandemic. One of them, a Dr McIntyre did two studies on masks that were very interesting, but only her second study, not yet published was directly relevant to HCW using masks in the hospital setting. She said flat out that the surgical masks were not efficacious based on her research comparing both in 24 hospitals in Beijing, China last year. Will the IOM ignore the results of that study, and go with the opinions of experts like Bonnie? Probably so.

Where is your research, Bonnie?

OK, I am calming down, and getting ready for my computer class which will take my mind off of this no win situation...

Edited by indigo girl

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NotReady4PrimeTime has 23 years experience as a RN and works as a RN, CNCCP(C).

16 Articles; 71,082 Visitors; 7,339 Posts

No worries Indigo. I just sometimes feel that Canada and Canadians are vilified when we don't deserve to be. Call me thin-skinned...

I just was reading my work email and we had yet another management clarification of our newly modified contact and droplet precautions (actually it was a verbatim regurg of the one we got last week and the week before...) about aerosolizing procedures yadda yadda. So I replied and asked about my being able to smell soap through my N95, and the lax attention to the CDC recommendations for fit testing. Got an instant reply, "I'm out of the office until September 1. If this is urgent contact the supervisor on call..." (Guess that means I'm not going to get my scheduling problems ironed out either. Sigh.)

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indigo girl works as a visiting nurse.

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http://www.bloomberg.com/apps/news?pid=20601081&sid=a9vKlznnyeQ4

Last weekend, a quarter of Western Australia’s 105 adult intensive care beds were occupied by swine flu patients who needed ventilators to breathe, according to Towler.

While fewer than 0.5 percent of swine flu sufferers may need hospitalization, those who do can remain in intensive care for up to three weeks, occupying a bed that could be used for 15 heart bypass patients. Christchurch Hospital, the biggest on New Zealand’s South Island, postponed non-emergency procedures requiring an ICU stay such as heart bypass as flu patients -- three-quarters needing mechanical ventilation -- filled up the 12-bed unit and nine other hastily created intensive-care beds, according to Shaw.

What’s more, a 10th of those critically ill patients needed their blood pumped through an artificial lung, a procedure known as extracorporeal membrane oxygenation, or ECMO, that only one hospital in New Zealand offers.

“I’ve seen nothing like this,” said John Beca, head of pediatric intensive care at New Zealand’s national children’s hospital in Auckland. Five of Beca’s six ECMO units have been used simultaneously this winter. He’s ordering three more.

Maquet Cardiopulmonary AG, a subsidiary of Sweden’s Getinge AB, has received a 50 percent jump in orders for the life- support system in Australia, Clinical Director Juergen Boehm said. The German company is doubling production of the units, which cost as much as 60,000 euros ($85,000) apiece, and plans to increase its inventory of tubes, artificial lungs and other disposable ECMO equipment to about 500 sets, from 100 usually.

Orders for ECMO accessories are up about 20 percent in Australia and New Zealand, said Joseph McGrath, a spokesman for Minneapolis-based Medtronic Inc., which also makes the devices.

(hat tip PFI/Monotreme)

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indigo girl works as a visiting nurse.

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This one's for you, janfrn. Now, don't you feel better about those poor physicians getting megabucks per hour? They are in the frontlines, according this guy. They are self employed after all, and they have to make a living. The nurses and other staff are salaried, so no worries, mate...

Alberta MD group defends $500 per hour to treat H1N1

http://www.dose.ca/news/story.html?id=1912592

(hat tip PFI/snowhound1)

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CrunchRN has 25 years experience as a ADN and works as a Nurse.

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So will those physicians also do the nursing care when the nurses stay home in droves so they won't expose there families for their paltry salary.

Hey Doc - empty my bedpan and do it now!:chuckle:chuckle:chuckle

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NotReady4PrimeTime has 23 years experience as a RN and works as a RN, CNCCP(C).

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Oh it gets better. I just read this morning's paper (this is happening on my doorstep, you know) and am fuming at this statement:

"... the rates of pay are meant to compensate doctors for the risk of exposing themselves and their families to the flu virus."

Even worse is that our union is saying "we" don't care about the money, we just want some guarantees that there will be enough masks for all of us. WRONG!! I don't want to expose my liver-transplant-recipient son or my elderly parents to this potentially fatal virus any more than this legion of physicians wants to expose their families. And really, who is at greater risk? The physician who does a 2 minute physical assessment and then does the rest of his doctoring from the hallway, or the ICU nurse IN THE ROOM for 12 hours? Will they compensate me if my son gets sick and dies from H1N1 after a prolonged ICU stay? Of course not, because, as they said in California, he could have gotten it in the community! I posted a comment on the CBC's website related to this story (didn't use my name but I bet you could ID it...) and am going to see what kind of response it got from the public in just a few minutes.

Our union did make some comments about our staffing issues... you know the magically resolved nursing shortage in Alberta that disappeared because the minister of health and the CEO of Alberta Health Services said there isn't one... Right now on our business-as-usual PICU we're staffing most shifts with anywhere from 20 to 50% overtime. What the heck will we do when the unit is packed to the rafters with sick kids and we haven't been able to hire any new nurses?

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oramar works as a returned nurse.

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So will those physicians also do the nursing care when the nurses stay home in droves so they won't expose there families for their paltry salary.

Hey Doc - empty my bedpan and do it now!:chuckle:chuckle:chuckle

I have posted on threads where nursing were talking about layoffs. I told them that if I was an experienced nurse that wanted to make some extra money I would be signing up at a couple of agencies. Even though we are in middle of labor glut at the moment, the glut will turn on a dime into a shortage if the flu situation gets dicey in the next few months. Between nurses out sick and new nurses finding out for the first time what working short in a epidemic is like, I think a shortage will rear its head very quickly. Older nurses who have experienced a heavy flu season before will not be shocked by being told they have to take another patient from the ER, then another after that even though they have a heavier patient load than they ever carried in their life. I do believe that a certain portion of nurses will just walk. I say that because half way through the heavy flu season of 1999-2000 I gave my two weeks notice and bolted. I just went "I am to old for this" and retired for the first time. Took three years off but did eventually come back. Now well into my 60s I am really to old to take 12 patients on a med/surg unit during a pandemic. In Pennsylvania we have a "no mandation" law. During a pandemic that goes out the window because there is a clause that allows employers to mandate during an epidemic or other emergency.

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