Pressure reduction for ECMO kids

Pediatric Critical Care Columnist · Apr 24, 2014

We use Gortex covered memory foam pads for our smaller kids. They're very similar to the Sizewise bassinet pad, but don't have the non-skid bottom cover. We can x-ray through them and usually do. We put an Ultrasorb pad on top to collect oozing and use positioning aids underneath as needed. We also use two different sizes of Gel-E donuts for under ears, occiputs, elbows, heels, between knees (of the littler kids). The last time we had a PRI in an ECMO patient it wasn't from the bed, it was from the cannula resting on her ear. We couldn't pad it well enough because of the tenuous position of the cannula in the kid's neck and the fact that even small adjustments to how it was lying caused flows to drop. We've had some runs of as long as 8 weeks without a PRI. Actually, the kids we have the most trouble with are the ones on BiPAP! The bridges of their noses sometimes break down a bit.

Sloan RN · May 27, 2014

You don't turn or reposition your ECMO patients? We do. Patients who are big enough go in a KinAir bed if possible, otherwise kids are in our standard PICU bed (which has some pressure-reduction technology) or a crib. We use Z-flows and pillows for pressure reduction and turn/reposition every 2 hours just like with any other immobile patient. Even the most unstable ECMO patients can usually tolerate a 15-degree turn to one direction or the other. We use Mepilex dressings on bony prominences and under the neck cannulas.

meanmaryjean, DNP, RN · May 29, 2014

90% of our ECMO kids are newborns. They are in radiant warmers.

picurn10 · Jun 11, 2014

we've had more than a few pts on ECMO who were so unstable, or their cannulas were so precarious, that we didn't turn at all, but its more typical to have to do small turns because they are unstable. We don't seem to have one set standard for our kids. We have some pads that have a moldable putty inside, we use gel pads, mepilex, and specialty beds on the bigger kids.

We use this stuff inside our radiant warmers for newborns.

nursingreimagined · Jun 23, 2014

I have had several patients on ECMO and it's extremely rare that a patient is too unstable to turn. There are nurses and specialists uncomfortable with turning certain patients but I find that you can almost always tilt at the very least. We use z-flows and gel pillows for pressure relief and we do X-ray through them. We get an order from the physicians at initiation approving X-ray through the z-flow. Then, if the film is unacceptable we can always do another one w/o the z-flow but that hasn't been our experience. ECMO is not an excuse for skin breakdown when it comes to getting reimbursement. Good luck! :)

Pediatric Critical Care Columnist · Jun 23, 2014

Having been called into the room when a patient's cannula slipped out of his neck while he was being lifted and he exsanguinated, I'm not anxious to repeat that experience. I relive that day in my nightmares all too often.

I have also recently had an infant on VA ECMO for entero/rhinovirus pneumonia, too small to allow proper VV cannulation, who deteriorated and lost flows every time he was touched. For any reason. I wasn't even able to sneak a small roll under his side to bank him a bit. I really don't like my patient's sats to be in the 30s, his SBP also in the 30s and his flows half of what they should be. So for a whole shift he was a hands-off baby. We successfully decannulated him 10 days later and he has no PRIs.