ECMO

ECMO Securement

Note: Apply Foresight to patient before draping to save yourself the hassle later.

Warning: Be prepared to do a Septostomy post ECMO

Equipment

Open from ECMO Cart

• ECMO instruments
• 16/18 Coons dilators - (Only need the 16Fr)
• 20/22 Coons Dilators - (Only need the 20Fr)
• Arterial vented cannula - Normally 16fr.
• Venous cannula - Normally 21fr.
• Irrigation bulb syringe
• ”Carrot tops” Orange vessel tourniquets
• 2-0 Ethibond Multi Pack

Open from room stock

• Micropuncture
• 8fr Pinnacle
• Amplatz SS 7cm tip (x 2 for Spies)
• Cordis 150J
• Probe cover
• (1) Perclose
• (2) 0-prolene (or 2-0, ask)
• (2) Biopatch

Standby

• Amplatz Extra Stiff
• Glidewire
• Alternative sizes of cannulas
• Arrow 5 and 6fr braided sheaths for antegrade bypass
• Male-Male luer adapter for antegrade bypass

Procedure

Protip:
Separate Coons dilators. We use the 16 and 20 French. The other can go to the back table for standby. This eliminates confusion during the rapid access portion of the procedure. Protip:
Arrange instruments. Have 6 tubing clamps and heavy trauma shears immediately available to the physician. Needle driver and Mayo scissors are used for suturing after cannula are in place.

1. Arterial access with ultrasound and micro puncture (Usually left groin)
2. Short sheath wire and 8fr. dilator
3. Pre-close
4. Stiff wire inserted
5. 16fr. Coons dilator
6. Arteria Cannula inserted
7. Pull wire and dilator while MD clamps
8. Venous access (Daniels uses big needle and ultrasound)(Usually right groin)
9. Stiff wire inserted (Usually no pre-close)
10. 20fr. Coons dilator
11. Venous cannula inserted (Hold dilator in place in cannula while advancing)
12. Pull wire and dilator while MD clamps
13. CST hands over sterile portion of circuit
14. Clamp circuit while MD cuts tubing
15. Assist MD in cutting and untwisting circuit
16. Use irrigation syringe to assist MD in air-free connection between circuit and cannula
17. 2-0 or 0-Prolene used to create purse-string closures around each cannula
18. See securement section below
19. Carrot-top cut to ~5” used to protect Perclose sutures from being pulled or cut
20. Bio-patches placed
21. Clean and dress both sites

Device Securement

Warning: Use Cor-Knot device unless signed off to hand tie sutures. Cor-Knot device uses 2-0 Ethibond

• 2-0 or 0-Prolene purse-strings on both cannula secured with Woggle devices or knotted.
• Cannulas secured with 0 or 2-0-Ethibond at the skin in the provided suture ring, between suture ring and flange, and around flange where tubing connects to cannula.
• 2-0 or 0-Ethibond deep skin sutures double-wrapped and tight around the cannula. Both sides x 3
• Total of 3 sutures on the cannula and 3 on the tubing for each side.

Note: Surgicel can be used at the skin for further bleeding control.

Cor-Knot

• Cor-Knot kit from ECMO cart
• All suture used with Cor-Knot has to be 2-0 or smaller!

Daniels

• White Nurolon "White Nye" - ECMO cart
• Will secure Prolene purse string with White Nye and carrot top to Arterial Cannula

Spies

• Prep bilateral groins, right radial and right IJ. Patient will need a leave-in swan and RIGHT radial A-line before leaving room.

Egrie

• Substitute Vascular dilator kit for Coons dilators
• Substitute white nylon and Martin free needles for securement suture

Antegrade Perfusion

• Use Arrow short braided sheath on ECMO cart
• Ultrasound and micro puncture used to access SFA below arterial cannula
• Use double-male lure adaptor to attach sheath side-port to arterial cannula vent.

Septostomy

See Septostomy page

Bedside Antegrade perfusion

Open

• ECMO instrument tray
• Pack
• Braided sheath 6 or 7 fr.
• Male to Male adapter
• Micropuncture
• 5fr. sheath (Just for wire)
• US probe cover
• 0-Ethibond (CT-1)
• Bedside kit
• Table