ECMO

Daniels/Spies - Draft

Wires:

Open

• Amplatz SS 1cm tip
• Cordis 150J

Standby

• Amplatz Extra Stiff
• Glidewire

Sheaths:

Open

• 8fr Pinnacle

ECMO cart:

Open

• ECMO instruments
• 16/18 Coons dilators
• 20/22 Coons Dilators
• Arterial vented cannula - Normally 16fr.
• Venous cannula - Normally 21fr.
• Irrigation bulb syringe
• ”Carrot tops” Orange vessel tourniquets

Standby

• Alternative sizes of cannulas
• Arrow 5 and 6fr braided sheaths for antegrade bypass
• Male Male luer adapter for antegrade bypass

Misc Supplies:

Open

• Micropuncture
• Probe cover
• 25g lido needle (Daniels)
• (2) Perclose
• (2) 0 Silk or Ethibond (Not for Sheridan)
• (2) 2-0 Prolene (Open 4 for Dr. Sheridan)
• (2) “Suture Locks”
• (2) Biopatch

Egrie

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

Procedure

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

Septostomy

See Septostomy page

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.

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Approved: MM/DD