ECMO: Difference between revisions
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{{Note| Apply Foresight to patient before draping to save yourself the hassle later. }} | |||
=Daniels/Spies - Draft= | =Daniels/Spies - Draft= | ||
===Also used for Dr. Sheridan=== | ===Also used for Dr. Sheridan=== | ||
=== | ===Equipment:=== | ||
*Micropuncture | |||
*8fr Pinnacle | |||
*Amplatz SS 7cm tip (x 2 for Spies) | *Amplatz SS 7cm tip (x 2 for Spies) | ||
*Cordis 150J | *Cordis 150J | ||
*Probe cover | |||
*(1) Perclose | |||
*(2) 0-Prolene on a CT1 Needle | |||
*(1) White Nylon | |||
*(2) Biopatch | |||
===ECMO cart Supplies:=== | |||
===ECMO cart:=== | |||
====Open==== | ====Open==== | ||
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====Standby==== | ====Standby==== | ||
*Amplatz Extra Stiff | |||
*Glidewire | |||
*Alternative sizes of cannulas | *Alternative sizes of cannulas | ||
*Arrow 5 and 6fr braided sheaths for antegrade bypass | *Arrow 5 and 6fr braided sheaths for antegrade bypass | ||
*Male Male luer adapter for antegrade bypass | *Male-Male luer adapter for antegrade bypass | ||
=== * Be prepared to perform a septostomy post ECMO implant * === | === * Be prepared to perform a [[septostomy]] post ECMO implant * === | ||
===Egrie=== | ===Egrie=== | ||
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==Procedure== | ==Procedure== | ||
{{Note|Spies would like bi-fem, right radial and right IJ prepped. Patient will need a leave-in swan and RIGHT radial A-line before leaving room.}} | {{Note|Spies would like bi-fem, right radial and right IJ prepped. Patient will need a leave-in swan and RIGHT radial A-line before leaving room.}} | ||
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#Stiff wire inserted | #Stiff wire inserted | ||
#16fr. Coons dilator | #16fr. Coons dilator | ||
# | #Arteria Cannula inserted | ||
#Pull wire and dilator while MD clamps | #Pull wire and dilator while MD clamps | ||
#Venous access (Daniels uses big needle and ultrasound)(Usually right groin) | #Venous access (Daniels uses big needle and ultrasound)(Usually right groin) | ||
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#Use irrigation syringe to assist MD in air-free connection between circuit and cannula | #Use irrigation syringe to assist MD in air-free connection between circuit and cannula | ||
#0-Prolene used to create purse-string closures around each cannula | #0-Prolene used to create purse-string closures around each cannula | ||
# | #See securement section below | ||
#Carrot-top cut to ~5” used to protect Perclose sutures from being pulled or cut | #Carrot-top cut to ~5” used to protect Perclose sutures from being pulled or cut | ||
#Bio-patches placed | #Bio-patches placed | ||
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*Additional deep 0-Prolene stitch through a 3” long carrot-top secured to the cannula with white nylon ties. (Minimum 2 nylon ties) | *Additional deep 0-Prolene stitch through a 3” long carrot-top secured to the cannula with white nylon ties. (Minimum 2 nylon ties) | ||
*Arterial cannula secured with 0-Ethibond at the skin in the provided suture ring. | *Arterial cannula secured with 0-Ethibond at the skin in the provided suture ring. | ||
{{Warn|Use Cor-Knot device unless signed off to hand tie sutures. Cor-Knot device uses 2-0 Ethibond}} | |||
====At the tubing connection==== | ====At the tubing connection==== | ||
Latest revision as of 21:02, 31 July 2024
Note: Apply Foresight to patient before draping to save yourself the hassle later.
Daniels/Spies - Draft
Also used for Dr. Sheridan
Equipment:
- Micropuncture
- 8fr Pinnacle
- Amplatz SS 7cm tip (x 2 for Spies)
- Cordis 150J
- Probe cover
- (1) Perclose
- (2) 0-Prolene on a CT1 Needle
- (1) White Nylon
- (2) Biopatch
ECMO cart Supplies:
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
- Amplatz Extra Stiff
- Glidewire
- Alternative sizes of cannulas
- Arrow 5 and 6fr braided sheaths for antegrade bypass
- Male-Male luer adapter for antegrade bypass
* Be prepared to perform a septostomy post ECMO implant *
Egrie
- Substitute Vascular dilator kit for Coons dilators
- Substitute white nylon and Martin free needles for securement suture
Procedure
Note: Spies would like bi-fem, right radial and right IJ prepped. Patient will need a leave-in swan and RIGHT radial A-line before leaving room.
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.
- Arterial access with ultrasound and micro puncture (Usually left groin)
- Short sheath wire and 8fr. dilator
- Pre-close
- Stiff wire inserted
- 16fr. Coons dilator
- Arteria Cannula inserted
- Pull wire and dilator while MD clamps
- Venous access (Daniels uses big needle and ultrasound)(Usually right groin)
- Stiff wire inserted (Usually no pre-close)
- 20fr. Coons dilator
- Venous cannula inserted (Hold dilator in place in cannula while advancing)
- Pull wire and dilator while MD clamps
- CST hands over sterile portion of circuit
- Clamp circuit while MD cuts tubing
- Assist MD in cutting and untwisting circuit
- Use irrigation syringe to assist MD in air-free connection between circuit and cannula
- 0-Prolene used to create purse-string closures around each cannula
- See securement section below
- Carrot-top cut to ~5” used to protect Perclose sutures from being pulled or cut
- Bio-patches placed
- Clean and dress both sites
Securement and anti-bleeding protocol
At the Skin:
- 0-Prolene purse-strings on both cannula secured with Woggle devices.
- Additional deep 0-Prolene stitch through a 3” long carrot-top secured to the cannula with white nylon ties. (Minimum 2 nylon ties)
- Arterial cannula secured with 0-Ethibond at the skin in the provided suture ring.
Warning: Use Cor-Knot device unless signed off to hand tie sutures. Cor-Knot device uses 2-0 Ethibond
At the tubing connection
- 0-Ethibond deep skin sutures double-wrapped and tight around the cannula. Both sides.
~8-10”down
- 0-Ethibond deep skin sutures double-wrapped and tight around the cannula. Both sides.
- Suture locks can be used above the knees for further strain relief.
Note: Surgicel can be used at the skin for further bleeding control.
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.
Spies' Decan without Pre-Closure!
- 12F Dilator
- 10F Dilator
- 8F Dilator
- 2 Perclose
- Standard J
Clamp arterial cannula, cook needle stick to the cannula. Standard J advanced and cannula removed. 12F dilator inserted, pressure held for 5 or so minutes. Dilator downsized to 10F, pressure held. Perclose times one. 8F dilator advanced and pressure held. Second perclose deployed.
Approved: MM/DD
