ECMO

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

Daniels/Spies - Draft

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

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.

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. 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

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.

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Approved: MM/DD