Ebook Nursing care and ECMO: Part 2
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Ebook Nursing care and ECMO: Part 2
Chapter 5Monitoring the ECMOChirine MossadeghAs we saw in the previous chapter, the ECMO device is complex and requires a precise, thorough, and const Ebook Nursing care and ECMO: Part 2tant management.The aim of this chapter is to describe and explain the different aspects of managing ECMO patients at bedside after implantation. We will be discussing here only about centrifugal pumps. The monitoring of an ECMO patient starts first like the surveillance of any ICU patient starting Ebook Nursing care and ECMO: Part 2with a head-to-toe assessment of the patient:•Vital signs: heart rate, mean arterial blood pressure (MAP), temperature, saturation. central venous preEbook Nursing care and ECMO: Part 2
ssure (CVP)•Physical assessment noting: hypoperfusion signs, sweating, moisture level•Neurological status: consciousness, pupillary reaction•Check of Chapter 5Monitoring the ECMOChirine MossadeghAs we saw in the previous chapter, the ECMO device is complex and requires a precise, thorough, and const Ebook Nursing care and ECMO: Part 2self and the surveillance of all the potential risks linked to the ECMO.5.1Monitoring the Circuit5.7.7 The Circuit CheckIt is a complete check up of the ECMO: plugs, fluid connectors, alarms, the integrity of the whole circuit:c. MossadeghCritical Care Department. Cardiology Institute. Groupe Hospit Ebook Nursing care and ECMO: Part 2alier Pitié Salpétrière.47. Boulevard de I'hopital. 756513 Paris cedex 13. Francee-mai 1: cmossadegh @yahoo.fr© Springer International Publishing SwitEbook Nursing care and ECMO: Part 2
zerland 201745c. Mossadegh. A. Combes (eds.). Nursing Care and ECMO, nni in iM7«n9 2 2 in in in I A s46c. Mossadegh•The position of the device: The ECChapter 5Monitoring the ECMOChirine MossadeghAs we saw in the previous chapter, the ECMO device is complex and requires a precise, thorough, and const Ebook Nursing care and ECMO: Part 2 the parameters immediately as he enters the room.•Power supply: Check that the ECMO is correctly plugged, if possible, to a secure plug (a red power outlet). Every ECMO device, whatever the brand, has a power and a battery light on the controller; make sure the battery light is off and the power li Ebook Nursing care and ECMO: Part 2ght is on.On some device, there is an additional on/off switch next to the plug itself.Finally, make sure the power supply alarm is switched on whichEbook Nursing care and ECMO: Part 2
alerts you in case of an accidental unplugging or an electrical dysfunction.•Fluid connections: Fluids (air and oxygen) are connected to a blender whiChapter 5Monitoring the ECMOChirine MossadeghAs we saw in the previous chapter, the ECMO device is complex and requires a precise, thorough, and const Ebook Nursing care and ECMO: Part 2the right connection of the fluid tubing to the oxygenator and gas hoses.•The cannulas and tubing:-For the ECMO to run properly, there must be no kinks on the full length of your cannulas. The sutures of the cannulas have to be in place. The presence of tie-bands in the appropriate places and the sa Ebook Nursing care and ECMO: Part 2fety of all connectors should be checked. The entire circuit (tubing and oxygenator) must be inspected with a flashlight, looking for clots and/or fibEbook Nursing care and ECMO: Part 2
rin , and more specifically the connectors. pigtails, or stopcocks that may be on the circuit. Every center has its own tubing configuration, front a Chapter 5Monitoring the ECMOChirine MossadeghAs we saw in the previous chapter, the ECMO device is complex and requires a precise, thorough, and const Ebook Nursing care and ECMO: Part 2 allow monitoring pressures, use as IV access to infuse volume or medication. The more connections that are present on the circuit, the more stagnation of blood is created. It enhances the risk of clot formation. That is why complex circuits must be watched with much more caution.-The ECMO (VV or VA Ebook Nursing care and ECMO: Part 2) allows blood oxygenation. Hence, there is a color difference between cannulas: the admission cannula is dark red. deoxygenated blood, and the reinfuEbook Nursing care and ECMO: Part 2
sion cannula (starting after the oxygenator) is light red. oxygenated blood. The nurse should check this color difference between the cannulas (Fig. 5Chapter 5Monitoring the ECMOChirine MossadeghAs we saw in the previous chapter, the ECMO device is complex and requires a precise, thorough, and const Ebook Nursing care and ECMO: Part 2 the ECMO. to ensure a correct support or replacement of the cardiac function for VA ECMO or to ensure an adequate gas exchange for vv ECMO.The pump being nonocclusive, the how rate must always be above 2 L/min. Under that flow rate, there is a risk of backflow, leading to an inefficient ECMO run.Th Ebook Nursing care and ECMO: Part 2e ECMO flow depends on a few parameters:-The preload: determined by volemia, venous tone, the position, and the size and length of the admission cannuEbook Nursing care and ECMO: Part 2
la.-The afterload: determined by vascular resistance, the position, size and length of the reinfusion cannula, and the length of the tubing between thChapter 5Monitoring the ECMOChirine MossadeghAs we saw in the previous chapter, the ECMO device is complex and requires a precise, thorough, and constChapter 5Monitoring the ECMOChirine MossadeghAs we saw in the previous chapter, the ECMO device is complex and requires a precise, thorough, and constGọi ngay
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