Regular modification of ECMO settings as per patient's condition
10
Perform regular blood gas analysis
11
Maintain patient’s fluid and electrolyte balance
12
Administration of prescribed anticoagulants
13
Regular check of coagulation profile
14
Ensuring proper ventilator settings
15
Monitor for possible infections or complications
16
Perform routine patient care activities and hygienic practices
17
Continuous evaluation of patient's clinical response to ECMO
18
Approval: Patient Care Monitoring
19
Deciding on the timing of weaning off ECMO
20
Ramp down ECMO support
21
Removal of ECMO cannulas once stabilized
Assessment of patient's condition
Assess the patient's medical condition to determine their eligibility for ECMO. Evaluate vital signs, blood gas values, and hemodynamic status. Consider the patient's underlying comorbidities and the severity of their respiratory or cardiac failure. Identify any contraindications or potential risks that may affect the success of the ECMO procedure. Ensure clear documentation of the patient's baseline status.
1
Evaluate vital signs
2
Assess blood gas values
3
Evaluate hemodynamic status
4
Identify contraindications
5
Document baseline status
Determination of the need for ECMO
Analyze the patient's condition and discuss with the ECMO team to determine whether ECMO is an appropriate treatment option. Consider the failing organ system, the likelihood of recovery, and the potential benefits of ECMO. Assess alternative treatment options and make an informed decision based on available data. Collaborate with specialists and involve the patient and their family in the decision-making process.
1
Analyze patient's condition
2
Discuss with ECMO team
3
Assess alternative options
4
Collaborate with specialists
5
Involve patient and family
Approval: Need Assessment
Will be submitted for approval:
Determination of the need for ECMO
Will be submitted
Placement of patient under general anesthesia
Prepare the patient for the administration of general anesthesia in order to ensure their comfort and safety during the ECMO procedure. Verify the patient's fasting status and obtain their consent. Administer pre-anesthetic medications as prescribed. Monitor the patient's vital signs throughout the anesthesia induction process. Use standardized monitoring methods and equipment to ensure accurate measurement and assessment. Communicate effectively with the anesthesia team to maintain optimal patient care.
1
NPO (Nothing by mouth) for 6 hours or more
2
NPO for 2-6 hours
3
NPO less than 2 hours
4
Fasting status unknown
1
Blood pressure monitor
2
Pulse oximeter
3
Capnography device
4
Electrocardiogram (ECG)
5
Temperature monitoring device
Setting up the ECMO circuit and machine
Prepare the necessary equipment and assemble the ECMO circuit and machine. Ensure proper positioning and connection of all components in accordance with established guidelines. Verify the integrity and functionality of the circuit, including tubing, connectors, and oxygenator. Prime the circuit with appropriate solutions and remove any air bubbles. Perform required safety checks and ensure that alarms and monitoring systems are activated. Conduct a final inspection to confirm proper setup before initiating ECMO support.
1
ECMO machine
2
Cannulae
3
Tubing and connectors
4
Oxygenator
5
Pumps
Performance of cannulation procedure
Perform the cannulation procedure to establish access for the ECMO circuit. Administer local anesthesia and ensure aseptic technique throughout the procedure. Select appropriate cannulae size and site based on the patient's anatomy and condition. Monitor the patient's vital signs and manage any complications that may arise during cannulation. Collaborate with the surgical team to ensure safe and successful cannulation.
1
Femoral artery and vein
2
Jugular vein and carotid artery
3
Axillary artery and vein
4
Subclavian vein and internal jugular vein
5
Other
Connect patient to ECMO machine
Connect the cannulae to the appropriate ports on the ECMO circuit. Ensure proper alignment and secure connections to prevent any leaks or disconnections. Confirm adequate blood flow and oxygenation through the circuit. Monitor the patient's vital signs and adjust pump settings as necessary to maintain optimal perfusion and oxygenation. Collaborate with the perfusionist and ECMO team to ensure smooth ECMO initiation.
1
Connect arterial line
2
Connect venous line
3
Confirm blood flow
4
Monitor vitals
5
Adjust pump settings
Monitor vitals and machine parameters regularly
Regularly monitor the patient's vital signs and machine parameters to assess the stability of the ECMO support. Monitor parameters such as blood pressure, heart rate, oxygen saturation, and ECMO flows. Utilize appropriate monitoring equipment and techniques. Document and communicate any significant changes or abnormalities promptly to the ECMO team for further evaluation and intervention.
1
Blood pressure
2
Heart rate
3
Oxygen saturation
4
ECMO flows
5
Temperature
Regular modification of ECMO settings as per patient's condition
Continuously assess the patient's clinical response to ECMO and modify the ECMO settings accordingly. Adjust pump speed, sweep gas flow, and oxygenator settings based on the patient's hemodynamic status and blood gas values. Collaborate with the ECMO team to optimize the support and ensure the patient's stability. Document the changes made and communicate the modifications to other members of the healthcare team.
1
Pump speed
2
Sweep gas flow
3
Oxygenator settings
4
Other
Perform regular blood gas analysis
Regularly obtain blood samples for analysis to monitor the patient's oxygenation, acid-base balance, and electrolyte levels. Follow proper blood sampling techniques to ensure accurate results. Collaborate with the laboratory team for timely analysis and interpretation of the blood gas values. Use the results to guide further ECMO adjustments and patient management decisions.
1
Obtain blood samples
2
Collaborate with lab team
3
Interpret blood gas values
4
Make ECMO adjustments
5
Document results
Maintain patient’s fluid and electrolyte balance
Monitor the patient's fluid status and electrolyte levels to ensure proper balance during ECMO support. Administer crystalloids, colloids, or blood products as needed to maintain adequate intravascular volume. Adjust the composition of replacement fluids to correct any imbalances. Collaborate with the nursing team and the ECMO coordinator to implement a comprehensive fluid and electrolyte management plan.
1
Monitor fluid status
2
Monitor electrolyte levels
3
Administer fluids or blood products
4
Adjust replacement fluid composition
5
Collaborate with nursing team
Administration of prescribed anticoagulants
Administer anticoagulants as prescribed to minimize the risk of blood clot formation within the ECMO circuit. Follow the recommended dosage and infusion rates based on the patient's weight, coagulation profile, and individual needs. Monitor the patient for any signs of bleeding or adverse reactions to the anticoagulant therapy. Collaborate with the pharmacy team to ensure appropriate medication management and monitoring.
1
Heparin
2
Bivalirudin
3
Argatroban
4
Citrate
5
Other
1
Monitor coagulation profile
2
Assess for bleeding
3
Monitor for adverse reactions
4
Manage drug levels
5
Collaborate with pharmacy team
Regular check of coagulation profile
Regularly monitor the patient's coagulation profile to assess their hemostatic status and adjust anticoagulation therapy if needed. Obtain laboratory test results, including activated partial thromboplastin time (aPTT) and anti-Xa levels. Interpret the results in the context of the patient's overall clinical condition. Collaborate with the laboratory team and the ECMO coordinator to ensure timely testing, interpretation, and interventions.
1
Obtain aPTT and anti-Xa levels
2
Interpret test results
3
Adjust anticoagulation therapy
4
Collaborate with lab team
5
Document results
Ensuring proper ventilator settings
Ensure the patient is receiving appropriate ventilator support while on ECMO. Continuously assess the patient's respiratory status and adjust ventilator settings as needed to maintain adequate oxygenation and ventilation. Monitor parameters such as tidal volume, peak inspiratory pressure, and positive end-expiratory pressure. Collaborate with the respiratory therapy team to optimize ventilator settings and minimize lung injury.
1
Tidal volume
2
Peak inspiratory pressure
3
Positive end-expiratory pressure
4
Respiratory rate
5
Fraction of inspired oxygen (FiO2)
Monitor for possible infections or complications
Vigilantly monitor the patient for any signs or symptoms of infections or complications related to the ECMO procedure. Assess for fever, leukocytosis, purulent drainage, or any other indicators of infection. Monitor for circuit-related issues such as clotting, air embolism, or mechanical failures. Collaborate with the infection control team and follow established protocols for prevention and management of infections.
1
Systemic infection
2
Cannula site infection
3
Circuit clotting
4
Air embolism
5
Mechanical failure
1
Assess for fever
2
Assess leukocyte count
3
Monitor for purulent drainage
4
Monitor circuit integrity
5
Collaborate with infection control team
Perform routine patient care activities and hygienic practices
Provide routine care to the patient to ensure their comfort, hygiene, and overall well-being during ECMO support. Implement appropriate infection prevention measures, including sterile techniques and hand hygiene. Perform regular oral care, skin care, and positioning to prevent complications. Collaborate with the nursing team to address the patient's specific care needs and enhance their overall experience.
1
Perform oral care
2
Provide skin care
3
Assist with urinary care
4
Implement infection prevention measures
5
Collaborate with nursing team
Continuous evaluation of patient's clinical response to ECMO
Continuously assess the patient's clinical response to ECMO therapy to evaluate its effectiveness and guide further management decisions. Monitor the patient's hemodynamic stability, respiratory status, and overall organ function. Document any changes or trends observed. Collaborate with the medical team to interpret findings, discuss potential interventions, and adjust the treatment plan as necessary.
1
Monitor hemodynamic stability
2
Assess respiratory status
3
Evaluate organ function
4
Document changes or trends
5
Collaborate with medical team
Approval: Patient Care Monitoring
Will be submitted for approval:
Continuous evaluation of patient's clinical response to ECMO
Will be submitted
Deciding on the timing of weaning off ECMO
Evaluate the patient's clinical status and specific ECMO parameters to determine the appropriate timing for weaning off ECMO support. Consider the stability of the patient's respiratory and/or cardiac function, blood gas values, and overall organ recovery. Collaborate with the ECMO team and other specialists to make an informed decision. Prepare a weaning plan and communicate it to the entire healthcare team.
1
Stable respiratory function
2
Stable cardiac function
3
Improved blood gas values
4
Organ recovery
5
Other
Ramp down ECMO support
Initiate the process of gradually decreasing ECMO support once the decision for weaning has been made. Make appropriate adjustments to pump speed and/or sweep gas flow according to the weaning plan. Monitor the patient closely for any signs of deterioration or instability during the ramp down process. Inform the entire healthcare team about the progress and ensure coordinated care.
1
Gradually decrease pump speed
2
Adjust sweep gas flow
3
Monitor patient closely
4
Communicate with healthcare team
5
Document progress
Removal of ECMO cannulas once stabilized
Ensure the patient is stable and meets the necessary criteria before removing the ECMO cannulas. Collaborate with the surgical team to perform the cannula removal procedure. Administer appropriate anesthesia and closely monitor the patient throughout the process. Manage any bleeding or complications that may occur. Document the procedure and provide post-removal care.
