{"id":22101,"date":"2020-03-23T23:56:39","date_gmt":"2020-03-23T23:56:39","guid":{"rendered":"https:\/\/www.process.st\/templates\/covid-19-procedure-daily-management-and-monitoring-of-ecmo-audit\/"},"modified":"2024-05-16T06:22:23","modified_gmt":"2024-05-16T06:22:23","slug":"covid-19-procedure-daily-management-and-monitoring-of-ecmo-audit","status":"publish","type":"post","link":"https:\/\/www.process.st\/templates\/covid-19-procedure-daily-management-and-monitoring-of-ecmo-audit\/","title":{"rendered":"COVID-19 Procedure: Daily Management and Monitoring of ECMO Audit"},"content":{"rendered":"\n<section id=\"covid19-procedure-daily-management-and-monitoring-of-ecmo-audit\">\n <h2>COVID-19 Procedure: Daily Management and Monitoring of ECMO Audit:<\/h2>\n <div class=\"image-content\">\n  <figure>\n   <a href=\"https:\/\/ps-attachments.s3.amazonaws.com\/439a0bd5-b1de-4d82-ad50-4e4fff099f10\/iSrrFnBpRr0KAE4vpA5IEA.png\" alt=\"COVID-19 Procedure: Daily Management and Monitoring of ECMO Audit:\" target=\"_blank\" rel=\"noopener\"> <img decoding=\"async\" loading=\"lazy\" src=\"https:\/\/ps-attachments.s3.amazonaws.com\/439a0bd5-b1de-4d82-ad50-4e4fff099f10\/iSrrFnBpRr0KAE4vpA5IEA.png\"> <\/a><!-- No caption -->\n  <\/figure>\n <\/div>\n <div class=\"text-content\">\n  <p>This process template is part of our <a href=\"http:\/\/process.st\/covid-19-procedures\" rel=\"nofollow noopener\" target=\"_blank\">COVID-19 Procedures<\/a> pack.&nbsp;<\/p>\n  <p>It is built as a reproduction of the procedures outlined in the&nbsp;<em><a href=\"https:\/\/video-intl.alicdn.com\/Handbook%20of%20COVID-19%20Prevention%20and%20Treatment.pdf\" rel=\"nofollow noopener\" target=\"_blank\">Handbook of COVID-19 Prevention and Treatment<\/a>&nbsp;<\/em>(2020) produced by The First Affiliated Hospital, Zhejiang University School of Medicine (FAHZU).&nbsp;<\/p>\n  <p>FAHZU had great success in combatting the novel Coronavirus COVID-19 and this handbook outlines best-practices, procedures, and useful charts for hospitals and medical centers to practically employ.&nbsp;<\/p>\n  <p>The items contained within the handbook were compiled according to clinical experience.&nbsp;<\/p>\n  <p>You can edit this process template to adapt it to the specific needs of your institution. When you come to follow the procedure, you can run this template as a checklist. You can add form fields throughout the checklist to gather information. You can connect your Process Street account with other platforms via automation to automatically store or utilize any data entered into your checklists.&nbsp;<\/p>\n  <p>Alternatively, you can choose to print this checklist out to display on the walls of the important areas where it will need to be followed. Selecting to print the checklist will reformat it for greater offline readability.&nbsp;<\/p>\n  <p>If you need support setting up automations you can visit our <a href=\"https:\/\/www.process.st\/help\/\" rel=\"nofollow noopener\" target=\"_blank\">Help Site<\/a> or contact our customer success team directly.<\/p>\n  <p>You can find the full handbook embedded below.<\/p>\n <\/div>\n <div class=\"text-content\">\n  <p><em>Process Street is not a medical institution and the items contained in this process template are illustrative and not intended to be understood as medical advice. Please refer to the attached PDF document for any and all medical or operational recommendations.&nbsp;<\/em><\/p>\n <\/div>\n<\/section>\n<section id=\"enter-checklist-details\">\n <h2>Enter checklist details<\/h2>\n <div class=\"text-field-content form-field-content\">\n  <div class=\"form-group\">\n   <label> Who is responsible for implementation? <\/label> <input type=\"text\" placeholder=\"Something will be typed here...\" disabled class=\"form-control\">\n  <\/div>\n <\/div>\n <div class=\"text-field-content form-field-content\">\n  <div class=\"form-group\">\n   <label> Who is responsible for review? <\/label> <input type=\"text\" placeholder=\"Something will be typed here...\" disabled class=\"form-control\">\n  <\/div>\n <\/div>\n <div class=\"date-field-content form-field-content\">\n  <div class=\"form-group\">\n   <label> This process is due to be completed by <\/label>\n   <div class=\"date-container\">\n    <button type=\"button\" disabled class=\"btn btn-default\"> <i class=\"fa fa-calendar btn-icon\"><\/i> Date will be set here <\/button>\n   <\/div>\n  <\/div>\n <\/div>\n<\/section>\n<section id=\"check-ecmo-equipment-hourly\">\n <h2>Check ECMO equipment hourly<\/h2>\n <div class=\"text-content\">\n  <p>ECMO equipment should be managed by ECMO perfusionists and the following items should be checked and recorded every hour:<\/p>\n <\/div>\n <div class=\"multi-select-content form-field-content\">\n  <div class=\"form-group\">\n   <label> (Subtasks) <\/label>\n  <\/div>\n  <ul class=\"items\">\n   <li class=\"item\">\n    <div class=\"step-number-container\">\n     <div class=\"step-number\">\n      1\n     <\/div>\n    <\/div>\n    <div class=\"step-checkbox-container\">\n     <div class=\"step-checkbox\"><\/div>\n    <\/div>\n    <div class=\"item-name-static\">\n     Pump flow rate\/rotation speed\n    <\/div><\/li>\n   <li class=\"item\">\n    <div class=\"step-number-container\">\n     <div class=\"step-number\">\n      2\n     <\/div>\n    <\/div>\n    <div class=\"step-checkbox-container\">\n     <div class=\"step-checkbox\"><\/div>\n    <\/div>\n    <div class=\"item-name-static\">\n     Blood flow\n    <\/div><\/li>\n   <li class=\"item\">\n    <div class=\"step-number-container\">\n     <div class=\"step-number\">\n      3\n     <\/div>\n    <\/div>\n    <div class=\"step-checkbox-container\">\n     <div class=\"step-checkbox\"><\/div>\n    <\/div>\n    <div class=\"item-name-static\">\n     Oxygen flow\n    <\/div><\/li>\n   <li class=\"item\">\n    <div class=\"step-number-container\">\n     <div class=\"step-number\">\n      4\n     <\/div>\n    <\/div>\n    <div class=\"step-checkbox-container\">\n     <div class=\"step-checkbox\"><\/div>\n    <\/div>\n    <div class=\"item-name-static\">\n     Oxygen concentration\n    <\/div><\/li>\n   <li class=\"item\">\n    <div class=\"step-number-container\">\n     <div class=\"step-number\">\n      5\n     <\/div>\n    <\/div>\n    <div class=\"step-checkbox-container\">\n     <div class=\"step-checkbox\"><\/div>\n    <\/div>\n    <div class=\"item-name-static\">\n     Ensure that the temperature controller is flowing\n    <\/div><\/li>\n   <li class=\"item\">\n    <div class=\"step-number-container\">\n     <div class=\"step-number\">\n      6\n     <\/div>\n    <\/div>\n    <div class=\"step-checkbox-container\">\n     <div class=\"step-checkbox\"><\/div>\n    <\/div>\n    <div class=\"item-name-static\">\n     Temperature setting and actual temperature\n    <\/div><\/li>\n   <li class=\"item\">\n    <div class=\"step-number-container\">\n     <div class=\"step-number\">\n      7\n     <\/div>\n    <\/div>\n    <div class=\"step-checkbox-container\">\n     <div class=\"step-checkbox\"><\/div>\n    <\/div>\n    <div class=\"item-name-static\">\n     Preventing clots in circuit\n    <\/div><\/li>\n   <li class=\"item\">\n    <div class=\"step-number-container\">\n     <div class=\"step-number\">\n      8\n     <\/div>\n    <\/div>\n    <div class=\"step-checkbox-container\">\n     <div class=\"step-checkbox\"><\/div>\n    <\/div>\n    <div class=\"item-name-static\">\n     No pressure to the cannulae and the circuit tubing is not kinked, or no \"shaking\" of ECMO tubes\n    <\/div><\/li>\n   <li class=\"item\">\n    <div class=\"step-number-container\">\n     <div class=\"step-number\">\n      9\n     <\/div>\n    <\/div>\n    <div class=\"step-checkbox-container\">\n     <div class=\"step-checkbox\"><\/div>\n    <\/div>\n    <div class=\"item-name-static\">\n     Patient's urine color with special attention to red or dark brown urine\n    <\/div><\/li>\n   <li class=\"item\">\n    <div class=\"step-number-container\">\n     <div class=\"step-number\">\n      10\n     <\/div>\n    <\/div>\n    <div class=\"step-checkbox-container\">\n     <div class=\"step-checkbox\"><\/div>\n    <\/div>\n    <div class=\"item-name-static\">\n     Pre &amp; post membrane pressure as required by the doctor\n    <\/div><\/li>\n  <\/ul>\n <\/div>\n<\/section>\n<section id=\"monitor-equipment-during-shifts\">\n <h2>Monitor equipment during shifts<\/h2>\n <div class=\"text-content\">\n  <p>The following items during every shift should be monitored and recorded:<\/p>\n <\/div>\n <div class=\"multi-select-content form-field-content\">\n  <div class=\"form-group\">\n   <label> (Subtasks) <\/label>\n  <\/div>\n  <ul class=\"items\">\n   <li class=\"item\">\n    <div class=\"step-number-container\">\n     <div class=\"step-number\">\n      1\n     <\/div>\n    <\/div>\n    <div class=\"step-checkbox-container\">\n     <div class=\"step-checkbox\"><\/div>\n    <\/div>\n    <div class=\"item-name-static\">\n     Check the depth and fixation of cannula to ensure that the ECMO circuit interfaces are firm\n    <\/div><\/li>\n   <li class=\"item\">\n    <div class=\"step-number-container\">\n     <div class=\"step-number\">\n      2\n     <\/div>\n    <\/div>\n    <div class=\"step-checkbox-container\">\n     <div class=\"step-checkbox\"><\/div>\n    <\/div>\n    <div class=\"item-name-static\">\n     The water level line of the temperature controller\n    <\/div><\/li>\n   <li class=\"item\">\n    <div class=\"step-number-container\">\n     <div class=\"step-number\">\n      3\n     <\/div>\n    <\/div>\n    <div class=\"step-checkbox-container\">\n     <div class=\"step-checkbox\"><\/div>\n    <\/div>\n    <div class=\"item-name-static\">\n     The power supply of the machine and the connection of the oxygen\n    <\/div><\/li>\n   <li class=\"item\">\n    <div class=\"step-number-container\">\n     <div class=\"step-number\">\n      4\n     <\/div>\n    <\/div>\n    <div class=\"step-checkbox-container\">\n     <div class=\"step-checkbox\"><\/div>\n    <\/div>\n    <div class=\"item-name-static\">\n     The cannula site for any bleeding and swelling\n    <\/div><\/li>\n   <li class=\"item\">\n    <div class=\"step-number-container\">\n     <div class=\"step-number\">\n      5\n     <\/div>\n    <\/div>\n    <div class=\"step-checkbox-container\">\n     <div class=\"step-checkbox\"><\/div>\n    <\/div>\n    <div class=\"item-name-static\">\n     Measure leg circumference and observe whether the lower limb on the operation side is swollen\n    <\/div><\/li>\n   <li class=\"item\">\n    <div class=\"step-number-container\">\n     <div class=\"step-number\">\n      6\n     <\/div>\n    <\/div>\n    <div class=\"step-checkbox-container\">\n     <div class=\"step-checkbox\"><\/div>\n    <\/div>\n    <div class=\"item-name-static\">\n     Observe lower limbs, such as dorsalis pedis artery pulse, skin temperature, color, etc.\n    <\/div><\/li>\n  <\/ul>\n <\/div>\n<\/section>\n<section id=\"perform-daily-monitoring-duties\">\n <h2>Perform daily monitoring duties<\/h2>\n <div class=\"text-content\">\n  <p>Post membrane blood gas analysis.<\/p>\n <\/div>\n<\/section>\n<section id=\"maintain-anticoagulation-balance\">\n <h2>Maintain anticoagulation balance<\/h2>\n <div class=\"text-content\">\n  <p>The basic goal of ECMO anticoagulation management is to achieve a moderate anticoagulation effect, which ensures that certain coagulation activity under the premise of avoiding excessive activation of coagulation. That is to maintain the balance among anticoagulation, coagulation and fibrinolysis.<\/p>\n  <p>The patients should be injected with heparin sodium (25-50 IU\/kg) at the time of intubation and maintained with heparin sodium (7.5-20 IU\/kg\/h) during the pump flow period.<\/p>\n  <p>The dosage of heparin sodium should be adjusted according to APTT results which should be held between 40-60 seconds. During the anticoagulation period, the number of skin punctures should be reduced as less as possible.<\/p>\n  <p>Operations should be taken gently. The status of bleeding should be observed carefully.<\/p>\n <\/div>\n<\/section>\n<section id=\"implement-the-ultraprotective-lung-ventilation-strategy\">\n <h2>Implement the \"ultra-protective lung ventilation\" strategy<\/h2>\n <div class=\"text-content\">\n  <p>Implement the \"ultra-protective lung ventilation\" strategy to avoid or reduce the occurrence of ventilator-related lung injury.<\/p>\n  <p>It is recommended that the initial tidal volume is&lt; 6 ml\/kg and the intensity of spontaneous breathing is retained (breathing frequency should be between 10-20 times\/min).<\/p>\n <\/div>\n<\/section>\n<section id=\"monitor-patient-status\">\n <h2>Monitor patient status<\/h2>\n <div class=\"text-content\">\n  <p>Closely observe the vital signs of patients, maintain MAP between 60-65 mmHg, CVP &lt; 8 mmHg, 5pO2 &gt; 90%, and monitor the status of urine volume and blood electrolytes.<\/p>\n <\/div>\n<\/section>\n<section id=\"follow-transfusion-procedures\">\n <h2>Follow transfusion procedures<\/h2>\n <div class=\"text-content\">\n  <p>Transfuse through the post membrane, avoiding infusion of fat emulsion and propofol.<\/p>\n <\/div>\n<\/section>\n<section id=\"evaluate-the-ecmo-oxygen-generator-every-shift\">\n <h2>Evaluate the ECMO oxygen generator every shift<\/h2>\n <div class=\"text-content\">\n  <p>According to the monitoring records, evaluate the ECMO oxygenator function during every shift.<\/p>\n <\/div>\n<\/section>\n<section id=\"sources\">\n <h2>Sources:<\/h2>\n <div class=\"text-content\">\n  <ul>\n   <li><em><a href=\"https:\/\/video-intl.alicdn.com\/Handbook%20of%20COVID-19%20Prevention%20and%20Treatment.pdf\" rel=\"nofollow noopener\" target=\"_blank\">Handbook of COVID-19 Prevention and Treatment<\/a>&nbsp;<\/em>(2020) produced by The First Affiliated Hospital, Zhejiang University School of Medicine (FAHZU)<\/li>\n  <\/ul>\n <\/div>\n<\/section>\n<section id=\"related-checklists\">\n <h2>Related Checklists:<\/h2>\n <div class=\"text-content\">\n  <ul>\n   <li><a href=\"https:\/\/www.process.st\/checklist\/covid-19-procedure-isolation-area-management\/\" rel=\"nofollow noopener\" target=\"_blank\">COVID-19 Procedure: Isolation Area Management<\/a><\/li>\n   <li><a href=\"https:\/\/www.process.st\/checklist\/covid-19-procedure-disinfection-procedures-for-covid-19-isolation-ward-area\/\" rel=\"nofollow noopener\" target=\"_blank\">COVID-19 Procedure: Disinfection Procedures for COVID-19 Isolation Ward Area<\/a><\/li>\n   <li><a href=\"https:\/\/www.process.st\/checklist\/covid-19-procedure-lung-transplantation-pre-transplantation-assessment\/\" rel=\"nofollow noopener\" target=\"_blank\">COVID-19 Procedure: Lung Transplantation Pre-Transplantation Assessment<\/a><\/li>\n   <li><a href=\"https:\/\/www.process.st\/checklist\/covid-19-procedure-nursing-care-during-treatment-alss\/\" rel=\"nofollow noopener\" target=\"_blank\">COVID-19 Procedure: Nursing Care During Treatment (ALSS)<\/a><\/li>\n   <li><a href=\"https:\/\/www.process.st\/checklist\/covid-19-procedure-protocol-for-donning-and-removing-ppe\/\" rel=\"nofollow noopener\" target=\"_blank\">COVID-19 Procedure: Protocol for Donning and Removing PPE<\/a><\/li>\n   <li><a href=\"https:\/\/www.process.st\/checklist\/covid-19-procedure-staff-management-workflow-and-health\/\" rel=\"nofollow noopener\" target=\"_blank\">COVID-19 Procedure: Staff Management (Workflow and Health)<\/a><\/li>\n   <li><a href=\"https:\/\/www.process.st\/checklist\/covid-19-procedure-daily-management-and-monitoring-of-ecmo-audit\/\" rel=\"nofollow noopener\" target=\"_blank\">COVID-19 Procedure: Daily Management and Monitoring of ECMO Audit<\/a><\/li>\n   <li><a href=\"https:\/\/www.process.st\/checklist\/covid-19-procedure-digital-support-for-epidemic-prevention-and-control\/\" rel=\"nofollow noopener\" target=\"_blank\">COVID-19 Procedure: Digital Support for Epidemic Prevention and Control<\/a><\/li>\n   <li><a href=\"https:\/\/www.process.st\/checklist\/covid-19-procedure-discharge-standards-and-follow-up-plan-for-covid-19-patients\/\" rel=\"nofollow noopener\" target=\"_blank\">COVID-19 Procedure: Discharge Standards and Follow-up Plan for COVID-19 Patients<\/a><\/li>\n   <li><a href=\"https:\/\/www.process.st\/checklist\/covid-19-procedure-disinfection-of-covid-19-related-reusable-medical-devices\/\" rel=\"nofollow noopener\" target=\"_blank\">COVID-19 Procedure: Disinfection of COVID-19 Related Reusable Medical Devices<\/a><\/li>\n   <li><a href=\"https:\/\/www.process.st\/checklist\/covid-19-procedure-disinfection-procedures-for-infectious-fabrics-of-suspected-or-confirmed-patients\/\" rel=\"nofollow noopener\" target=\"_blank\">COVID-19 Procedure: Disinfection Procedures for Infectious Fabrics of Suspected or Confirmed Patients<\/a><\/li>\n   <li><a href=\"https:\/\/www.process.st\/checklist\/covid-19-procedure-disposal-procedures-for-covid-19-related-medical-waste\/\" rel=\"nofollow noopener\" target=\"_blank\">COVID-19 Procedure: Disposal Procedures for COVID-19 Related Medical Waste<\/a><\/li>\n   <li><a href=\"https:\/\/www.process.st\/checklist\/covid-19-procedure-disposal-procedures-for-spills-of-covid-19-patient-blood-fluids\/\" rel=\"nofollow noopener\" target=\"_blank\">COVID-19 Procedure: Disposal Procedures for Spills of COVID-19 Patient Blood\/Fluids<\/a><\/li>\n   <li><a href=\"https:\/\/www.process.st\/checklist\/covid-19-procedure-procedures-for-handling-bodies-of-deceased-suspected-or-confirmed-patients\/\" rel=\"nofollow noopener\" target=\"_blank\">COVID-19 Procedure: Procedures for Handling Bodies of Deceased Suspected or Confirmed Patients<\/a><\/li>\n   <li><a href=\"https:\/\/www.process.st\/checklist\/covid-19-procedure-procedures-for-taking-remedial-actions-against-occupational-exposure-to-covid-19\/\" rel=\"nofollow noopener\" target=\"_blank\">COVID-19 Procedure: Procedures for Taking Remedial Actions against Occupational Exposure to COVID-19<\/a><\/li>\n   <li><a href=\"https:\/\/www.process.st\/checklist\/covid-19-procedure-surgical-operations-for-suspected-or-confirmed-patients\/\" rel=\"nofollow noopener\" target=\"_blank\">COVID-19 Procedure: Surgical Operations for Suspected or Confirmed Patients<\/a><\/li>\n  <\/ul>\n <\/div>\n<\/section>\n","protected":false},"excerpt":{"rendered":"<p>COVID-19 Procedure: Daily Management and Monitoring of ECMO Audit: This process template is part of our COVID-19 Procedures pack.&nbsp; It is built as a reproduction of the procedures outlined in the&nbsp;Handbook of COVID-19 Prevention and Treatment&nbsp;(2020) produced by The First Affiliated Hospital, Zhejiang University School of Medicine (FAHZU).&nbsp; FAHZU had great success in combatting the [&hellip;]<\/p>\n","protected":false},"author":3,"featured_media":22102,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"ep_exclude_from_search":false,"cover_icon_emoji":"","cover_icon_url":"","tasks_count":"12","template_description":"Follow this COVID-19 procedure to perform the manage and monitor ECMO equipment and patient status. This template can be run as a checklist from within the Process Street app or it can be printed out and displayed. 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