CHHS14/049

Canberra Hospital and Health ServicesClinical ProcedureExtra-Corporeal Membrane Oxygenation (ECMO) Set-Up – Adults onlyContents

Contents....................................................................................................................................1

Purpose.....................................................................................................................................2

Alerts.........................................................................................................................................2

Scope........................................................................................................................................ 2

Equipment Required by ECMO Retrieval Team.........................................................................2

Implementation........................................................................................................................ 3

Evaluation................................................................................................................................. 4

Related Policies, Procedures, Guidelines and Legislation.........................................................4

References................................................................................................................................ 4

Definition of Terms...................................................................................................................4

Search Terms............................................................................................................................ 4

Consultation..............................................................................................................................5

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Do not refer to a paper based copy of this policy document. The most current version can be found on the ACT Health Policy Register

CHHS14/049

Purpose

The purpose of this procedure is to outline the roles and responsibilities of medical and nursing staff and the equipment needed to set up for a patient that is being initiated on Extra Corporeal Membrane Oxygenation (ECMO) before being transported to the appropriate hospital for the commencement of ECMO.

The procedure will generally be performed by the ECMO retrieval team, with the support of Intensive Care Unit (ICU) doctors and nurses, and Operating Theatre scrub nurses.

Scope

Alerts

Nil alerts

Scope

This policy involves both medical and nursing staff involved in taking care of a critically ill patient: ICU specialist, primary team specialist, cardiothoracic surgeon/s, cardiac anaesthetist/s, perfusionist, operating theatre and ICU nursing staff.

Equipment Required by ECMO Retrieval Team

Procedure

Notify Theatre team leader that an ECMO retrieval team is arriving, that the ECMO equipment is required (as detailed above), and that a theatre nurse may be required in ICU.Obtain the equipment required for ECMO.

Equipment

No Stock Item Stock location1 Cannula trolley Cardiothoracic theatre

(Perfusionist to bring)2 Avalon Insertion kits 100cm/210cm guide wire “3 Blackflow tubing 30 cm “4 Sterile universal/ St MAYO Scissors x 2 “5 ECMO machine with circuit primed

Centrifugal pump module, Rota flow hand crank, Holder for ECMO, Holder for Rota-flow , 1x 1L crystalloid, 2x tubing clamps

“

6 Tape to secure cannulae “7 3 way tap on 10 cm extension line “8 Hi flow 3 way tap (Maquet) x 3 “9 3/8 -3/8 inch connector and Y-connector “

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CHHS14/049

10 Maquet rotaflow sensor plate “11 Sterile Whole body drapes x2 ICU/OT12 Sterile gowns x 3 , sterile gloves x3 ICU

S No Stock Item Stock location13 Sterile Eye-hole drapes x 2 ICU14 Cap x4 ICU15 Face mask x 4 ICU16 Goggles x 4 ICU17 Sterile gauze sets x 10 ICU18 Procedure trolley ICU/OT/CSSD19 Procedure pack ICU20 Aqueous Povidine-iodine cleaning solution ICU/OT21 Sterile tubing clamps x 10 OT/ICU/CSSD22 Syringes (4 x 10 ml, 2x 50ml Bladder syringes for ECMO cannulae) ICU23 Needles (4 x 23 G, blunt drawing needle) ICU24 1% Lignocaine x4 ICU25 ECHO machine with compatible TOE probe with sterile sheath for

ultrasoundICU

26 Transducer circuit x2 ICU27 1 L sterile 0.9% saline ICU28 6 x OPSITE 30 x 28 cm dressings ICU29 Heparin 5000u x 5 (for Heparin locking cannulae) ICU30 2 x MERSILK 1/0 & 2/0 sutures (to secure cannulae ) ICU31 2 x PROLENE 2/0 sutures (if purse string suture required) ICU32 Hemochrom ACT machine and Kaolin ACT tubes ICU33 30 cm monitoring extension line ICU34 Electric razor/ razer x3 ICU35 Tape to secure cannulae ICU36 Duoderm squares x 2 ICU

Implementation

Existence of this procedure will be included in orientation of staff to Intensive Care.

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Do not refer to a paper based copy of this policy document. The most current version can be found on the ACT Health Policy Register

CHHS14/049

Evaluation

Outcome MeasuresBi-annual audit of ECMO insertion in the Intensive Care Unit to be initiated and reported to the Quality Assurance Committee in ICU, specifically assessing time from retrieval team arrival to time of successful cannulation (this is not a common procedure in the ACT).Feedback from ECMO retrieval team to ICU.

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Related Policies, Procedures, Guidelines and Legislation

PoliciesInfection Control Policy

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References

1. Sidebotham D et al. Venovenous extracorporeal membrane oxygenation in adults: Practical aspects of circuits, cannulae, and procedures. J Cardiothoracic Vasc Anesth 2012: 26(5): 893-909.

2. Combes Alain et al. Extracorporeal membrane oxygenation for respiratory failure in adults. Curr Opin Crit Care 2012, 18:99-104.

3. Hung M, Vuylsteke, Valchanov. Extracorporeal membrance oxygenation: coming to ICU near you. J Inten Care Soc 2012. 13(1):31-38.

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Definition of Terms

ECMO: Extra-corporeal membrane oxygenation

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Search Terms

Extracorporeal Membrane OxygenationExtracorporeal CirculationRespiratory TherapyECMO

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Doc Number Version Issued Review Date Area Responsible PageCHHS14/049 1.0 December 2014 Dec 2019 ICU 4 of 5

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Consultation

Position/Division of person(s) consulted

Feedback ReceivedYes/No

Feedback incorporatedYes/No

Comment

The Canberra Hospital Perfusion Services

Yes Yes

TCH Cardiothoracic Surgical Department

Yes Yes

TCH Intensive Care Unit

Yes Yes

St Vincents Hospital (Darlinghurst) ECMO Retrieval Unit

Yes Yes

Perioperative care unit The Canberra Hospital

No N/A

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Disclaimer: This document has been developed by ACT Health, <Name of Division/ Branch/Unit> specifically for its own use. Use of this document and any reliance on the information contained therein by any third party is at his or her own risk and Health Directorate assumes no responsibility whatsoever.

Date Amended Section Amended Approved ByEg: 17 August 2014 Section 1 ED/CHHSPC Chair

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Do not refer to a paper based copy of this policy document. The most current version can be found on the ACT Health Policy Register