word: extracorporeal life support: change out pump...

EXTRACORPOREAL LIFE SUPPORT: CHANGE OUT PUMP HEAD

DOCUMENT TYPE: PROCEDURESite Applicability

Patients receiving Extracorporeal Life Support (ECLS) are cared for in the Pediatric Intensive Care Unit, where there are specially trained staff to provide this care.

Practice Level/CompetenciesECLS is considered a specialized skill and only those with advanced training in ECLS and extracorporeal equipment are to perform this task.

Perfusionist

ECLS Specialist

Equipment & Supplies1. 4 sterile clamps.2. Sterile towels3. Sterile scissors4. Sterile Rotaflow or CentriMag® pump head 5. 2 sterile Rotaflow connector adapters –

(If using ¼” circuit)6. Sterile gloves 7. 2 x 60 ml syringes filled with plasma-lyte A8. 2% chlorhexidine gluconate with 70% alcohol swabs (CHG/alcohol)9. Crash cart at bedside

ProcedureSTEPS RATIONALEEmergency change out:1. Separate from ECLS

a. Clamp the arterial and venous lines above the bridge – clamp the bridge.

*Refer to reference diagram #1

To stop the ECLS flow and isolate the patient from the circuit. Reference; procedure for: ECLS: Emergency Separation.

2. Call an ECLS CODE Assistant to help with change out Prepare to fully ventilate patient when off

ECLS support. Have inotropes available Crash cart at bedside

To ensure appropriate health care providers are notified of emergency.

Pump Head change out:1. Gather equipment.2. Have assistant ready 2 60ml

syringes with Plasma-lyte A and attach one syringe to venous line negative access pressure stopcock.

3. Open sterile green towel, place on floor under existing pump head and add equipment.

*If using ¼” circuit and Rotaflow add adaptors see rationale.

On ¼” circuit the rotaflow requires adaptor connectors to accommodate the 3/8” inlet and outlet of the pump head. The adaptors are graduated ¼” - 3/8” with a small segment of 3/8” tubing attached to accommodate pump head 3/8” connector.

C-05-12-60173 Published Date: 23-Apr-2019 of 5 Review Date: 23-Apr-2022

This is a controlled document for BCCH& BCW internal use only – see Disclaimer at the end of the document. Refer to online version as the print copy may not be current.

AdaptersRotaflow

ECLS Support Cart 4 th drawer

PediVas

Rotaflow

Adaptors


DOCUMENT TYPE: PROCEDURE4. Swab tubing areas to be clamped with CHG/alcohol

swabs maintaining aseptic technique.Reduces transmission of microorganisms.

5. Don the sterile gloves - then if using ¼” circuit and Rotaflow pump head attach adaptor maintaining aseptic technique.

Reduces transmission of microorganisms.

6. Using sterile clamps - Double clamp inlet tubing and the outlet tubing close to pump head leaving about 1” between clamps.

*Refer to reference diagram #1

Allows for room to cut tubing between clamps.

7. Using sterile scissors cut inlet and outlet tubing between the clamps closest to pump head - hand off to assistant keeping the tubing cut end in the upright position.

Maintaining sterile technique and reduces transmission of microorganisms.

8. Attach venous line to inlet of new blood pump head.

9. Hold Pump Head inverted and remove clamp. Allows air to rise.10. De-air pump head : have assistant push volume

(Plasma-lyte A) via the venous line negative access pressure stopcock and fill inverted blood pump head - keeping pump head outlet upward and tilt to expel air from outlet port.

Allowing air to rise and exit the pump head outlet.

11. De-air remaining tubing segment and attach to the blood pump head outlet and remove clamp.

12. Remove faulty blood pump head from driver. If using Levitronix CentriMag system see reference diagram #2.

13. Apply ultrasonic coupling paste to pump head if using Maquet Rotaflow system.

Required conductor for circuit to flow sensor interface.

14. Place new blood pump Head in motor. If using Levitronix CentriMag® system see reference diagram #2.

15. Remove bridge clamp.16. Turn pump on 2000 RPM and circulate via the

bridge.Establishes flow in ECLS circuit for quality check.

17. Check for air at Pump Head and oxygenator. If no air detected prepare to go back on support.

18. If air detected perform de-airing procedure as per de-airing procedure.

19. When clear prepare to go back on ECLS support.

Going back on support:1. Turn console RPM’s to 2000 or as required to

overcome circuit afterload.2. Clamp the bridge and unclamp venous line. Allows circuit to generate pressure to assist in

overcoming pump afterload.3. Check for air at the oxygenator and arterial

tubing segment.4. Slowly unclamp arterial line checking for back

flow - if there is no back flow, slowly re-initiate ECLS flow.

If back flow occurs, clamp arterial line and increase RPM’s then slowly reinitiate ECLS flow by unclamping the arterial line.

5. Increase RPM’s to full ECLS flow.C-05-12-60173 Published Date: 23-Apr-2019 of 5 Review Date: 23-Apr-2022



DOCUMENT TYPE: PROCEDURE6. Check bridge clamp and adjust, maintaining 100

ml/min of flow if using thumb clamp and 100-300 ml/min of flow if using laminar flow clamp.

100-300 ml/min of bridge flow reduces the risk of fibrin/clot formation and minimizes the risk of hemolysis.

Reference Diagram #1

Reference Diagram #2C-05-12-60173 Published Date: 23-Apr-2019 of 5 Review Date: 23-Apr-2022



DOCUMENT TYPE: PROCEDURE

DocumentationDocument on ECLS Flowsheet:

date and time of event time of separation from ECLS time of re-initiation of ECLS unexpected outcomes related to emergency intervention complete Patient Safety & Learning System (PSLS) report.

ReferencesBC Children’s Hospital reference: EXTRACORPOREAL LIFE SUPPORT: EMERGENCY SEPARATION

BC Children’s Hospital reference: EXTRACORPOREAL LIFE SUPPORT: BRIDGE THUMB CLAMP REPOSITIONING

CentriMag® Primary console operating Manual: https://www.perfusion.ws/documents/Centrimag/CentriMag-Primary-Console.pdf

RotaFlow Centrifugal Pump. (n.d.). Retrieved from https://www.maquet.com/int/products/rotaflow-centrifugal-pump/

Definitions




DOCUMENT TYPE: PROCEDUREECLS (Extracorporeal Lift Support) is an extracorporeal technique which provides cardiac and respiratory support to patients whose heart and/or lungs are unable to meet physiological requirements necessary to sustain life.

ECLS Specialist is defined as the technical specialist trained to manage the ECLS system and clinical needs of the patient on ECLS. The ECLS Specialist is a registered Nurse (RN) or Registered Respiratory Therapist (RRT) who has completed an ECLS training course. This role is supported under the direction and supervision of an ECLS trained physician.

Version HistoryDATE DOCUMENT NUMBER and TITLE ACTION TAKEN03-Oct-2018 CC.14.33 Extracorporeal Life Support: Change Out

Pump HeadApproved at: BCCH Best Practice Committee

31-Jan-2019 C-05-12-60173 Extracorporeal Life Support: Change Out Pump Head

Approved at: PICU Quality & Safety Committee

DisclaimerThis document is intended for use within BC Children’s and BC Women’s Hospitals only. Any other use or reliance is at your sole risk. The content does not constitute and is not in substitution of professional medical advice. Provincial Health Services Authority (PHSA) assumes no liability arising from use or reliance on this document. This document is protected by copyright and may only be reprinted in whole or in part with the prior written approval of PHSA.



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