EXTRACORPOREAL LIFE SUPPORT: CONNECTOR CHANGE OUT

DOCUMENT TYPE: PROCEDURE Site Applicability

Patients receiving ECLS are cared for in the Pediatric Intensive Care Unit, where there is specially trained staff to provide this care.

Practice Level/Competencies

ECLS is considered a specialized skill and only individuals with advanced training in ECLS and whose skill has been validated are to perform this task.

Perfusionist the event of an emergency or directed by the Perfusionist:

ECLS Specialist

Equipment & SuppliesGather from the ECLS Support cart:

1. 8 clamps

2. Sterile connector with luer lock

3. 3-way stopcock

4. MED-RX extension set (pig-tail)

5. Sterile gloves

6. Sterile towels

7. Sterile scissors

8. 1 - 60 ml syringes

9. Blunt needle

10. Plasma-lyte A bag spiked with fluid transfer set (on ECLS circuit)

11. 2% chlorhexidine gluconate with 70% alcohol swab (CHG/alcohol)

12. Dead end cap

Steps & Rationale STEPS RATIONALEEMERGENCY CHANGE OUT:

1. Emergently SEPARATE from ECLS

a. Clamp the arterial and venous line above the bridge, clamp the bridge and stop the pump.

Emergency change out is defined by air entrainment caused by crack or breakage of connector or actively leaking blood.BC Children’s Reference- ECLS: Emergency Separation from Extracorporeal Life Support.

2. Clamp tubing near inflow and outflow ends of the connector then place a second clamp one inch away. See reference #1 and # 3.

Reference #1 3. Perform a vigorous scrub with CHG/alcohol Prevents introduction of infectious organisms.

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EXTRACORPOREAL LIFE SUPPORT: CONNECTOR CHANGE OUT

DOCUMENT TYPE: PROCEDURE swabs to the tubing between the clamps. Move immediately to step 5 and 6 to limit time off

ECLS support. 4. Gather equipment. Open the sterile towel

and add equipment, keeping sterile separated from non-sterile.

5. Glove using aseptic technique. Health care workers must wear gloves as an additional barrier when it is anticipated that one’s hands may come in contact with blood. Reduces transmission of microorganism.

6. Assemble equipment as shown in reference #2.

Maintaining sterile technique, fill a 60ml syringe with plasma-lyte A and attach to stopcock.

Reference #2 7. Use sterile scissors cut the tubing between

both sets of clamps nearest to connector to be discarded. Discard old connector. Hand circuit tubing and clamp to a helper keeping cut tubing end sterile.

The faulty connector is now removed. Have helper keep cut end in the upright position to keep from de-priming cut segment.

8. Insert new connector into one tubing end. For circuit integrity safety, make sure connector is inserted into the tubing pass the second barb on the connector.

9. Turn the stopcock open to the syringe filled with plasma-lyte A then prime and de-air the stopcock, extension set, connector and tubing holding connector on a 450 angle.

Facilitates an air free prime.

10. Prime and de-air the remaining tubing by having a helper push fluid from attached syringe spilling from the connector to the tubing while inserting the connector into the tubing.

Facilitates an air free prime.

For circuit integrity and safety, make sure connector is inserted into the tubing pass the second barb on the connector.

11. Turn stopcock off to everything, clamp pigtail extension set closest to connector and remove the syringe. Attach a dead end cap to stopcock.

Allows for circuit flow while checking circuit integrity.

12. Remove remaining clamps.13. Remove bridge clamp and turn pump RPM to

2000 and re-circulate via bridge.Allows for circuit flow while checking circuit integrity.

14. Check for air at the oxygenator, connectors and blood pump.

15. If circuit is free of air re-establish ECLS flow. If air detected refer to the appropriate de-airing procedure for the specific circuit in use.

16. Once full ECLS flow is obtained, re-establish bridge flow by adjusting bridge clamp.a. Slowly open bridge until the desired

bridge flowrate is achieved. Thumb clamp: 100 to 300 ml/min

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EXTRACORPOREAL LIFE SUPPORT: CONNECTOR CHANGE OUT

DOCUMENT TYPE: PROCEDURE

Reference diagram # 3

DocumentationDocument on ECLS Flowsheet:

date and time of event

time of separation from ECLS

time of re-initiation of ECLS

reason for change out

unexpected outcomes related to emergency intervention.

ReferencesBC Children’s Hospital and BC Women’s Hospital + Health Centre. EXTRACORPOREAL LIFE SUPPORT: BRIDGE FLOW MONITORING

http://policyandorders.cw.bc.ca/resourcegallery/Documents/BC%20Children's%20Hospital/CC.14.22%20Extracorporeal%20Life%20Support%20Bridge%20Flow%2 0Monitoring.pdf

BC Children’s Hospital and BC Women’s Hospital + Health Centre. EXTRACORPOREAL LIFE SUPPORT:BRIDGE THUMB CLAMP REPOSITIONING

http://policyandorders.cw.bc.ca/resourcegallery/Documents/BC%20Children's%20Hospital/CC.14.23%20Extracorporeal%20Life%20Support%20Bridge%20Thumb %20Clamp%20Repositioning.pdf

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EXTRACORPOREAL LIFE SUPPORT: CONNECTOR CHANGE OUT

DOCUMENT TYPE: PROCEDURE BC Children’s Hospital and BC Women’s Hospital + Health Centre. EXTRACORPOREAL LIFE SUPPORT: EMERGENCY SEPARTATION

http://policyandorders.cw.bc.ca/resourcegallery/Documents/BC%20Children's%20Hospital/CC.14.25%20Extracorporeal%20Life%20Support%20Emergency%20Se paration.pdf

BC Children’s Hospital and BC Women’s Hospital + Health Centre. INITIAITON OF EXTRACORPOREAL LIFE SUPPORT

http://policyandorders.cw.bc.ca/resourcegallery/Documents/Order%20Sets/PICU%20Extracorporeal%20Life%20Support%20(ECLS)%20Initiation%20PD%20Mar% 2026,%202018%20and%20guideline2.pdf

Infection Control, BC Children’s Hospital and BC Women’s Hospital + Health Centre. Hand Hygiene.

http://policyandorders.cw.bc.ca/resourcegallery/Documents/Infection%20Control/IC.03.03.%20Hand_Hygiene%20feb%208%202017_JS.pdf

Gail M Annich M.D., William R Lynch M.D., Graeme MacLaren M.D., Jay M Wilson M.D. and Robert H Bartlett MD (2012) Extracorporeal Cardiopulmonary Support in Critical Care, 4th edition (107-130).

DefinitionsECLS (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.

Developed ByBCCH ECLS Team Lead

Version HistoryDATE DOCUMENT NUMBER and TITLE ACTION TAKEN19-Jul-2021 C-05-12-62562 Extracorporeal Life Support: Connector

Change OutApproved 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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EXTRACORPOREAL LIFE SUPPORT: CONNECTOR CHANGE OUT

DOCUMENT TYPE: PROCEDURE

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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.