Coming into to visit your loved one for the first time can be overwhelming, you’ll see lots of equipment which has been carefully arranged near the bedside of a patient on ECMO support.
In Victoria, our patients are cared for by dedicated ICU staff including doctors, nurses and allied health professionals that have received ECMO specific training.
It is normal for our patients have medical staff with them at all times, to receive more frequent medical reviews and see more specialists.
The typical ICU environment is generally busy and noisy, with equipment and monitoring alarms sounding regularly, but as patients recover, quieter environments are more appropriate.
Usually there is a dialysis machine to help with fluid control and a ventilator to control breathing as well as an ECMO machine. The ECMO machine itself is on a trolley with two shelves – one for the ECMO controller (console) and one for the water heater (helps to keep patients warm) – and is usually at the foot of the bed.
Tubes with ECMO blood flow in them can be seen entering and leaving the ECMO console and it is usual for there to be a colour difference in the blood entering and leaving the ECMO console.
The dialysis machine has bags of fluid attached which need to be changed regularly. It is connected to the ECMO blood circuit so it nearby the ECMO machine.
The ventilator machine is usually at the head of the bed and is connected to a breathing tube. Some patients on ECMO don’t need a ventilator and will not have a breathing tube.
In addition to the machines, there are ‘lines’ which deliver medicines directly to the patient’s blood stream. These are connected to infusion pumps which control the delivery of these medicines. Infusion pumps use alarms to communicate with staff.
A tube to carry urine to a bag is also common, as is a nasal tube to the stomach, to allow feeding.
A flat screen monitor collects and displays information from the patient to help staff detect changes and respond quickly. These monitors also use alarms to communicate with nursing staff.
Most importantly there is a bedside nurse in charge of all the devices, lines and tubes. The nurse is always available for the patient on ECMO. The patient is the reason they are at work and is the centre of their attention. Nurses caring for ECMO patients get lots of support from doctors and other staff in the ICU to coordinate care. If a nurse steps away to perform a duty or have a break, then the patient is handed over to a neighbouring nurse for that period of time.
It is essential for patients to receive pressure care of the skin during ECMO.
Our nursing and medical staff typically have computers on specialised trolleys to perform their work.
This varies over the course of an illness but common things that occur are: daily blood tests and chest x-rays, change of shift/handover of bedside staff, ICU ward rounds (generally 2-4 per day) with lots of staff present all at once for 10-20 minutes and include patient contact, physiotherapist sessions, personal care, visits from speciality medical teams from outside the ICU.
Daily blood tests and chest x-rays are common.
ECMO cannulas (tubes that connect the ECMO system to the blood stream) are always well secured to the patient to prevent accidental removal while on support. Observed movement that is allowed by the bedside nursing staff is beneficial to patients on ECMO. Many factors are relevant when planning movements on ECMO and the team should be able to explain these to you. Well secured ECMO cannulae do not come out accidentally and many precautions are taken to prevent accidental cannula removal. Some patients have been able to walk on ECMO but this is rare.
It is uncommon to eat normally during ECMO and most patients require supplemental feeding via an artificial tube in the stomach or via the intravenous (IV) route. Feeding needs are considered every day. Many patients lose weight and muscle in particular during severe illnesses that require ECMO which is hard to prevent. It is due to the illness – not underfeeding.
Information and resources for patients, families and caregivers who have experienced an ICU journey - mylifeaftericu.com
