The prevention of complications is fundamental to successful ECMO care and there are a number of fundamental precautions to prevent common and severe complications.
Securing Cannulae
All ECMO lines must be secured at two points with properly adherent skin dressings (Grip-locks with skin preparation). For femoral cannulae, securing of lines should be on the thigh (above the knee) to prevent cannula withdrawal with knee flexion. Initial securing is the responsibility of the cannulator and cannot be delegated. All ECMO line dressings are maintained by bedside nursing staff.
Cannulae Positions
Checked each shift (as part of nursing checklist). Medical staff must also check cannulae positions radiologically when reviewing images. Any change in the position of a cannula must be referred to the ICU Consultant immediately for management.
ECMO cannulae dressings
Sterility must be maintained and insertion sites kept unsoiled. Special attention must be given to jugular vein cannula in particular to prevent contamination and migration. All cannulae dressings are maintained by bedside nursing staff.
Distal perfusion cannula
The placement is mandatory in conjunction with femoral artery cannulation. It must not be delayed in patients considered possible survivors. In ECPR cardiac revascularisation is often judged to be more time-critical than the distal perfusion cannula, however the delay is usually short (<2 hours) and the consultant with the patient is able to monitor the lower limb. If the percutaneous approach fails an immediate request is made to the vascular surgical unit to assist in placing the cannula
ECMO clamps
4 ECMO clamps are kept at the bedside at all times. There are a variety of emergencies that require immediate clamping of the circuit to avoid further major complications such as air embolism, circuit rupture, accidental decannulation. Where patients have a jugular line inserted, an ECMO clamp should be available at the “head of the bed”.
Replacement ECMO console and circuit
At all times there is a replacement rotaflow console and Cardiohelp console plugged in outside of cubicle one. The emergency primed circuit on a rotaflow console is kept with the ECPR equipment but can be used for any emergency in the unit e.g. an emergency circuit change.
Avoid Alcohol-based Cleaning Solutions
These solutions (including triclosan) should not come into contact with the ECMO circuit as they may cause cracking of some circuit components (Emergency: circuit rupture). Betadine should be the only antiseptic solution stored in the ECMO patient cubicle. The ICU Consultant should be notified immediately if alcohol solutions come into contact with the circuit. Alcohol and chlorhexidine body wash wipes should not be used on ECMO patients.
Electrical Safety
Do not allow water to enter the ECMO drive unit
