nursing care of the ecmo patient · nursing care of the ecmo patient sheila chucta, dnp, rn,...
TRANSCRIPT
10/1/2018
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Nursing Care of the ECMO Patient
Sheila Chucta, DNP, RN, APRN-CNS, CCRN, ACNS-BC
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ICU Leveling
Staffing
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Didactic Class/Hands on Training- Initial
Discuss Pathophysiology that leads a patient to need the technology surrounding ECLS
Pathophysiology and Indications for ECLS
Patient selection
Describe techniques involved with ventilator management for patients undergoing ECLS therapy
Advanced ventilator management
Patho/phys of ARDS
Describe the interplay of the ECLS circuit in relation to drug therapies
Drug properties, drug dosing, and routine monitoring during ECLS
Anticoagulation
Apply knowledge gained from lecture to patient at the bedside
ECLS equipment
Training
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Ongoing
Training
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The process begins
We’re Getting an ECMO……
Preparing for Admission
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Handoff
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A, B, C
Immediate Needs
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Sorting out the Lines, Tubes, and Drains
Circulation
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Hemodynamics
Monitoring
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Massive Transfusion Protocol - MTP
Monitoring
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Equipment
Monitoring
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Circulation/Neuro Checks
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Transporting the ECMO patient
We have to go where????
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System and Nursing
Transportation Policy
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Nursing Documentation
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Orders
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The Next Steps In Patient Care…….
Beyond Initial Placement
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Family
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“Mobility Crew” Avoiding Deconditioning
Immobility
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CVICU Turning Protocol
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Critical Care Mobility Guideline
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Mechanical Assist Policy
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Mobility Rounds – Individualizing Care
Progressing Mobility
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“Skin Squad”
Weekly rounds
Review of findings
Review plan of care for skin integrity
Looking at trends over time – information entered into an electronic data base
Skin/Wound Care
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Operation Ross Liberation
Delirium
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“Bug Squad”
Infection Surveillance
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Phone calls to patients – unit nurse coordinator
• Assist getting into programs
Victory Lap
Post Discharge
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Always Learning and Improving Care Delivery
Continue to improve documentation of process
• Addition of distal perfusion line to EMR
Increasing family involvement with care
• Engaging family in early mobility
Revisions in Mechanical Assist Policy
• Team revisions – Nursing, Perfusion, Physicians, and VAD
coordinators
Incorporation of ABCDEF bundle into care
• Delirium Reduction
Lessons Learned
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Wexnermedical.osu.edu
What Questions Do Have?
Thank You