Central access devices
Any central access device in an ECMO patient follows the routine requirements to minimise the risk of central line associated bloodstream infections. Specific considerations in the ECMO patient are listed here.
- Procedure must be performed by SR, fellow or consultant.
- Screening ultrasound scan for thrombus in both internal jugular veins before placing any access device in jugular veins to avoid bilaterally occlusion.
- Anticoagulation is not routinely paused for the procedure but may be paused if the circumstances require this.
- Betadine is used in all ECMO patients. NO chlorhexidine solutions.
- The femoral site is in proximity to the femoral ECMO cannula is to be avoided unless there is no suitable alternative site. Besides the infection risk there is potential for flow obstruction on the arterial return side.
Use of fibrinolytics
Systemic fibrinolysis is commonly considered in the setting of a massive pulmonary embolism. Ideally, patients are assessed early if ECMO level support is required and deemed a suitable option to support the right heart. Initiation of VA ECMO should be immediate in the ‘pre-arrest’ clinical situation or if acute right heart failure with increasing inotropes develops. However, if a patient with pulmonary embolism is reviewed at a later stage prior fibrinolytics are NOT a contraindication to extracorporeal support.