Initial cannulae dressings and ECMO line securing must be performed by the cannulator (medical) and cannot be delegated. The bedside nurse is responsible for maintaining the cannula dressings and re-dressing soiled or inadequate dressings. Escalate to and involve senior supports (ECLS CNC/ECLS CON) in any dressing concerns/issues/planning. This allows changes over time to be followed and optimal timing of interventions.
The procedure of re-dressing requires a minimum of two nurses/proceduralists. The dressing should only be replaced in the day shift unless absolutely necessary (cannula is unsafe/unsecured). Prior to any dressing change, the medical consultant should be informed.
Line position monitoring is performed at least once per shift for patients with peripheral cannulae. Skin markings (with indelible marker) adjacent to the wire-plastic junction of the cannula allow quick detection of cannula movement but would not be routinely used. Migrating ECMO cannulae must be immediately reported. The measurements are also recorded on the ECMO daily checklist. ECMO lines are secured with specialised adhesive dressings to prevent movement (Griplock). A minimum of two dressings/griplocks per line. The two griplocks should both be positioned above the knee. Dressings should be completed with betadine only and cannulae should be visible through the dressing. Use products that absorb ooze (e.g.kaltostat) if required. Do not place dressing/ gauze underneath the cannulae as this can aid migration/dislodgement.
Securing of cannulae in ipsilateral cannulation can be more challenging. The cannulae should be fixated in two points above the knee.