Pediatric ECMO Prime Gas
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Prime gases for ECMO
Does anyone's Perfusion team or ECMO activation team run prime gases before putting a patient on ECMO? I am trying to figure out if these results should cross the patient's chart, bill the patient, and how to create an order in RALS and Epic to do so.
Any information is greatly appreciated.
Does anyone's Perfusion team or ECMO activation team run prime gases before putting a patient on ECMO? I am trying to figure out if these results should cross the patient's chart, bill the patient, and how to create an order in RALS and Epic to do so.
Any information is greatly appreciated.
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As for this question, for all blood primed circuits, we do a circuit gas. The most common things that I look at in that gas are the PCO2 and PaO2, is the oxygenator doing its job. Then I look at the Bicarb, make sure it is not too low. Finally, I look at the K, to make sure it is not too high. On a 3 kg patient, their estimated blood volume is 240 ml. My smallest circuit has nearly the same priming volume, so those patients get a complete exchange. So I want to make sure that what I attach to them, won't hurt them more...When we do the circuit gases, they end up in the chart, which I like, since this is something I can use to show that I attached a safe circuit to the patient. Most times, we treat it like any other gas when we select it on the Istat.
Hope this is helpful!
Yes, staff perform priming testing in both Ecmo and CVOR circulatory pumps using the POC analyzers. This testing is done on the fluid prior to the patient blood being introduced... so it's NOT representative of the patient's condition. The users run these samples using a specific "Patient ID" so that the POC teams knows what it is and documents it as such in the POC middleware. These test results do NOT go to the patients EMR where there is the potential of having these results misinterpreted as actual patient values.
After the patients' blood is introduced to the circulatory pumps the users use the patients' actual ID and these test result are uploaded into the EMR.
Our perfusion teams use the prime gas (circuit gas) function on our GEMs. We have a special sample type that they can select on the GEMs when these gases are performed. The way we have it built in our LIS system is that it does drop into the patient's chart, but they will not trend with any other blood gas samples; no charge is dropped since it is not a true sample (premixed fluid), and only staff can review these results, not dropped in My Chart for patient review. It also has a specific order name to distinguish it from other blood gas samples.