Care of Children on Extra-corporeal membrane oxygenation ( ECMO ) Support - Leeds Children’s Hospital Standard Operating Procedure for

Publication: 17/11/2016  --
Last review: 25/01/2018  
Next review: 01/01/2021  
Standard Operating Procedure
CURRENT 
ID: 4790 
Approved By:  
Copyright© Leeds Teaching Hospitals NHS Trust 2018  

 

This Standard Operating Procedure is intended for use by healthcare professionals within Leeds unless otherwise stated.
For healthcare professionals in other trusts, please ensure that you consult relevant local and national guidance.

Leeds Children’s Hospital Standard Operating Procedure for Care of Children on ECMO Support

Background and indications for standard operating procedure/protocol

Extra-corporeal membrane oxygenation (ECMO) support is a highly specialised form of cardio-respiratory support delivered to children when conventional intensive care has failed. The PICU in Leeds provides this care for children with congenital cardiac defects. Occasionally children with acquired cardiac conditions or respiratory failure may need to be commenced on ECMO support in Leeds, whilst awaiting transfer to another center.

This SOP should be used the multi-disciplinary team involved in the care of patients who require ECMO support. The minimum staffing levels as set out in this SOP must be adhered.

Page 2: SOP during the period of transition

Page 3: SOP after the transition period

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SOP during the period of transition

1. Children on ECMO must be reviewed by multi-disciplinary team once every 24 hours. The minimum quorum should include:

Consultant in Paediatric Intensive Care
Consultant in Paediatric Cardiac Surgery
Perfusionist
PICU Junior Doctor / ANP
Nurse in charge of PICU bay / cubicle (as appropriate)
Bedside PICU nurse

A management plan from the MDT review must be documented in the patient notes and PICU nursing chart following this review. Any changes or deviations from this management plan should be communicated to the above team members at the earliest opportunity.

2. A member of the Perfusion team should be present in PICU to manage the ECMO circuit throughout the ECMO run.

3. Trainee ECMO specialist:

  1. Trainee ECMO specialist will be assigned to work alongside the Perfusionist whenever feasible. The Trainee ECMO specialist should not take full responsibility of ECMO circuit until they are assessed to be competent.
  2. A minimum of 60 hours of pump time is essential before trainees can be assessed for competency. This may have to be extended based on the needs of the trainee.
  3. Once assessed to be fully competent, ECMO specialist can start to take time limited responsibility of the circuit with the Perfusionist resident in hospital.
  4. Trainee ECMO specialist are required to maintain a log of pump time and attend regular wet lab sessions.

4. A bedside nurse competent in taking care of Level 3/4 PICU patient should be allocated to these patients at all times. Preferably this should be another trainee ECMO specialist allowing them to gain experience. If there are two or more trainee ECMO specialists on shift, they should be allocated to an area where they can be close to the patient on ECMO.

5. If the staffing levels would not allow for a nurse and trainee ECMO specialist to be allocated to the patient, the trainee ECMO specialist should be allocated to the patient. Any additional trainee ECMO specialists on shift should be allocated to be in-charge of the area (bay or cubicle) the patient is in and to other patients in the area, as appropriate, to maximize training opportunity.

Any deviation from the above staffing level should be escalated immediately to PICU Nurse in charge, who should inform the on call PICU and Paediatric Cardiac Surgical Consultants.

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SOP following the transition period

The time frame for the end of transition period is dependent on the opportunity to train up the ECMO specialist. The ECMO specialists are going to be gaining competence at different times, the end of transition period will not be a fixed date, but will be dependent on their availability.

1. Children on ECMO must be reviewed by multi-disciplinary team once every 24 hours. The minimum quorum should include:

Consultant in Paediatric Intensive Care
Consultant in Paediatric Cardiac Surgery
Perfusionist
ECMO Specialist
PICU Junior Doctor / ANP
Nurse in charge of PICU bay / cubicle (as appropriate)
Bedside PICU nurse

A management plan from the MDT review must be documented in the patient notes and PICU nursing chart following this review. Any changes or deviations from this management plan should be communicated to the above team members at the earliest opportunity.

2. A member of the Perfusion team will be responsible at all times for

  1. For assembling the ECMO circuit
  2. Managing the circuit while the patient is being stabilised (this may take 12 - 24 hours)
  3. Changing components of circuit as decided by MDT
  4. Responding to circuit emergencies
  5. Managing the circuit during chest exploration, cannula repositioning, moving the patient, attempted weaning and other procedures as decided by MDT
  6. Managing the routine ECMO run if staffing levels in PICU doesn’t allow a trained ECMO specialist to be allocated to the patient or if the trained ECMO specialist needs pump time

A member of Perfusion team will be expected to attend the patient on ECMO twice daily (preferably at the time of MDT review) and support the ECMO specialist. They will be expected to remain resident in hospital during ECMO runs, unless agreed by the MDT on the day.

3. ECMO specialist:

  1. A trained and currently competent ECMO nurse specialist will be assigned to manage the ECMO circuit when feasible. They should not take responsibility for the patient or bay/cubicle.
  2. To maintain competence, the ECMO specialist must have a minimum of 60 pump hours in a calendar year and attend regular wet lab sessions. They are required to keep a log of pump time and training activities.

4. A bedside nurse competent in taking care of Level 3/4 PICU patient should be allocated to these patients at all times. Preferably this should be another trainee/trained ECMO specialist allowing them to gain experience. If there are two or more trainee/trained ECMO specialists on shift, they should be allocated to an area where they can be close to the patient on ECMO.

5. If the staffing levels would not allow for a nurse and trainee/trained ECMO specialist to be allocated to the patient, the trainee/trained ECMO specialist should be allocated to the patient. Any additional trainee/trained ECMO specialists on shift should be allocated to be in-charge of the area (bay or cubicle) the patient is in and to other patients in the area, as appropriate, to maximize educational opportunity.

Any deviation from the above staffing level should be escalated immediately to PICU Nurse in charge, who should inform the on call PICU and Paediatric Cardiac Surgical Consultants.

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Provenance

Record: 4790
Objective:

The mode of delivery of ECMO care is in the process of transition in LTHT. A selected cohort of PICU nurses are being trained to become ECMO specialist. The aim of this SOP is to ensure these children receive a minimum standard of care during and after this period of transition.

Clinical condition:
Target patient group:
Target professional group(s): Secondary Care Doctors
Secondary Care Nurses
Adapted from:

Evidence base

Not supplied

Document history

LHP version 1.0

Related information

Not supplied

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