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Infant with Congenital Diaphragmatic Hernia, Pre and Post-operative Care — Preparation for VA ECMO Cannulation — Clinical Pathway: Inpatient and ICU

Infant with Congenital Diaphragmatic Hernia Clinical Pathway, Pre and Post-operative Care — Inpatient and ICU

Preparation for VA ECMO Cannulation

Immediate Actions
  • Activate ECMO Order Set (infants < 10 kg)
  • Call Blood Bank
    • Alert to ECMO Cannulation x4-2527
Consults/Contacts
  • General Surgery Fellow/Attending
    • Book case with the OR
      • OR Team and equipment brought to bedside
      • Sedation by Neonatology (Anesthesiology typically not present)
    • Location: N/IICU bedside
  • ECMO
    • Notify PHL ECMO 1st Contact via Epic secure chat
  • Blood Bank
    • Alert to ECMO Cannulation x4-2527
  • Cardiology
    • Notify need for Echo to assess ECMO cannula position
      • Weekdays: PHL Card Pulm Hyper IPM via Epic secure chat
      • Evenings and weekends: PHL Card Cnslt 1st Contact via Epic secure chat
  • Brain Ultrasound
    • Notify PHL Port US 1st Contact or call x5-7030 if not already done
  • Neurology
    • Notify Neuro Cnslt NICU-CICU 1st Contact via Epic secure chat of formal consult
  • Video EEG
    • Notify Neuro ICU EEG 1st Contact via Epic secure chat for video EEG placement after cannulation
Labs, Imaging
  • Ensure the following have been obtained:
    • PT, PTT, INR, Fibrinogen, AT3
    • Newborn screen
    • DNA extraction
    • Blood culture, if indicated
    • Brain ultrasound
    • Echo: may defer postnatally if unstable and/or normal fetal Echo
    • Type & Screen and Blood Type Confirmation
Medications
  • Sedation and neuromuscular blocking agent to prevent air embolism:
    • Fentanyl 10 mcg/kg/dose + 1-2 doses of 5 mcg/kg/dose
    • Vecuronium 0.2 mg/kg/dose + 1-2 doses of 0.1 mg/kg/dose
  • Perioperative prophylaxis:
    • Regardless of scheduled antibiotics, administer cefazolin 30 mg/kg/dose prior to cannulation when surgeon present
    • Note: Cefazolin not available in Pyxis
Nursing Preparation Prepare using N/IICU RN ECMO Cannulation Checklist

 

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