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

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

VA ECMO Decannulation

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 and Support Team
    • Notify PHL ECMO 1st Contact via Epic secure chat
  • Notify Blood Bank of ECMO Decannulation
    • 4-2527
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
Decannulation
  • Patient Readiness
    • Consider ETT exchange to Microcuff
    • Continue TPN if infant was not on CRRT
    • Adequate access, infusions running via patient’s central access and not ECMO circuit
    • Place DL PICC in lower extremity by experienced PICC team or Interventional Radiology at bedside, as needed