Complex_RUA_Interdisciplinary_Care.docx21.pdf

Extracorporeal Membrane Oxygenation

Tamika Therlonge

Chamberlain University College of Nursing

NR341: Complex Adult Health

Professor Bacchus

14 February 2021

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Introduction

The therapeutic modality I will be discussing with this paper is Extracorporeal Membrane

Oxygenation, or ECMO. This therapeutic modality is one that requires specific training above

and beyond general entry-level nursing education as it deals with very complex technology and

is utilized in patients with a severe condition that could potentially be life-threatening and must

be handled delicately. An example of a case study in which this therapeutic modality would be

utilized is an 80-year-old female client who is experiencing myocarditis, or inflammation of the

heart muscle. The patient is frail and having difficulty breathing, fainting, experiencing chest

pain, and is feeling lightheaded and fatigued. After administrations of ACE inhibitors, diuretics,

and beta blockers have not helped improve her heart condition, the health care provider has

decided to focus on measures to ease the load off of the patient’s heart instead. This is when the

ECMO therapeutic modality will come into play as the provider has ordered for the patient to be

placed on extracorporeal membrane oxygenation to allow her heart and lungs to rest and heal.

Explanation and Background

Extracorporeal Membrane Oxygenation is essentially a machine that provides life support

for patients with illnesses that are so severe and even life-threatening that their heart and lungs

can no longer sustain the workload to continue to properly support their systems on their own

(American Thoracic Society, 2020). ECMO provides these individuals with a support by working

outside their bodies to pump blood from the patient to an artificial lung device where oxygen is

added, and the blood is artificially pumped back into the patient as their heart normally would.

There is no specific patient population that this therapeutic modality is used for, as it can be

utilized across all age ranges from pediatric to geriatric, however it is meant for people suffering

from certain illnesses or disorders. The patient population this modality would be aimed towards

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would include individuals who have a heart condition in which their heart can no longer

effectively pump enough blood to their entire body, those whose lungs are not strong enough to

provide oxygen for their bodies even with administered oxygen or their lungs are not able to

adequately remove carbon dioxide, even with the use of a mechanical ventilator. Additionally,

this modality is also utilized for patients who are suffering from an incurable disease and may be

waiting for a transplant of a heart or lungs. The medications administered to patients utilizing the

ECMO machine include analgesia, sedation, blood thinners, and opioids to treat any pain the

patient may experience and to ease any stress or discomfort that may occur (Sieg et al., 2019).

Examples of sedation drugs include benzodiazepines while examples of opioids to treat pain

include morphine or fentanyl. An example of a blood thinner that may be utilized to prevent the

blood from clotting in the tubes is heparin When starting a patient on an ECMO machine, a

healthcare professional with advanced training, such as a perfusionist, a nurse, or respiratory

therapist must ensure to adjust the settings of the machine to ensure the patient is safely given the

adequate and accurate amount of heart and lung support needed. The therapeutic modality of

ECMO is one that is very costly with the mean estimated cost of this procedure being $70,000

including pre- and post-procedures for ECMO along with hospital stay, making it a resource

demanding procedure (Mishra et al., 2016).

Risks and Benefits

The therapeutic modality of ECMO can greatly benefit patients suffering from illnesses

impairing the function of their heart and lungs as it allows these organs to rest and essentially

heal from the straining and stressful workload that may have been placed upon them before,

trying to pump blood and oxygen throughout the body. Some ways to promote positive outcomes

for these patients include implementing actions to prevent infections such as frequent

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handwashing before and after care and frequent monitoring of the tube insertion sites for any

signs of infection. Along with positive outcomes with this modality, there are also complications

that may arise. Patients utilizing an ECMO machine are at risk for complications such as

bleeding, infection, stroke, and kidney failure during the use of this modality (American

Thoracic Society, 2020). Bleeding can be prevented with constant and careful monitoring of the

patient through lab tests and physical examinations to ensure there is no active bleeding. Kidney

failure can also be prevented through careful and frequent assessment of lab values to ensure

they are functioning and receiving adequate blood flow. In the event that the kidneys are not

receiving adequate support, the patient may be connected to a machine to do the work of the

kidneys for them, called dialysis. Infections can be prevented by methods previously stated such

as frequent hand hygiene and assessment of tubal sites. The prevention of stroke due to small

blood clots that may occlude flow to the brain can be prevented with the use of heparin as a

blood thinner.

Interdisciplinary Team’s Roles and Responsibilities

The interdisciplinary team that would provide direct care for a patient utilizing the

ECMO modality include an ECMO specialist and surgeon, an intensive care nurse, a respiratory

therapist, a cardiologist, a pharmacist, and a dietician. The cardiologist initially assesses the heart

conditions of the patient and determines whether or not the patient may need the ECMO

modality. The surgeon places the tubes, or cannulas, into the large veins or arteries of the patient

that may either be located in the neck, chest, or groin. The ECMO specialist and respiratory

therapist work together to control the machine and adjusts the settings of the machine based off

of the patient’s condition to give the patient the accurate amount of support needed to their lungs

and heart (American Thoracic Society, 2020). The intensive care nurse provides frequent

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monitoring and assessment of the patient in order to ensure all the patient’s systems are working

well and receiving adequate blood and to ensure the patient is not developing any infections. The

ICU nurse also provides education and therapeutic communication to the family and loved ones

of the patient. The pharmacist provides the medications that will be required for this procedure

for the patient including the sedation, opioids, and anticoagulants. The dietician will work with

the ICU nurse to ensure the patient receives adequate nutrition through intravenous fluids. The

roles and responsibilities of the nurse as a member of the interdisciplinary team caring for the

patient is to be an advocate for their patient and ensure their patient is receiving therapeutic care.

The nurse monitors and assesses the patient constantly to ensure the machine is working

therapeutically and the ensure there are no developing complications such as infections, bleeding

or kidney failure. The nurse also ensures to provide education and communication with the

family and loved ones of the patient to the extent desired by the patient.

Nursing Scope of Practice

The Registered Nurse providing care for a patient utilizing the therapeutic modality of

ECMO must have advanced knowledge in providing intensive and critical care to these patients,

as the illnesses that tend to lead to the use of this modality are those that are more severe and

incurable such as lung and heart failures. These patients require close and constant monitoring

and assessment as their status may change for the worse as they have tubes directly leading into

their arteries and ventricles. The skills needed for this care includes the ability to read and

interpret vitals and lab results, the ability to perform a complete and thorough head to toe

assessment, the ability to initiate IV lines and maintain correct flow, the ability to provide

therapeutic communication and education to families, and the ability to work well with other

professional members of the staff caring for their patients. The attitudes needed by a nurse caring

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for this type of patient needs to include compassion, patience, confidence in skill, therapeutic

towards family and loved ones, and willing cooperation with other members of the

interdisciplinary team to provide the best care possible for the patient.

Patient Education

As a nurse caring for a patient utilizing the ECMO modality, there will be concerned

family members and loved ones who do not fully understand what is going on, including the

patient themselves. The education that must be provided to the patient and family first and

foremost will be explanation of the patient’s condition or diagnosis, and what it means. The nurse

will then have to provide an explanation of the ECMO modality, including what it is used for,

how the procedure is performed, and what it means for the patient to have it done and what they

can expect as risks, benefits, and outcomes of this procedure. The nurse can discuss this

information with the patient and family by providing informative brochures and booklets that go

into detail and provide images to help the patient and family better understand. The nurse will

explain the care that will be provided while the patient is on this machine, along with the

medications that will be administered, their purpose, effects, and benefits. The nurse can evaluate

the effectiveness of their teaching by asking the patient and family to repeat back to her what

they have learned and understood about the procedure and asking for any concerns or questions

they may still have.

Conclusion

Overall, with this paper, I attempted to thoroughly discuss the therapeutic modality of

Extracorporeal Membrane Oxygenation, also known as a life support machine. This machine

provides a therapeutic support to patients whose heart and lungs have been severely impaired and

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can no longer supply adequate blood and oxygen needed to support their organs and body

functions as a whole. This machine essentially does the work of the lungs and heart for the

patient, allowing the patient’s organs to rest and heal themselves as much as possible. For

patients and family members who may want to learn further about this therapeutic modality, the

American Thoracic Society provides thorough information on the therapeutic modality of

Extracorporeal Membrane Oxygenation.

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References

American Thoracic Society. (2020, March). What is extracorporeal membrane

oxygenation? https://www.thoracic.org/patients/patient-resources/resources/what-is-

ecmo.pdf

Mishra, V., Svennevig, J. L., Bugge, J. F., Andresen, S., Mathisen, A., Karlsen, H., Khushi, I., &

Hagen, T. P. (2016). Cost of extracorporeal membrane oxygenation: Evidence from the

Rikshospitalet University hospital, Oslo, Norway. European Journal of Cardio-Thoracic

Surgery. https://doi.org/10.1016/j.ejcts.2009.06.059

Sieg, A., Pandya, K., Winstead, R., & Evans, R. (2019). Overview of pharmacological

considerations in extracorporeal membrane oxygenation. Critical Care Nurse, 39(2), 29-

43. https://doi.org/10.4037/ccn2019236

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