Education Newsletter February 2023

JoAnna Bentsen
April 3, 2023

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Change to ECMO Charting Starts March 1st 
ECMO will be moving out of the "ECMO Shift" and "ECMO Hourly" tabs and into the "Devices" tab within eStar. Some key points and changes to note are:
- When adding the device into eStar, the LDA avatar will populate for you to add in the cannula sites. Once Cannula's are removed- the LDA should remain active until the sutures are removed
- Device assessment and settings are all documented from this tab. This includes dressings, pump properties (including platform) with the addition of ECMO SvO2 and Venous Pressure.
- The checklist is now loaded virtually. Remember to complete this at any handover of RN, before and after transport, and after any significant event. The checklist can be cosigned within eStar.

For any more information, see the LMS titled " ECMO Documentation Update (VUH)" 
 Reach out to Lynne Craig, Keesha Albert, JoAnna Bentsen or Jess Williams with any questions
 
Additional Temporary Mechanical Circulatory Support (T-MCS) Information: Impella Continuous Cardiac Output (CO) and Cardiac Power Output (CPO)

The Impella console can continuously calculate CO and CPO following manual input of a reference CO value. One benefit of entering this data provides continuous plotting of data points on the LVEDP/CO Trend screen. The trend screen is a good visual to see if the patient’s native heart function has recovered as the level of Impella support is weaned.
 
** While NOT required, this can be a useful tool** 

To Enter Cardiac Output: Visit the MENU tab and select "enter cardiac output" utilizing the grey knob or arrows to adjust the value. 

A continuous cardiac output will now show for 8 hours. Each time a thermodilution value is updated or the patients clinical status changes, the cardiac output can be re-entered. 

If 8 hours of time elapses, an advisory notification will appear to place a new value. This value will time out if ignored and the CPO will disappear form the home screen. 

While trending, if the patients heart is recovering, the trends screen will show a stable MAP and LVEDP in conjunction with the CO and CPO. 
 
Next Skills Day is February 23 
from 0700 to 1200! 
At this skills day we will be offering information on:
Peritoneal Dialysis, Calcium Citrate and Zoll Defibrillators/Crash Cart/Codes 
You can also complete your IABP Competency! 
** you do not have to stay for 5 hours, simply stop into the conference room at any point**
New! CVC Maintenance Checklist  

Hot off the press from a multidisciplinary team including Drs. Brennan and Balakrishna, Koratney Speidel and the Quality Champions, this is a new tool that will increase the discussion around central access in the CVICU! Goals of this new initiative are to

  • Capture the issues we experience with lines in the CVICU, give advice on how to mediate those issues, and to also address tracing your lines/checking concentrations/compatibility/reducing med errors. 
  • Work in conjunction with the K card, but to capture more CV specific issues/offer verbiage for nurses to use in rounds/advice for mediating some of the CVC woes often seen in the CVICU. 
  • Infections identified with our central lines are maintenance related, so that is why this checklist is maintenance specific

When can this checklist be used?! 
Quality champions will be rounding and completing line audits in the next few weeks to start implementing the checklist into the unit culture and workflow. 
These talking points are PERFECT to bring up during multidisciplinary rounds, helping our provider colleagues understand some common difficulties you are seeing with your central lines. 

We are at 5 CLABSIs for FY23 - there's still plenty of time left to prevent CLABSIs, any little bit helps! 

 
Upcoming Educational Opportunities!!! 

CVICU Procedure and Emergency Management Course: March 21st 
CVICU IABP Super User Course: March 22nd 
**Sign up in LMS**
CCRN Review Course: May 24-25th (This will come up via nurse alerts STAY VIGILENT, spots fill up fast!) 
CVICU Website Link
  • New ECMO Documentation goes live March 1st- complete the LMS to see comprehensive changes 
  • You can calculate a continuous cardiac output (CCO) and Cardiac Power Output (CPO) on the Impella console by loading in your most recent thermodilution value
  • Next Competency Skills Day is February 23rd from 0700-1200. Stop in anytime during those 5 hours to get information and complete your competency.
  • There is a new CVC Maintenance checklist that speaks to specific woes we see with our central lines within the CVICU, use these topics during rounds to increase awareness of lines and prevent CLABSI's
  • There's some great classes coming up, GO TO THEM!
 
CVICU INQUIRER | February 2022
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