Troubleshooting: Bleeding Cannula Site:
Because of the large size of the ECMO cannulas, and the need for anticoagulation, the cannula insertion sites often ooze. Occasionally, there is more brisk and ongoing blood loss from the cannula site which can lead to anemia and hemodynamic instability. If the ECMO cannula site is bleeding excessively, then:
- Alert the service that inserted the cannulas.
- Ensure the cannula is positioned properly at the skin (and that it hasn't migrated out since insertion).
- Place absorbent dressings at the site.
- Apply firm sustained manual pressure for 5-15 minutes.
If the bleeding persists despite the above measures, then:
- Heparin may need to be temporarily discontinued.
- Correction of coagulopathy: aim for a near-normal INR, platelets >50-100, fibrinogen >1.5.
- A surgical repair might be necessary, either at the bedside or in the operating room.
Next page: Troubleshooting: Hemolysis