Troubleshooting: Dropping Flows:
Regardless of whether the circuit is V-A or V-V, if flows unexpectedly drop then this needs to be addressed immediately, since:
- Low flows can lead to clotting in the circuit.
- Low flows are usually indicative of a sinister process which needs to be addressed.
If you encounter low flows, then:
- Make sure the pump speed is at the target RPM.
- Inspect the circuit for kinks or occlusions.
- Inspect the membrane for large clots.
- Inspect the cannula sites to ensure there has been no malposition.
- Inspect the circuit for chatter and look for other signs of fluid responsiveness.
- It is reasonable to try a bolus of fluid if you think the patient may have intravascular volume depletion.
- If the above measures do not solve the problem, then this warrants consultation with the surgical team.
- Cannula position may be checked with a chest x ray or echocardiography.
- If a patient is centrally cannulated, then an echocardiogram is extremely important to help rule out central obstruction.
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