Name of the Procedure:

Extracorporeal Membrane Oxygenation (ECMO)/Extracorporeal Life Support (ECLS) Removal of Peripheral (Arterial and/or Venous) Cannula(e), Percutaneous, 6 Years and Older

Summary

This procedure involves the removal of cannulae (tubes) that have been inserted into a patient's blood vessels (arterial and/or venous) for ECMO or ECLS. ECMO/ECLS is a life-support technique used to oxygenate and pump blood outside of the body. The removal process is performed percutaneously (through the skin) and is applicable to patients aged 6 years and older.

Purpose

The procedure addresses the cessation of ECMO/ECLS support once the patient's heart and/or lungs have sufficiently recovered. The goal is to safely remove the cannulae to eliminate the risk of infection or other complications associated with prolonged insertion.

Indications

• Recovery of heart and/or lung function to the extent that ECMO/ECLS support is no longer needed.
• Patient stabilization with the ability to sustain vital functions without extracorporeal support.
• Age: 6 years and older.

Preparation

• The patient may be required to undergo fasting for a few hours before the procedure.
• Medication adjustments might be necessary, as advised by the physician.
• Pre-procedure diagnostic tests may include blood work, imaging studies, and a thorough physical examination to confirm stability and readiness for cannula removal.

Procedure Description

1. The patient is positioned comfortably, and the cannula site is sterilized.
2. Local anesthesia or sedation may be administered to minimize discomfort.
3. The physician carefully removes the cannulae using percutaneous techniques, which involve small incisions or punctures in the skin.
4. Pressure is applied to the site to control bleeding.
5. The site is then cleaned and dressed to promote healing and prevent infection.

Duration

The procedure typically takes around 30 to 60 minutes.

Setting

This procedure is usually performed in a hospital setting, often in an intensive care unit (ICU) or a specialized procedural area.

Personnel

• Physician (typically a cardiothoracic surgeon or specialist in critical care medicine)
• Nurses
• Anesthesiologist or sedation specialist (if applicable)

Risks and Complications

• Bleeding at the cannula site
• Infection
• Blood clots
• Skin or tissue damage at the insertion sites

Benefits

• Removal of foreign materials and the associated infection risk
• Transition towards complete recovery and independence from life-support systems
• Improvement in patient comfort and mobility

Recovery

• Immediate post-procedure care includes monitoring for bleeding and signs of infection.
• Patients may need to rest for a few hours.
• Follow-up appointments to ensure proper healing and recovery.
• Specific instructions on wound care and activity limitations.

Alternatives

• Continue ECMO/ECLS support if the patient is not yet stable.
• Transition to other forms of mechanical ventilation or support if partial assistance is still required.

Patient Experience

• The patient might feel slight discomfort or pressure during cannula removal, but local anesthesia or sedation typically minimizes pain.
• Post-procedure, there may be some tenderness or bruising at the site.
• Pain management will be provided, and comfort measures such as dressings will be used to ensure proper healing.