Pressure Injury Prevention Bundle during Intra-Extracorporeal Membrane Oxygenation (ECMO) Treatment Process

Abstract

Purpose: This Quality Improvement (QI) was aimed to reduce Hospital Acquired Pressure Injuries (HAPIs) in the critical illness patients who are requiring Extracorporeal Membrane Oxygenation (ECMO) treatment process.

Background: During ECMO treatment, patients are at extreme risk to develop HAPIs. And it is very challenging to prevent these HAPIs because patients are under hemodynamic unstable and/or clinically unsafe to be turned. In addition, it creates high anxiety and fear in relation to possible loss of blood float, accidental decannulation or disconnection, pump failure and time/ labor consuming issues when turning the patient. July 2015 to December 2015, at an academic suburban medical center, the incidence of HAPI was 10.4 / 100 ECMO patient days. It showed 1 HAPI/10 ECMO days.

Methods: Wound, Ostomy Continence (WOC) nurse utilized a live image mapping system to monitor pressure points during Intra-ECMO treatment which requires the patient to be at a 10-20 degree reverse Trendelenburg position to facilitate ECMO blood floating. Meanwhile WOC nurse analyzed every previous ECMO HAPI event and initiated intra-ECMO Prevention Bundle (PB). The PB was implemented and revised based on ongoing new HAPI incidence, nursing feedbacks, ECMO medical provider’s engagement and WOCN’s critical thinking. Multiple products were trialed with both failure and success which leaded to the final PB as best standard practice guideline.

Results: In 2016, intra- ECMO HAPI incidence decreased to 1.7/100 ECMO patient days. In 2017, it further reduced to 0.56 /100 ECMO patient days with 52% Veno-Venous (VV) ECMO survival rate and 36% Veno-Arterial (VA) ECMO survival rate.

Conclusions: Despite the challenging of ECMO process, HAPI can be reduced with the PB. However, in order to place the ECMO PB in time, ECMO nurses should anticipate and implement the bundle immediately upon every new ECMO case.