Care actions and nursing diagnoses for patients with extracorporeal membrane oxygenation: knowledge translation

Leão, Aline Valli de; Azzolin, Karina de Oliveira; Lucena, Amália de Fátima; Souza, Emiliane Nogueira de

doi:10.1590/2177-9465-EAN-2023-0067en

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RESEARCH • Esc. Anna. Nery 28 • 2024 • https://doi.org/10.1590/2177-9465-EAN-2023-0067en copy

Care actions and nursing diagnoses for patients with extracorporeal membrane oxygenation: knowledge translation

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective

to map diagnoses and nursing actions for the care of adult patients with extracorporeal oxygenation membrane, considering a protocol and a computerized prescription system and the inclusion of new care actions, in a process of translating knowledge to clinical practice.

Methods

descriptive and exploratory study, with cross-mapping between a care protocol and a computerized system of at a university hospital, from 2014 to 2018. Two meetings were held with the nursing manager and members of the extracorporeal oxygenation membrane team to validate the actions.

Results

most common diagnoses used in the 45 medical records of patients with extracorporeal membrane oxygenation were: Risk of infection (100%); Impaired spontaneous ventilation (93.33%); Self-care deficit syndrome (93.33%).

Conclusion and implications for practice

The mapping included 25 new actions, associated with 14 nursing diagnoses in the computerized system, aiming to disseminate knowledge and its application in real care for patients with extracorporeal oxygenation membrane.

Keywords:
Nursing Care; Nursing Diagnosis; Evidence-Based Nursing; Extracorporeal Membrane Oxygenation; Standardized Terminology

Domain	Class	Nursing diagnosis	Related factor	Care actions included in the nursing prescription system
Elimination and exchange	Urinary function	Impaired urinary elimination	Neuromuscular/musculoskeletal impairment	Perform bladder ultrasound to observe urinary retention and/or residue
		Alteration in tissue perfusion: Renal	Impaired oxygen transport through the capillary and/or alveolar membrane	Guide patient/family on how to:
				Perform bladder ultrasound to observe urinary retention and/or residue
				Monitor renal replacement therapy coupled with ECMO
	Respiratory function	Impaired gas exchange	Change in alveolar capillary membrane	Perform sweep maneuver on ECMO (10L gas flow for 10 seconds)
				Monitor and record ECMO blood flow and revolutions per minute
				Monitor and record ECMO gas flow and oxygen flow
				Inspect ECMO arterial line, venous line, centrifugal pump and oxygenating membrane with flashlight for clots and fibrin
				Monitor operation, temperature, water level of ECMO console heating device
				Check the presence of clamps, flashlight and emergency box in the ECMO patient box

Domain	Class	Nursing diagnosis	Related factor	Care actions proposed for inclusion
Activity /Rest	Cardiovascular/ pulmonary responses	Decreased cardiac output	Cardiac pump failure	Guide patient/family on how to:
				Perform SWEEP maneuver on ECMO (10L gas flow for 10 seconds)
				Monitor and record ECMO blood flow and revolutions per minute
				Monitor and record ECMO gas flow and O₂F
				Inspect ECMO arterial line, venous line, centrifugal pump and oxygenating membrane with flashlight for clots
				Implement care with arterial/venous puncture of large vessels
				Implement care with large vessel venipuncture
				Check cannulas for kinks or disconnections
				Monitor operation, temperature, water level of the ECMO console heating device
				Check the presence of clamps, flashlight and emergency box in the ECMO patient's box
			Altered contractility	Guide patient/family on how to:
			Altered blood volume	Guide patient/family on how to:
			Septic shock	Guide patient/family on how to:
		Ineffective tissue perfusion: Cardiopulmonary	Impaired blood flow	Guide patient/family on how to:
				Perform SWEEP maneuver on ECMO (10L gas flow for 10 seconds)
				Monitor and record ECMO blood flow and revolutions per minute
				Monitor and record ECMO gas flow and O₂F
				Inspect ECMO arterial line, venous line, centrifugal pump and oxygenating membrane with flashlight for clots
				Implement care with arterial/venous puncture of large vessels
				Implement care with large vessel venipuncture
				Check cannulas for kinks or disconnections
				Monitor operation, temperature, water level of the ECMO console heating device
				Check the presence of clamps, flashlight and emergency box in the ECMO patient’s box
		Risk of ineffective cerebral tissue perfusion	Vascular alteration	Report change in color and temperature of extremities
		Risk of ineffective cerebral tissue perfusion	Side effects of treatment	Report change in color and temperature of extremities
	Self-care	Deficit in self-care: bathing and hygiene	Restrictive therapy	Assess level of sedation
				Ask the team to accompany the ECMO patient to the bath
				Check that cannulas and other devices are securely attached to the ECMO patient before beginning body hygiene.
				Perform body hygiene on the ECMO patient with the support of at least 4 team members
		Self-care deficit syndrome		Assess level of sedation
				Ask the team to accompany the ECMO patient to the bath
				Check that cannulas and other devices are securely attached to the ECMO patient before beginning body hygiene.
				Perform body hygiene on the ECMO patient with the support of at least 4 team members

Domain	Class	Nursing diagnosis	Related factor	Care action proposed for inclusion
Perception/ Cognition	Cognition	Acute confusion	Related to side effects of medication	Guide patient/family on how to:

Domain	Class	Nursing diagnosis	Related or risk factor	Care actions proposed for inclusion
Safety/Security	Infection	Risk of infection	Invasive procedure	Change ECMO cannulas dressings
				Implement ECMO circuit care
				Inspect ECMO cannulas insertion site
	Physical Injury	Risk of impaired skin integrity	Immobility	Protect skin adjacent to ECMO cannula/circuit
		Risk of impaired skin integrity	Immobility	Reposition ECMO patient in bed with at least 3 team members
		Impaired tissue integrity	Impaired mobility	Guide patient/family on how to:
				Report changes in color and temperature of extremities
				Compare the ECMO patient's warmth and peripheral pulses
				Observe changes in skin color
		Risk of pressure injury	Impaired mobility	Protect skin adjacent to ECMO cannula/circuit
		Risk of pressure injury	Impaired mobility	Reposition ECMO patient in bed with at least 3 team members
		Risk of bleeding	Adverse effects of therapy	Guide patient/family on how to:
				Implement care when changing central venous catheter dressings
				Checking ACT / APTT in patients on ECMO
				Change dressings on ECMO cannulas insertions
				Implement ECMO cannulas fixation care
				Implement ECMO circuit care
				Inspect ECMO cannulas insertion sites
			Hematological disorders	Guide patient/family on how to:
				Implement care when changing central venous catheter dressings
				Checking ACT / APTT in patients on ECMO
				Change dressings on ECMO cannulas insertions
				Implement ECMO cannulas fixation care
				Implement ECMO circuit care
				Inspect ECMO cannulas insertion sites
			Mechanical trauma	Guide patient/family on how to:
			Vascular alteration	Guide patient/family on how to:

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[1] Corresponding author: Aline Valli de Leão. alinevallideleao@gmail.com