PULSION Medical Systems
PiCCOplus Setup Guide April 2007
Setup Guide
12 Pages
Preview
Page 1
Setup A Central venous catheter G
B A
B Injectate-temperature sensor housing PV4046 (included in PV8115)
C Injectate-temperature sensor cable PC80109
C
D PiCCO Catheter (e.g. PV2015L20)
E PULSION disposable pressure transducer PiCCO Monitoring Kit PV8115
F
H D
E
F Pressure cable PMK -206 G AUX Adapter cable
(to connect on rear panel)
PC81200 H Connection cable to bedside monitor PMK-XXX
PiCCO plus
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Patient Admission 1 Choose <Yes> for a new patient, old data will be deleted, modify with and + a) select patient’s gender b) select patient’s mode
PULSION PiCCO plus V6.2 Last patient calibration at 09/12 03:33p Patient Weight Height Gender Mode New patient?
-
-
201000200 75.0 kg 175 cm male adult Yes 1
+
2 Confirm with
2
INPUT Patient 201000200 Weight 75.0 kg Height 175 cm Gender male Mode adult Catheter type PV 2015L20 Injectate temperature Inj Vol (min. 15ml) 4 CVP Range PCCO Range AP
-
+
(PBW 70,6kg) 3
ACC : 342 < 8 °C 15 ml 10 mmHg 5 0..10 l/min 6 60..160 mmHg
<24°C = room tempered injectate; <8°C = iced injectate
3 Enter patient ID number, weight, height, gender and mode of the patient. If ID number is changed, previously stored data will be deleted for safety reasons. Arterial catheter will be detected automatically. 4 The minimal required injectate volume is recommended in ( ). 15ml iced NaCl 0.9% as the default setting for adult patients. Enter CVP. 5 Upper/lower limit of the display range of PCCO. 6 Upper/lower limit of the display range of the arterial blood pressure.
PiCCO plus
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Zeroing 1
AP Zeroing Zero adjust
2 Press zero button.
apply 0 mmHg
measured AP
1 Open transducer to the atmospheric pressure. Perform zeroing first on PiCCO plus then on bedside monitor.
15 mmHg
3 Confirm with Difference from pressure transducer to patient’s heart level can be corrected. Default setting <0>.
3
2
4 Thermodilution screen
PULSION PiCCO plus
5 Configuration screen
V6.2
6 Input screen 7 Pulse-contour screen
4
CFG
5
INP
6
7
AP
8
8 Pressure-zeroing screen
PiCCO plus
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Configuration CONFIGURATION Date Time (change delete previous results) TD Sound Parameter selection Display span RS232 Printmode Language Weight/Height/Temp
-
09/12 * 03:33 p On Individual 5d PiCCO Basic ENG lb./in./˚F
+
Configure Display
(individual)
(CVP)
on
SVR SV SVV
on on on
TB
on
ITBV/GEDV
GEDV
-
*C aution: Modifying date and/or time will automatically delete patient related data. Press CFG to Configuration-screen. To select most important PiCCO parameters choose <individual> and Basic setup: Cannot be changed and displays most common parameter as default. Individual: User can configure own parameter selection.
+
PiCCO plus
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Thermodilution 201000200 9/12 03:33p Time VI CI CFI GEDI MEAN * ** *** ****
TB37.0 EVLW ****
AP 97
117 71
(CVP) 12 SVR **** PC ** **** CI HR 78 SVI *** 0 10s 20s 2 STABLE STA 1 II ABS
TI8 CFG
201000200 9/12 03:33p Time VI CI CFI GEDI MEAN * ** *** ***
TB37.0 EVLW ****
SVV (GEDI)
8%
Press Press
1
for Thermodilution screen. STA
to perform a measurement.
2 Wait until <STABLE> appears. Perform a rapid and smooth injection. 3 Spike to saline bag.
****
INFO
AP 97
117 71
3
(CVP) 12 SVR **** PC ** **** CI HR 78 SVI *** 0 10s Injection STA II ABS
20s TI8 CFG
SVV (GEDI)
8% ****
INFO
PiCCO plus
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Thermodilution II 1
201000200 9/12 03:33p Time VI CI CFI GEDI 11:49 2.92 4.5 479 MEAN
TB37.0 EVLW *7 7
AP 97 (CVP) SVRI PC CI HR SVI
117 71
1
SVV (GEDI)
20s ** ∆T 0.24/TI12
II ABS
CFG
STA
for further measurements.
Perform initially 3 thermodilution measurements. *In case of EVLW >10ml/kg it is recommended to use iced injectate for further measurements.
12 2157
2.38
0 10s STA
Press
**If ∆T <0,15°C, it may be necessary to increase the injectate amount and/or use iced injectate.
78 38
8%
Select iced injectate <8°C in the input-screen.
479
INFO
2
Deviating measurements (“?” at value) should be deleted. 2
Press
INFO
PiCCO plus
to change to info screen.
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Calibrate 201000200 9/12 03:33p Time VI CI CFI GEDI 07:02p 0 2.81 4.0 450 07:03p 0 3.06 4.2 474 07:05p 0 3.16 4.1 489 11:56p 0 3.22 4.5 496 11:58p 0 2.90 4.5 475 11:59p 0 3.24 4.3 509 05:05a 0 2.92 4.5 520 05:06a 0 3.15 4.5 502
TB37.0 EVLW 8 8 8 8 8 7 8 6
05:29a 0 MEAN
8 8
2.96 2.69
4.5 480 4.5 480
∆T 0.31/TI12
AP 97 (CVP) SVRI PC CI HR SVI
117 71
12 2157
201000200 9/12 03:33p TB37.0 Time VI CI CFI GEDI EVLW 7 11:49 2.92 4.5 479 MEAN 7
2.38
SVV (GEDI)
479
0 10s
X DEL
X DEL
20s
∆T 0.31/TI12
and
once. Selected thermodilution curve
To delete this measurement press
12 2157
SVV (GEDI)
78 38
8% 479
II ABS
Deviating measurements should be selected with by pressing
(CVP) SVRI PC1 CI HR SVI
117 71
2.38
78 38
8%
AP 97
X DEL
, confirm is displayed.
again.
It is only possible to delete the current measurements under the dashed line. 1 The mean results of the thermodilution measurements of the last 10 minutes automatically calibrate the continuous cardiac output.
PiCCO plus
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Parameters Thermodilution results
TB37.0
Time
EVLW
VI
CI
CFI GEDI
03:04p 0 3.24 4.0 450 03:04p 0 2.92 4.2 489 03:04p 0 3.15 4.5 520 03:04p 0 2.96 4.28 480 MW
0
10s
AP 97
8 8 8 8 8
(CVP) SVRI PC CI HR SVI
∆T 0.31/TI12 II ABS
201000200 9/12 03:33p AP
117 71
12 2157
1
SVV (GEDI)
8% 479
2
TB37.0 AP 160 97
117 71
(CVP) SVRI PC 20 CI 6 HR SVI
12 2157
2.38
PCCI 3
0 SVV
1h
∆T 0.31/TI12 (GEDI) II ABS
4
INP
EVLW = Extravascular Lung Water PCCI = Pulse Contour Cardiac Index
78 38
INFO
INP
GEDI or ITBI = Global End-Diastolic Volume Index or Intrathoracic Blood Volume Index
2.38
20s STA
CI = Cardiac Index
Continuous results
201000200 9/12 03:33p
78 38
8%
1
SVV = Stroke Volume Variation.
to display arterial 2 Press pressure curve. 3 The display range of PCCI can be changed in the Configuration-Screen. 4 NB: Values can be displayed either as index values (CCI) or absolute values (CCO).
479
INFO
PiCCO plus
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Error Codes * * * : Inappropriate values, unavailable or not plausible parameters. +++ : The specification range is exceeded. - - - : A measurement parameter is below the display range. E : In case of errors during a thermodilution measurement the following codes (E) are displayed on the status line.
Error (E)
Interpretation
Possible Cause
Suggested Action
0
Technically good measurement
N/A
N/A
1
Injection error
Erratic injection
– Repeat injection. – Perform rapid and smooth injection.
2
Injectate temp. sensor error
Injectate temperature sensor cable or sensor housing loose or defective
–C heck connections of the injectate temperature sensor cable. If necessary change the cable. – Change injectate temperature sensor housing.
3
Inject over less than 7 sec
Slow injection >10 sec
– Repeat injection. – Perform rapid and smooth injection.
4
DST (downslope time) error
– Blood temperature fluctuations – Slow injection
– Stabilize patient temperature (stop infusions). – Repeat injection. – Perform rapid and smooth injection.
(e.g. 2 ml/5s)
PiCCO plus
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Error Codes Error (E)
5
Interpretation
Possible Cause
Baseline error
– Patient rewarming (more than 0.05C/min, 3ºC/h)
– Arterial thermodilution cable loose or defective
Suggested Action – Stabilize patient temperature. – Change arterial catheter.
6
MTt (mean transit time) calculation error
Erratic injection
– Repeat injection. – Perform rapid and smooth injection.
7
Time-out (Thermodilution curve longer than 90 sec)
– Thermistor of arterial catheter defective – Injection outside of CVC – High thermal volume – Unlikely low CO
– Change arterial catheter. – Check stopcocks and make sure that injectate is injected in CV-line. – Try to increase CO.
8
T injection > T Blood
Injectate temperature too high
– Use iced injectate.
9
Invalid PiCCO Calibration
– No valid pressure curve – Pressure line not properly connected or broken
–C heck the pressure line and transducer for air bubbles. – Check all connections from the catheter to the PiCCO plus.
PiCCO plus
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Normal Values Parameter
Abbreviation
Range
Unit
Cardiac Index
CI
3.0 – 5.0
I/min/m2
Stroke Volume Index
SVI
40 – 60
ml/m2
Global Enddiastolic Volume Index
GEDI
680 – 800
ml/m2
Intrathoracic Bloodvolume Index
ITBI
850 – 1000
ml/m2
Stroke Volume Variation
SVV
< 10
%
Systemic Vascular Resistance Index
S VRI
1970 – 2390
dyn*s*cm-5 *m2
Cardiac Function Index
CFI
4.5 – 6.5
1/min
Mean Arterial Pressure
MAP
70 – 90
mmHg
Extravascular Lung Water Index
ELWI
3.0 – 7.0
ml/kg
WARNING: PULSION Medical Systems is a medical device manufacturer and does not practice medicine. These normal values may not represent normal values for a particular person PULSION does not recommend general acceptance and use of these values for a specific patient.The treating physician is in any case responsible for determining and utilizing the appropriate diagnostic and therapeutic measures for each individual patient. More information could be found in the PiCCO plus operator’s manual.
PiCCO plus
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Optimized Oxygenation
O2 transport
O2 uptake
O2 extraction
O2 delivery 197 Route 18 South Suite 3000 East New Brunswick, NJ 08816 Phone: 732-514-6610 Fax: 732-514-6614 PULSION Medical Systems AG Stahlgruberring 28 81829 Munich, Germany Phone: +49-89-459914-0 Fax: +49-89-459914-18 [email protected]
O2 utilisation
O2 extraction
Cardiac Output Stroke Volume
Heart Rate
Preload GEDI
Afterload SVRI
Contractiliy CFI
Vasopressors
Inotropes
Pulmonary edema ELWI
www.PULSION.com Volume
MPI812905_US R00 © PULSION 04/2007
PiCCO plus
Fast decision support!
PULSION • SETUP GUIDE • FIN PULSION • 06-0294 MECH 2• 5.23.07
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