PiCCOplus Setup Guide April 2007

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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