Beruflich Dokumente
Kultur Dokumente
Booklet
Bucarest hemodynamic Monitoring
Workshop
Overview
Work booklet
Ongoing training is important: This work booklet was designed for training of medical and nursing staff in the
hospital. It should help to increase user confidence as well as getting more detailed information about the
PiCCO® and other PULSION Technologies.
Topics:
• Basic haemodynamic monitoring
• Measuring cardiac output
• Parameter calculation
• Parameters
• PULSION Technologies
• Literature
Please note: This work booklet has been provided as a template for adaption at the local hospital site and
should not in any way replace the operators manuals of PULSION products.
All information is provided without warranty. It is not for use in the USA.
Basics of haemodynamic
monitoring
Bucarest 2017
• Defined bolus injected via a temperature sensor placed in the distal lumen of
the central venous catheter
Arterial pulse contour analysis
Measuring cardiac output
CVC
Injectate sensor
housing and bolus
PulsioFlex, PiCCO2
or OEM Module
Pressure transducer
Arterial pressure sensor
cablel
Recommendations for catheter positions
PiCCO Catheter
A. axillaris
PiCCO Catheter 4F 8cm
A. brachialis
PiCCO Catheter 4F 16cm
PiCCO Catheter 4F 22cm
A. radialis
PiCCO Catheter 4F 50cm
A. femoralis
PiCCO Catheter 5F 20cm
PiCCO Catheter 3F 7cm (paediatric)
Thermodilution measurement
Transpulmonary Thermodilution
Parameter calculation
Bucarest 2017
Godje O et al. Accuracy of beat-to-beat cardiac output monitoring by pulse contour analysis in hemodynamical unstable patients.
Med Sci Monit 2001;7(6):1344-1350
Assessment of volumes
Transpulmonary Thermodilution
Intrathoracic thermal
volume
ITTV
Pulmonary thermal
volume
PTV
Global Enddiastolic
Volume
Intrathoracic thermal
volume
ITTV
CI:
• Amount of blood pumped by the heart
per minute indexed to the body surface
SVI:
• CI is the product of SVI and heart rate
For proper use of the parameters, the following preconditions must be fulfilled:
SV
SVV and PVV
<10 – 12%
• Pressure that builds up in the wall of the left ventricle during ejection
GEF: CFI:
• Percentage of volume in a heart • Used to estimate cardiac
chamber which is ejected with a contractility
single contraction
• Relation of flow and preload
• Picture of overall cardiac
contractility
Cardiac Power Index (CPI) & Left Ventricular Contractility
(dPmx)
CPI: dPmx:
• Power of left ventricular output in • Pressure changes during the systolic
watts phase (left ventricle) can be analysed
via the arterial pressure curve
• Strong independent predictor of
mortality in cardiogenic shock1 • Pressure increase over time (speed) is
calculated – trend information
Reference: unpublished data: Azriel Perel, MD, Department of Anaestesiology and Intensive Care, Sheba Medical Center, Tel Aviv University, Tel
Hashomer, Israel
Pulmonary Vascular Permeability Index (PVPI)
Pulmonary oedema
*This parameter will not be available by the PulsioFlex monitor from software version 5.0.Not every technology and parameter is available globally.
Please contact your local MAQUET sales representative to clarify approved technologies in your country
Overview
PiCCO Technology
PiCCO …
ProAQT offers…
• CITrend via any arterial standard catheter (including radial)
• Automatic (internal) and manual (external) calibration procedure
• ProAQT sensor with signal quality indicator LED
• For use in perioperative haemodynamic optimisation of high risk patients, with
high risk procedures or early recognition of unstable patients
Continuous Central Venous Oxygen Saturation
(ScvO2)
• Based on spectophotometry
• Fibreoptic probe for standard-CVC
• LED-signal is reflected by red blood cells and detected by a sensor
• Indications for use include patients in the Emergency Department, septic shock,
early goal directed therapy, cardiogenic shock
• Indocyanine green (ICG) dye is injected intravenously and excreted into the bile
via the liver
• LiMON finger clip sensor detects ICG concentration in the blood
• Elimination rate measured within 5 - 7 mins
• Parameter: PDR (plasma disappearance rate)
• Includes ICG calculator for the correct amount of dye according to patients
weight
• Indications for use include: liver surgery / transplantation, diagnosis and
monitoring in intensive care, hepatology / gastroenterology
Literature
Bucarest 2017