26-24 DELTA/DELTA XL/KAPPA VF8
26 P
ULSE CONTOUR CARDIAC OUTPUT (PICCO) MONITORING
Central Venous pressure
Check for accurate CVP signal and values before performing TD
measurement and calibration of Pulse Contour parameters.
Amount of Bolus
15 cc is normally adequate for most adult patients but can be changed as
necessary.
Temperature of Injectate
The signal is better with iced temperature injectate or cold temperature
injectate (refrigerated) or at least 10
o
C below blood temperature as opposed
to warmer/room temperature injectate. The reason for this is that the bolus has
to traverse a longer path (especially femoral catheter) before being detected at
the blood temperature thermistor end (as opposed to regular RH
Thermodilution CO where the path is much shorter). If warmer temperature
injectate is used, the difference in temperature will be very small, making it
hard to calculate a good CO measurement.
In case there is no pulmonary edema, room temperature injectate can be used.
Usually, warmer temperature injectate could be used if EVLWI <10.
If individual measurements are not in good agreement and the TD peak is low,
< 0.15 °C (59 °F), it is good to use iced injectate or at least injectate coming
out of the refrigerator.
Injectate temperature generally must not be warmer than 24 °C (75 °F). If
injectate temperature is above 31°C (88°F) or fluctuates and is invalid, no
measurement will be possible. An error message Check Injectate Probe will
be displayed and the p-IT values will display ***. Before starting a
measurement, make sure the thermistor is not exposed to an external heat
source like a warming blanket, etc. Flushing with a cold saline before the first
measurements helps to overcome these issues.
Injection time
The injection time must be within 7 sec. The injection should be done as
quickly as possible via the distal CV lumen.
A shorter injection makes a better signal. Also, the injection should be done as
smoothly as possible.
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