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PiCCO, CeVOX & LiMON Technology

Training in methodology, operation, application and safety. PiCCO, CeVOX & LiMON Technology. Icons & Navigation. i. More information (within the presentation). More information (external documents). Video . Back to start position . Start animation. Overview. A. Introduction

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PiCCO, CeVOX & LiMON Technology

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  1. Training in methodology, operation, application and safety PiCCO, CeVOX & LiMON Technology

  2. Icons & Navigation i More information (within the presentation) More information (external documents) Video Back to start position Start animation

  3. Overview A. Introduction B. Disposables C. Start-Up D. Measurement E. Parameters F. PiCCO Strategies

  4. User orientated presentation Basic nurse training Basic medical training Intensive care nurse training Intensive care medical training

  5. A. Introduction

  6. History of the PiCCO-Technology • Intelligent hemodynamic monitoring • Paradigm shift in hemodynamic monitoring • Integration into patient monitoring monitors • Most widely used less-invasive method PulsioFlex™2010 PiCCO22007 Dräger Smart Pod 2005 Philips PiCCO Module 2003 PiCCO plus 2002 PiCCO 1997 COLD System 1990

  7. PULSION – Made in Germany • Medical device manufacturer based in Munich, founded in 1990 • Production, development, management, marketing and distribution in Munich • Subsidiaries in USA, France, Spain, United Kingdom, Benelux, Poland, Austria and Switzerland • Distribution and licensing worldwide PULSION Head Office Clean Room Production

  8. Why Monitor Hemodynamics? • What are hemodynamics? • When is hemodynamic monitoring indicated? • What types of hemodynamic monitoring are there? • Why do you need the PiCCO-Technology? Illustrative case

  9. Key questions Is the O2supply sufficient?Volume or catecholamine's ?Is there Pulmonary edema?

  10. What are Hemodynamics? O2 uptake O2 transport O2 delivery O2 consumption Gas exchange Macro-circulation Micro-circulation Cellular O2consumption (Cardiac Output, Hb) (ScVO2, PDRICG*) Maintenance of oxygen extraction! * Parameter is not available in the USA

  11. Intervention Options - - - - + + + + Volume loading? Volume withdrawal? Diuretics? Vasopressors? Vasodilators? Inotropes? Catecholamines Hemoglobin Respiration Volume The correct decision, early!

  12. Anatomy and physiology of the circulatory system  Determinants of cardiac output: Preload: - Blood volume, blood available for pumping Afterload: - Resistance, against which the heart must pump Contractility: - Performance of the heart muscle Heart rate Circulatory model Flow is the result of: preload, afterload, contractility & heart rate

  13. Hemodynamic Parameters O2Delivery DO2 O2 Consumption VO2 Gas exchange? SaO2 O2 Transport? Hb Flow? CI Stroke Volume SVI x Frequency HR Preload GEDI SVV Afterload MAP SVRI Contractility dPmx, CPI* CFI*, GEF* Lung ELWI PVPI* Mixed- / Central- Venous O2-Saturation ScVO2   DO2 VO2 ! * Parameters are not available in the USA

  14. Treatment strategies Sepsis Cardiac surgery Cardiology Neurosurgery/ Neurology /Stroke Burns Trauma

  15. Monitoring and Diagnostic systems Diagnostics CO - Monitoring Doppler CT/ MRI TTE/TEE LiDCO rapid Diagnostics & Advanced Monitoring Vigileo Bioimpendance Vigilance / PAC PiCCO2 PulsioFlex

  16. B. Disposables

  17. PiCCO Catheter • For advanced hemodynamic monitoring with the PiCCO-Technology • Temperature sensor at the catheter tip for transpulmonary thermodilution • Pressure lumen for arterial pressure measurement • For use with • PiCCO2 • PiCCO plus • Philips PiCCO technology module and • Draeger Infinity® PiCCO SmartPod®.

  18. PiCCO Catheter Placement Options A. Axilla Adult 4F - 08cm A. Brachial Proximal 4F - 16cmAdultdistal (cubital) 4F - 22cm • Femoral Adult 5F - 20cm Children/peds3F - 07cm • Radial Adult 4F - 50cm* * Product is not available in the USA

  19. PiCCO Catheter Safety Tips • Catheter handling according to hospital hygiene policy • Latex and DEHP free • Remove catheter if there are any signs of inflammation/infection

  20. CeVOX Probe* • Continuous monitoring of ScvO2 • Convenient application • Access via already placed standard CVC • Easy application • Continuous ScvO2 within minutes * Product is not available in the USA

  21. CeVOX Probe Selection and Placement Remove slide clamp from CeVOX lumen No stopcock / 3 way tap in-between probe and CVC! CeVOX-probe indicator Remove slide clamp from CeVOX lumen! * Product is not available in the USA

  22. CeVOX* CVC-lumen • Blood samples for in-vivo calibration are withdrawn from the Y-connector at the end of the CeVOX probe. (if not possible then from the next (medial) lumen from the same CVC) • In-vitro calibration (pre-calibration) is not validated and raises hygiene issues • Keep the CeVOX lumen open by continuous flow • Online CVP via pressure transducer • 3ml/h flush solution via syringe pump • Infusions and medication can be administered via the CeVOX-CVC lumen • No catecholamines! * Product is not available in the USA

  23. CeVOX* probe safety tips • CeVOX probe and CVC handling according to hospital policy • Latex and DEHP- free • Remove CeVOX probe together with CVC if there are signs of inflammation at the injection site or signs of catheter related infection • Remove slide clamp from CeVOX lumen! • Do not place a stopcock (3 way tap) between probe and CVC * Product is not available in the USA

  24. PiCCO Pressure Transducer

  25. PiCCO Pressure Transducer • PV8215 PiCCO transducer incl. PV 4046 • PV8215-2 2in1 PiCCO transducer with continuous AP and CVP incl. PV4046 • PV8215CVP PiCCO transducer with discontinuous CVP incl. PV4046 • PV8615 CVP online transducer • DPT-100 In-Line transducer • PV4046 Injectate sensor housing PV82xx transducers are not available in all markets. Alternative products are available on request. Movie

  26. Transducer Safety Tips • Change transducer according to hospital policy (usually around every 96 hours) • PV82XX is Latex and DEHP free • Use only PULSION approved transducers for PiCCO monitoring (CE-Conformity).

  27. Injectate Sensor Housing PV4046 • Measures the temperature of injectate at time of injection • Included in PiCCO transducer kits • Also available separately

  28. C. Start-UP

  29. Connectivity Philips IntelliVue Model PiCCO2 Dräger Infinity PiCCO SmartPod PiCCO plus

  30. Connectivity PiCCO2 1 2 3 3 1 2 4 4 LiMON Sensor Flush bag CeVOX Module (Art. No. PC3015) LiMON Module* (Art. No. PC5100) Injectate-Sensor cable (Art. No. PC80109) Temperature cable (Art. No. PC80150) Pressure cable (Art. No. PMK-206) 1a 1a CeVOX probevia standard CVC PiCCO catheter PiCCO monitoring kit * Product is not available in the USA

  31. Connectivity Philips IntelliVue Module 1 2 3 1 2 3 Flush bag Injectate-Sensor cable (Art. No. PC80109) Temperature cable (Art. No. PC80150) Pressure transducer cable (Art. No. PMK-206) PiCCO catheter PiCCO monitoring Kit

  32. Connectivity DrägerInfinity PiCCO SmartPod® 1 2 3 1 2 3 Injectate Sensor cable (Art. No. PC80109) Temperature cable (Art. No. PC80150) Pressure transducer cable (Art. No. PMK-206) Flush bag To bedside monitor Connected to the back PiCCO catheter PiCCO monitoring kit

  33. Connectivity PiCCO plus PV8215 PV2015L20N

  34. PiCCO2Connectivity Input Output • CeVOX - • ScvO2 Module • PiCCO – Thermodilution • PiCCO – arterial pressure • Online - CVP • AUX port for connection to bedside monitoring CVP AP

  35. PiCCO2Connectivity Interface Mains Lead 2x USB LAN RS 232 Mains connection Potential- Equilization

  36. Start-Up 2 3 4 1 • Power Switch • On/Off button • Alarm indicator • Charge warning light PiCCO2 Blinking = charging Permanently on = Fully charged

  37. Screen layout Information bar Real-time arterial waveform Parameter fields Innovative visualizations Direct access buttons & dial knob Touch screen

  38. Direct Access Buttons and Navigation Dial 2 3 4 1 5 6 • On / Off • Help • Print • Suspend alarm • Back (to previous level) • Back (to main screen)

  39. Help Function - Press Help button to open the help screen Setup scheme

  40. Help Function Parameter -information

  41. Help Function Therapy algorithm

  42. Help Function Help funktion Physiological parameter model with intervention options

  43. Help Function How to contact PULSION and the PiCCO2 serial number

  44. Help Function Press „Exit“ or “Next” to proceed to next screen

  45. Zeroing of AP and CVP • Zero pressures once per shift and as required • Manually enter CVP in mmHg • Continuous CVP can be monitored via a second transducer

  46. System Check 1 2 3 1 2 3 AP plausible? (PiCCO and patient monitor) Systole identified? 3.. Blood temp (TB) plausible?

  47. PiCCO2Supports Your Decisions Spider VisionView the patient status at a glance ProfileDetailed insight at a parameter level • TrendsClinical course & treatment success

  48. Configuration of Parameters Press on the parameter field on the right side of the screen to go to parameter configuration

  49. Configuration of Alarms 8065

  50. Configuration of Normal and Target Values • Switch to target mode via Selection “Target Values” • Enter your target values • It is possible to adjust target ranges for each individual patient Normal values Target values

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