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PulsioFlex Monitoring Handling & Application

PulsioFlex Monitoring Handling & Application. Contend. A. StepWISE Concept B. PulsioFlex Monitor C. Integrated Technologies ProAQT Explanation Application LiMON Explanation Application CeVOX Explanation Application D. Configuration. A – I. PULSION Monitoring Philosophy. ICU.

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PulsioFlex Monitoring Handling & Application

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  1. PulsioFlex Monitoring Handling & Application

  2. Contend A. StepWISE Concept B. PulsioFlex Monitor C. Integrated Technologies • ProAQT • Explanation • Application • LiMON • Explanation • Application • CeVOX • Explanation • Application D. Configuration

  3. A – I. PULSION Monitoring Philosophy ICU Semi – Invasive PiCCO (Q4-2011) PiCCO Minimal- invasive CeVOX ProAQT, CeVOX Non- invasive LiMON LiMON OP

  4. O2 - Delivery DO2 Gas Exchange SaO2 O2 Transport Hb Flow CI Preload GEDI SVV / PPV Afterload MAP SVRI Contractility CFI, GEF dPmx, (CPI) Lung ELWI PVPI A – II. Haemodynamic Parameters Mixed / Central venous O2 - saturation ScVO2 O2 - Consumption VO2  ScvO2  DO2 VO2 ? Organ function liver? e.g. ScvO2 >75%? PDRICG! x Stroke Volume SVI HeartRate HR ProAQT/PiCCO parameter PiCCO exclusive parameter LiMON parameter CeVOX parameter 4

  5. B – I. Main Operating Functions • Main Menu: • Allows access to all configurations & functions • Mute Alarm • Main Menu • PowerSwitch

  6. B – II. Connections • Sensor - Ports • - ProAQT • Modular • Expansion • Port • Module Port • - CeVOX • - LiMON • USB Ports • -PDF printouts • Power Switch • & Power supply • Network Port • Network printing

  7. C – I. Setup of ProAQT • Setup: • ProAQT Sensor • next to • pressure-transducer • Preinstalled arterial pressure-transducer • > Pressure signal to patient monitor • ProAQT Sensor for CI measurement • > CI signal to PulsioFlex • Reusable adapter for mounting plate • (vendor-specific) • 30cm pressure line

  8. C – II. Setup of ProAQT • Setup: • ProAQT Sensor • on top of • pressure transducer • ProAQT Sensor for CI measurement • > CI signal to PulsioFlex • Preinstalled arterial pressure-transducer • > Pressure signal to patient monitor

  9. C – III. Principles of ProAQT-CITrend Measurement Automatic start value determination Based on the characteristics and details of the arterial pressure curve (innovative 250 Hz sampling) a start value is determined for cardiac index trend monitoring (CITrend) Continuous CI measurement The pulse contour of the arterial pressure curve is analysed and the continuous CITrend is measured. AD T Alternative manual calibration: For increased accuracy a measured CI value (e.g Echo) can be entered for manually calibrated cardiac index monitoring (CICal)

  10. C – IV. Calibration options of ProAQT CITrend - Monitoring 2 4 6 CI l/min T T New start value calculated Start value calculated Manual calibration by reference CI • Calibration by innovative Start Value  CITrend • Tracing of the CI trend is based on PiCCO Pulse Contour analysis • Options following the recognition of a haemodynamic change: • - Further Follow-Up of the CI trend • - As required: Recalculation of start value • - As required: Manual calibration by an external reference CI • (Echo, Doppler,…)  CICal

  11. C – III. First validation results PulsioFlex vs. PiCCO Start value vs. transpulmonary thermodilution Cardiac surgery patients (CABG) Every 10 minutes PulsioFlex vs. TPTD recorded ~200 measurements Auto calibration after induction of anesthesia and after weaning from Cardiopulmonary Bypass Passive Leg Raising after induction Bias, trending capabilities analysed 13

  12. Before Bypass (including PLR maneuver) C – III. First validation results Bein et al., Kiel, unpublished data, 2011 14

  13. After Bypass C – III. First validation results Bein et al., Kiel, unpublished data, 2011 15

  14. C – VI. Patient admission 1. Confirmation of new patient admission: • Yes: Any patient data is deleted • No: Any patient data is kept 2. Input of patient data 3. Input of patient characteristics 4. Close window

  15. C – VII. Zeroing of the pressure sensors 1. Touch pressure curve area 2. Open arterial system to atmosphere for zeroing > Baseline on monitor 3. Press „Zero“ – button 4. Close arterial system for measurement > Pressure- curve appears again on the monitor 5. As required enter CVP for SVRI - calculation 6. Close window

  16. C – VIII. Automatic CI Startvalue calibration 1. Touch CI parameter area 2. Start calibration with the„CI CAL“ button 3. Determine automatic start value with „CI“ 4. Press „Calibrate“ to store the start value 5. Close window 6. CITrend is measured continuously

  17. C – IX. Calibration of CI with external reference • 1. Touch CI parameter area • 2. Start calibration with„CI CAL“ • 3. Press Start Value to enter the start value manually • 4. Enter CI value • 5. Press „Calibrate“ to store • 6. Close window • 7. CICal is measured continuosly

  18. C – X. Adjustment of CI-Alarm settings • 1. Touch CI parameter area • 2. Select relevant alarm value • 3. Enter new alarm limit • 4. Close window

  19. D–I. Non-invasive liver function / splanchnic perfusion monitoring PDRICG– Plasma Disappearance Rate of Indocyanine Green (ICG) • Shows the excretion rate of ICG dye from the blood by the liver • Is a marker for global liver perfusion and liver function • PDR is below normal if: • the function of liver cells is compromised • the liver is not perfused adequately • Has a high prognostic significance for the prediction of mortality PDRICG 16 - 24% Distribution in blood Transported to liver Liver Intravenous ICG injection Excreted by liver Portal vein Gall bladder Duodenum 22

  20. D – II. LiMON PDRICG measurement • 1. Touch PDR area • 2. Start new measurement with „LiMON“ • 3. Determine required ICG-dose with calculator • 4. Start measurement • 5. Wait for stable signal • 6. Inject required ICG-dose • At the end of the measurement (5 mins) the PDRICG value will be displayed • 7. Close window

  21. E – I. CeVOX probe placement Remove CVC clamp from CeVOX lumen! Remove the clamp from CVC lumen where the CeVOX is placed! Make sure there is no stopcock between probe and the CVC!

  22. E – II. CeVOX ScVO2 calibration • 1. Touch ScvO2 area • 2. Start new calibration with „CeVOX“ • 3. Optional: Enter SaO2 value for DO2 measurement (substituted by SpO2) • 4. Follow the instructions for calibration on screen • 5. Enter values from venous BGA and press „calibrate“ to store the calibration • 6. Close window • Example of screen layout: ProAQT + CeVOX

  23. F – I. Selection of screen layout • 1. Touch any parameter area for layout selection • 2. Activate selection with „Layout“ • 3. Select a layout • 4. Store screen layout with „select“

  24. F – II. Selection of parameter configuration • 1. Touch a parameter area to be configured • 2. Select parameter field • 3. Select a parameter • 4. Close window

  25. F – III. Configuration of trend windows • 1. Touch the trend area that has to be configured • 2. If required activate „Double Trend display“ for trend overlays • 3. Select trend parameter • 4. Close window

  26. F – VI. Configuration of trend areas • Select time span • Both trend areas can be configured individually • Trend scaling • Auto scaling • Trend bar can be moved using your finger  

  27. F – IV. Alarm & Volume settings • „Alarm & Volume“ settings can be activated via the main menu or the status line • - Alarm volume can be muted

  28. F – V. Print features • - Define the time span and the time frame • - Select output device option

  29. Thank you for your attention

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