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Pulse Induced Continuous Cardiac Output (PiCCO) Monitoring

Pulsion Medical Systems: http://www.pulsion.com/index.php?id=35

The PiCCO is intended for determination and monitoring of cardiopulmonary and circulatory variables. The Pulsion PiCCO is indicated in patients where cardiovascular and circulatory volume status monitoring is necessary

Equipment required
 PiCCO monitor
 Red tipped arterial pressure & thermistor lead
 Green tipped injectate venous lead
 White Philips monitor lead (To Slave)
 PiCCO flush system and Hepsal (PV 8115)
 PiCCO arterial line (Figure 1)
 CVP access (Figure 1)
 Cool injectate solution (NaCl)
PiCCO Set Up
 Flush through PiCCO transducer kit (Do not add any extra Manometer lines)
 Connect thermistor to PiCCO catheter and white end to transducer
 Connect injectate temperature sensor connector (Blue end) to CVP using temperature housing from flush system
 Turn on PiCCO monitor

Data Input
 Patient – No need to input any data
 Weight – Enter patients weight (Kg’s)
 Height – Enter patients height (cm’s)
 Inline sensor type – PV4045PiCCO box should recognize the sensor type itself
 Injectate temperature - <8oC
 Injectate volume – 20mls or 15 ml depends on size of patient
 Catheter type – PV2015L13 Picco recognizes itself
 CVP – Enter patients Central Venous Pressure (CVP)

To Zero PiCCO Catheter
 Press return key from input menu (Button 5)
 Press AP button (Button 5)
 Open transducer to air – Press O button
 Close transducer to air
 Press return key twice (Button 5)
 Press button 4 for pressure waveform display

Thermodilution Measurement
 Press thermodilution menu (Button 1)
 Prepare 3 x 20ml syringes of cold NaCl
 Press start (Button 1)
 Wait until stable appears in bottom left hand corner of screen
 When stable inject 20mls NaCl
 Wait until ready appears on screen
 Repeat above twice (i.e. 3 in total)
 Any results not within 10% of the others need to be deleted. You require a minimum of 3 results within 10% of each other.

All individuals who are going to use PiCCO must undertake initial training by a designated trainer who has undergone appropriate training with Pulsion. Records of individuals trained will be kept for reference and audit.
Updates of training will be annually or sooner if required This paragraph is designed for the nurses

Training will commence on successful implementation of this guideline.
Training will be available to all medical personnel and nursing staff with at a minimum of eighteen months ITU experience.Again this is Chris Morgans work aimed at the nurses

Further Information
This guideline reflects all available evidence provided by Pulsion Medical systems, manufacturer of the PiCCO monitoring system.
Further information can be found in the PiCCO educational package and CD rom.