1. General

1.1 What are the indications and contraindications for PiCCO-Technology?

Indications:
Patients in whom cardiovascular and circulatory volume status monitoring are necessary. This includes patients in surgical, medical, cardiac and burn speciality units, as well as other speciality units where cardiovascular monitoring is desired, and patients undergoing major surgical interventions where cardiovascular monitoring is necessary.

Contraindications:
Patients in whom there are arterial access restrictions, for example due to femoral artery grafting or severe burns in areas where the arterial catheter would normally have been placed.
Note: The Axillary or Brachial artery can be used as an alternative site. Additionally a long radial artery catheter can be placed for short term use.
The PiCCO-Technology may give incorrect thermodilution measurements in patients with intracardiac shunts, aortic aneurysm, aortic stenosis, mitral or tricuspid insufficiency, pneumonectomy, macro lung embolism and extracorporeal circulation (if blood is either extracted from or infused back into the cardiopulmonary circulation). Please see more detailed answers below.

1.2 What external factors could influence the measured parameters in a false direction and what kind of pathological situations and illnesses may result in incorrectly measured parameters?

Air bubbles in the arterial pressure PiCCO Monitoring Kit will dampen the curve and possibly influence the Pulse Contour Cardiac Output. Clotting of the catheter due to improper flushing might also influence Pulse Contour Analysis.
An inadequate amount of indicator (i.e. not enough, or injectate too warm) will influence the thermodilution and volume calculations. The status line will alert you if the thermodilution is incorrect.
Clinical situations that may result in an incorrect measurement include severe arrhythmias (causing incorrect Pulse Contour Cardiac Output), raised EVLW (requiring more indicator), aortic aneurysm (causing the ITBV and GEDV to be overestimated when using the femoral arterial line), severe valve insufficiency (the CO will be correct, but preload volumes will be overestimated), rapidly changing body temperature (as malignant hyperthermia or rewarming influences the blood temperature baseline). Recirculation of indicator may occur in intracardiac shunts and in pediatric patients with open ductus botalli.

1.3 How long can a PULSIOCATH Arterial Thermodilution Catheter and other disposables be left in a patient?

In general the arterial line can be left for up to 10 days unless there are signs of infection around the catheter insertion site. Each hospital usually has its own local protocols for indwelling catheters and the frequency they should be changed or removed. It is very rare for a patient to get a systemic infection from the arterial catheter. Systemic infections are more commonly associated with central venous catheters.
Depending on the individual hospital's policy, the PiCCO Monitoring Kit and inline injectate sensor housing should be changed approximately every 3-5 days.
The PULSION long radial artery catheter (PV2014L50) is only intended for short term use, due to the intravascular length of up to 50cm.

 

1.4 Are there special recommendations for the use of the PiCCO in open-heart surgery?

On pump:
The initial calibration of the PiCCO should be done by thermodilution measurements after induction of anesthesia, before opening of the chest. During pulse contour calibration with thermodilution measurements the patient should be hemodynamically stable and have no significant change in body temperature. A recalibration can be done immediately before going to cardiopulmonary bypass (CPB), but this is not a necessity. During extracorporeal circulation the PiCCO cannot give any valid results due to lack of arterial waveform. Thermodilution measurements are not useful during extracorporeal circulation. As soon as the heart is pumping again the PiCCO will show the Cardiac Output from Pulse Contour Analysis. Immediate recalibration of pulse contour is usually not necessary, but volume status (GEDI) will be of interest immediately after bypass and after closing of the chest.

Off pump:
Initial calibration is done after induction of anesthesia. During the whole procedure, continuous Cardiac Output can be followed on a beat to beat basis. Recalibration during the procedure is not necessary. During the procedure, the index of Left Ventricular Contractility (dPmax) gives additional contractility information and can serve as an early warning for ischemic events.
It has also been shown that SVV serves as an indicator of cardiac volume responsiveness, even under open chest conditions.

 

1.5 Is it possible to use the PiCCO with a patient on intra-aortic balloon pump (IABP)?

The thermodilution measurement with the PiCCO is not influenced by the IABP, but the Pulse Contour Analysis is unable to provide valid continuous output. However, the PiCCO-Technology can be used to measure CO, preload volume GEDV and ITBV as well as EVLW with every thermodilution measurement.

1.6 What does the abbreviation “PiCCO” stand for?

“PiCCO” is neither a small Italian beer nor a coffee maker.
“PiCCO” means Pulse Contour Cardiac Output. The “i” is only included to have an easy sounding and pronounceable word.

 

PULSION is part of Maquet Getinge Group