Monitoring Cardiac Output

( Right Heart Method)

Sandy Wong
PCCI, Philips Healthcare
 Monitoring Cardiac Output ( Right Heart Method)

•  The following measurements using the

CCO/C.O. module could be carried out :
–  the right heart thermodilution
method (Swan Ganz)
–  the PiCCO method (transpulmonary
thermodilution

Internal use only PCCI, Philips Healthcare 2

 Monitoring Cardiac Output ( Right Heart Method)

Setting up RH C.O. Measurements :

•  1- C.O.Module
•  2 -C.O. Interface Cable
•  3 -Remote Start Switch
•  4 -Thermistor Connector
•  5 -Thermistor Connection Cable
•  6 -PA Catheter
•  7 -Injectate Temperature Probe
Housing
•  8 -Injectate Syringe
•  9 -Injectate Temperature Probe

Internal use only PCCI, Philips Healthcare 3

 Understanding the C.O. Procedure Window

1.  Average - column of averaged

values
2.  Unit column
3.  Continuously measured numeric
4.  Prompt message field
5.  Thermodilution curve of current
trial
6.  Curve alert message field
7.  Current trial number
8.  Setup information
9.  Trial numbers for the trial curves
10.  Trial curves
11.  Results table of current trial
12.  Trial curve scale

Internal use only PCCI, Philips Healthcare 4

 Monitoring Cardiac Output ( Right Heart Method)

•  Choose either method to open

the procedure window:

–  Select Cardiac Output in

the Setup C.O. or Setup
CCO menu
–  Select the Cardiac
Output SmartKey on the
Screen( if configured)
–  Press the START
hardkey on the front of the
C.O. plug-in module

Internal use only PCCI, Philips Healthcare 5

 Monitoring Cardiac Output ( Right Heart Method)

•  Setting the Computation Constant

(CompCt) :
–  Check that the correct
Computation Constant is
entered in the procedure
window.
–  This can be found in the
documentation supplied with
the catheter and is based on
the injectate volume, injectate
temperature and catheter type.
–  To change the value, in the
procedure window, select
Computation constant and use
the pop-up keypad to enter the
correct value.

Internal use only PCCI, Philips Healthcare 6

 Monitoring Cardiac Output ( Right Heart Method)

•  Key in Patient’s Height and

weight for Body Surface
Area (BSA) calculation.

Internal use only PCCI, Philips Healthcare 7

 Monitoring Cardiac Output ( Right Heart Method)

•  When you see the

message : Ready for new
measurement, select the
pop-up key Start C.O.

•  Note: if the measuring mode

is set to Auto the Start C.O.
key will also enable the
automatic start of
consecutive measurements.

Internal use only PCCI, Philips Healthcare 8

 Monitoring Cardiac Output ( Right Heart Method)

•  When you hear a ready

tone and see the message
Inject now!
–  inject the solution into
the right atrial port of
the Swan-Ganz
catheter. The optimal
injection rate is 2.5 ml/
second.

Internal use only PCCI, Philips Healthcare 9

 Monitoring Cardiac Output ( Right Heart Method)

•  At the end of the

measurement, the
thermodilution curve,
cardiac output, index
values and curve alerts (if
necessary) are displayed
and a message will
appear.
•  Wait before starting new
measurement
•  (Or in Auto mode, Prepare
for next injection or press
Stop.)

Internal use only PCCI, Philips Healthcare 10

 Monitoring Cardiac Output ( Right Heart Method)

•  When you see the Inject

now! message, repeat the
procedure until you have
completed the
measurements you want to
perform. You can perform a
maximum of six
measurements before
editing.

Internal use only PCCI, Philips Healthcare 11

 Monitoring Cardiac Output ( Right Heart Method)

•  If you perform more than

six measurements without
rejecting any, the oldest
will automatically be
deleted when a seventh
curve is stored.

Internal use only PCCI, Philips Healthcare 12

 Monitoring Cardiac Output ( Right Heart Method)

•  Review the trials.

Irregular trials or trials
marked with a "?"
should be reviewed
carefully.

•  Consider the similarity

of the values and the
shape of the C.O. curve.
A normal C.O. curve
has one smooth peak
and returns to the
temperature baseline
level after the peak.
Internal use only PCCI, Philips Healthcare 13
 Monitoring Cardiac Output ( Right Heart Method)

•  Reject unsatisfactory
trials: use the Select Trial
pop-up key to move
between trials, then
select the Accept Reject
pop-up key to accept or
reject trials.

•  If you are using a touch

screen you can accept or
reject trials directly by
tipping on the trial curve.

Internal use only PCCI, Philips Healthcare 14

 Monitoring Cardiac Output ( Right Heart Method)

•  Discard conspicuously
different values.

•  The background of
rejected trials is red and
the background of
accepted trials is green.

•  The monitor recalculates

the average values after
you reject or accept trials.

Internal use only PCCI, Philips Healthcare 15

 Monitoring Cardiac Output ( Right Heart Method)

•  Save average C.O.

values.

•  To close a measurement
series, you must save the
average values by
selecting the pop-up key
Save C.O..

Internal use only PCCI, Philips Healthcare 16

 Monitoring Cardiac Output ( Right Heart Method)

•  This sends the average

C.O. numeric to be
displayed on the main
screen, and stores the
averaged values in the
trends and calculations
databases.

Internal use only PCCI, Philips Healthcare 17

 Monitoring Cardiac Output ( Right Heart Method)

•  This table illustrates the

hemodynamic
parameters available
with each method,
whether they are
measured continuously,
and whether they can
be shown on the
monitor's main screen
or in the Hemodynamic
Calculations window.

Internal use only PCCI, Philips Healthcare 18

 Monitoring Cardiac Output ( Right Heart Method)

•  From the procedure

window, select the
pop-up key Perform
Calc to perform the
Hemo Calculations.

Internal use only PCCI, Philips Healthcare 19

 Monitoring Cardiac Output ( Right Heart Method)

•  You can document C.O.

measurements on the default
printer or recorder.
•  In the procedure window,
select the pop-up key Print/
Record.
•  From the pop-up list, choose:
– Print Results to print the
contents of the procedure
window
– Record Results to record the
contents of the procedure
window
– Record Trial to send an
individual trial curve to the
recorder.
Internal use only PCCI, Philips Healthcare 20
 Monitoring Cardiac Output ( Right Heart Method)

•  Things to note:

–  Catheter constant : Make sure that the arterial catheter constant for the
measurement is appropriate to the catheter used.

–  Computation Constant : Make sure that the computation constant for the
measurement is appropriate to the injectate volume, injectate temperature
and catheter type used. Check the packaging for the computation constant
code.

–  During the C.O. measurement procedure, the blood temperature alarms are
inactive. This is indicated by a crossed-out alarm symbol next to the
temperature numeric. Making alarms inactive during this procedure prevents
false alarms. The alarms are automatically reactivated when you have
completed the measurement procedure.

Internal use only PCCI, Philips Healthcare 21