1. Haemodynamic Monitoring Theory and Practice

2. 2 Haemodynamic Monitoring A.Physiological Background B.Monitoring C.Optimising the Cardiac Output D.Measuring Preload E.Introduction to PiCCO Technology F.Practical Approach G.Fields of Application H.Limitations

3. Knowledge of the limitations is essential for correct interpretation of the data! Limitations of the PiCCO parameters - thermodilution Limitations GEDV - data will give false-high with large aortic aneurysm - is not usable with intracardiac left-right shunt - can be overestimated in severe valvular insufficiency EVLW - data will be falsely high with gross pulmonary perfusion failure (macro-embolism) - is not usable with intracardiac left-right shunt

4. can only be used with fully controlled mechanical ventilation (minimal tidal volume 6-8ml/kg) and absence of cardiac arrhythmias (otherwise may give false high reading) Knowledge of the limitations is essential for correct interpretation of the data! Limitations of PiCCO parameters – pulse contour analysis Limitations SVV / PPV not valid when an IABP is in use (thermodilution is unaffected) All parameters of pulse contour analysis

5. PiCCO Technology in special situations Special clinical situations normally no interference with the PiCCO parametersRenal replacement therapy Prone positioning all parameters are measured correctly Peripheral venous injection not recommended, measurements possibly incorrect

6. Limitations of application of PiCCO Technology Limitations Because of the use of normal saline as indicator, PiCCO measurements are possible at virtually any desired frequency, even in children (over 5kg) and pregnant women. PiCCO Technology has no specific limitations of application

7. Contraindications to PiCCO Technology Limitations The usual precautions are required when puncturing larger blood vessels: coagulation disorders vascular prosthesis (use other puncture site, e.g. axillary) Because of the low invasiveness there are no absolute contraindications

8. The complications of PiCCO technology are confined to the usual risks of arterial puncture Complications of PiCCO Technology Limitations injuries associated with the puncture infection perfusion disturbances PULSION recommends that the PiCCO catheter be removed after 10 days at the latest

9. None the less …..