13 Monitoring Cardiac Output
Editing PiCCO C.O. Measurements
It is important to identify and reject erroneous trials, as the monitor uses all the measurement trial
values you do not reject to calculate the averaged cardiac output.
Review the trials. Irregular trials or trials marked with a "
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.
Reject unsatisfactory trials: use the
or reject trials directly by tipping on the trial curve. 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.
If all values are different from each other, there may be true hemodynamic instability caused, for
example, by severe cardiac arrhythmia.
Saving and Calibrating PiCCO C.O. Measurements
When you have finished editing the trials, you must save the results. This closes the measurement
series, sends the average C.O. numeric to be displayed on the main screen, and stores the averaged
values in the trends and calculations databases.
Before the monitor can calculate CCO, you must calibrate the measurement. You should also calibrate
CCO every eight hours, or if the hemodynamic condition of the patient changes consistently in the
same direction over 15 minutes, or if there are large or sudden changes in the patient's condition.
The monitor only uses C.O. measurements from within the last 15 minutes for calibrating CCO.
To save and calibrate,
In the procedure window, select the pop-up key
C.O. value to calibrate Continuous Cardiac Output (CCO).
Your monitor may be configured to have two separate pop-up keys,
of the combined
CCO calibration is patient-specific. When the C.O. module or measurement extension module is
plugged in after the patient has changed, make sure that the correct CCO calibration is used. When in
doubt perform a new CCO calibration first.
CCO Calibration Status Indicators
Each measurement trial is tagged with a calibration status indicator next to its trial number. Reflecting
the quality of the pressure signal during the thermodilution measurement, this tag indicates each trial's
validity to be used in a CCO calibration.
For a trial to be eligible for calibration, the pressure signal must be continuously available and
undisturbed starting 30 seconds before the first C.O. measurement of the series. Do not zero the
pressure measurement, change the pressure label, or disturb the pressure signal in any other way during
pop-up key to accept or reject trials. If you are using a touch screen you can accept
SaveC.O. &Cal CCO
A pressure signal for CCO was available during the measurement (valid for calibration)
" should be reviewed carefully. Consider
pop-up key to move between trials, then select the
SaveC.O. &Cal CCO
to use the averaged