PiCCO MONITORING

• Simple
• Safe
• Speedy
• specific
 INDICATIONS
• Haemodynamic instability
• Shock(cardiogenic shock)
• Sepsis
• Lung injury
• Pulmonary oedema
• Organ failure
 CONTRAINDICATIONS
• Contraindications to vascular device insertion
such as PVD,arterial grafting, overlaying
infection and coagulopathy
• Anatomic or physiologic derangements such
as constant cardiac arrhythmias, aortic valve
pathology
• Pt on circulatory assist device
• Unreliable arterial waveform(positional)
 What is PiCCO technology ?
• The PiCCO Technology is a combination of 2
techniques for advanced hemodynamic and
volumetric management without the necessity of a
pulmonary artery catheter in patients:
a. Transpulmonary thermodilution
b. Arterial pulse contour analysis
 Advantages of PiCCO
Less Invasiveness - Only central venous and arterial access required
- No pulmonary artery catheter required
- Applicable also in small children
Short Set-up Time - Can be installed within minutes
Dynamic, Continuous Measurement- Cardiac Output, Afterload and Volume Responsiveness
are measured beat-by-beat
No Chest X-ray - To confirm correct catheter position no x-ray is necessary
Cost Effective - Less expensive than pulmonary artery catheter technique
- Arterial PiCCO catheter can be in place for 10 days or
more
- Potential to reduce ICU stay and costs
More Specific Parameters - PiCCO parameters are easy to use and interpret even
for less experienced clinical staff
Extravascular Lung Water* - Lung edema can be excluded or quantified at the bed-side
The PiCCO measures the following main parameters:

Thermodilution Parameters
•Cardiac Output
CO
•Global Enddiastolic Volume GEDV
•Intrathoracic Blood Volume ITBV
•Extravascular Lung Water
EVLW*

Pulse Contour Parameters

•Pulse Continuous Cardiac Output PCCO
•Systemic Vascular Resistance SVR
•Stroke Volume Variation SVV
How does it work
The PiCCO-Technology uses any standard CV-line and
a thermistor-tipped arterial PiCCO-catheter instead of
the standard arterial line.
 CV
Central venous line (CV)
A
Thermodilution catheter with lumen for B
arterial pressure measurement
•Axillary (A)
•Brachial (B) R
•Femoral (F)
•Radial (R), long catheter F

Arterial pressure transducer

a. Transpulmonary Thermodilution

Transpulmonary thermodilution measurement simply requires the central venous

injection of a cold (< 8°C) or room-tempered (< 24°C) saline bolus…

CV Bolus
Injection
Lungs
Right Heart Left Heart

PiCCO Catheter
e.g. in femoral artery
 PiCCO Thermodilution Cardiac Output

After central venous injection of the indicator, the thermistor in the tip of the arterial
catheter measures the downstream temperature changes
The cardiac output is calculated by analysis of the thermodilution curve using a modified
Stewart-Hamilton algorithm:

-Tb Injection

t
 PiCCO Volumetric Parameters

Global Enddiastolic Volume GEDV

Intrathoracic Blood Volume ITBV
Extravascular Lung Water EVLW*
Global Enddiastolic Volume

Global Enddiastolic Volume (GEDV) is the volume of blood contained in the 4 chambers
of the heart.
 Intrathoracic Blood Volume

Intrathoracic Blood Volume (ITBV) is the volume of the 4 chambers of the heart + the
blood volume in the pulmonary vessels.
Volume assessment in patients with necrotizing pancreatitis: A
comparison of intrathoracic blood volume index, central venous
pressure, and hematocrit, and their correlation to cardiac index and
extravascular lung water index*
Huber, Wolfgang MD; Umgelter, Andreas MD; Reindl, Wolfgang
MD; Franzen, Michael MD; Critical Care Medicine:
August 2008 - Volume 36 - Issue 8 - pp 2348-2354
Extravascular Lung Water*

Extravascular Lung Water (EVLW)* is the amount of water content in the lungs. It allows
bedside quantification of the degree of pulmonary edema.
 PiCCO Preload Indicators

Intrathoracic Blood Volume, ITBV and Global Enddiastolic Volume, GEDV have shown to
be far more sensitive and specific to cardiac preload than the standard cardiac filling
pressures CVP + PCWP but also than right ventricular enddiastolic volume.

The striking advantage of ITBV and GEDV is that they are not wrongly influenced by
mechanical ventilation and give correct information on the preload status under any
condition.
Extravascular Lung Water*

Extravascular Lung Water, EVLW* assessment by transpulmonary thermodilution has

been validated against dye dilution and the reference gravimetric method.

Extravascular Lung Water, EVLW* has shown to have a clear correlation to severity of
ARDS, length of ventilation days, ICU-Stay and Mortality and to be superior to
assessment of lung edema by chest x-ray.
b. Arterial Pulse Contour Analysis

Arterial pulse contour analysis provides continuous beat-by-

beat parameters obtained from the shape of the arterial
pressure wave.
The algorithm is capable of computing each single stroke
volume (SV) after being calibrated by an initial
transpulmonary thermodilution.
Cardiac Output and Systemic Vascular Resistances

As pulse contour analysis continuously measures stroke volume and

arterial pressure, cardiac output (CO) and systemic vascular resistance
(SVR) are computed as follows:

CO is calculated as stroke volume x heart rate

SVR is calculated as (mean arterial pressure - central venous pressure) / C

Stroke Volume Variation (SVV)

In mechanically ventilated patients without arrhythmia,

SVV reflects the sensitivity of the heart to the cyclic changes in cardiac preload induced by
mechanical ventilation.

SVV can predict whether stroke volume will increase with volume expansion.
 How to use the PiCCO-Technology?

1.Connect the injectate-temperature sensor housing to the CV line

already in place.
2.Insert a PiCCO arterial thermistor catheter into a large artery,
preferable femoral artery, but also brachial / axillary artery and radial
artery (with long catheter).
3.Connect the injectate sensor, the arterial catheter’s thermistor and
pressure line to your PiCCO monitor.
4.For blood pressure transfer to any bedside monitoring system,
connect the cable at the back side of the PiCCO monitor.
5.Now the system is ready to work.
Normal values of indices:
Thank you
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