General

Hypothermia

• There is no influence on the thermodilution measurements as long as the patient’s temperature is stable. Cooled injectate should be used.

Fluctuating blood temperature

• Temperature fluctuations from the baseline are compensated by the device. Thermodilution measurement is not recommended in the event where a stable baseline is not possible, as shown by a change > 0.05°C /min.

Basic requirement for the assessment of the volume responsiveness parameter

• Controlled mechanical ventilation with no spontaneous breaths
• Sinus rhythm without arrhythmias and artefacts

Contraindications and complications

No absolute contraindications

• Usual precautions when accessing larger blood vessels. Coagulation problems,grafts (other sites such as the axillary artery can be used)

No increased complication rate

• Usual risk associated with arterial puncture: puncture injury, infection (extremely rare), impaired blood flow, haematoma.
• The maximum recommended placement period for the PiCCO catheter is 10 days.

No specific application restrictions

• As it is possible to use normal saline for the thermodilution measurements,there are no restrictions on the number of measurements possible, including in pregnancy and with children

Specific Therapies

Vasoconstrictors / Inotropes / Volume Therapy

• All parameters are correctly calculated. Where there are significant changes in the catecholamine requirements, or volume therapy, recalibration of the pulse contour analysis is recommended.

Intra-aortic Balloon Pump (IABP)

• The thermodilution parameters are measured correctly
  Pulse contour analysis is not accurate

Renal Replacement Therapy (continuous haemofiltration / dialysis)

• All the parameters are measured correctly provided the out- and inflow of the device is not lying in the indicator passage track

Heart

Valvular Insufficiency

• Regurgitation of the thermodilution injectate can prolong the transit time of the indicator, or interfere with the thermodilution curve. However, where a thermodilution curve is possible, the calculation of the cardiac output is correct. The extended mean transit time of the injectate can result in an overestimation in the GEDI / ITBI.

Aortic Stenosis

• All parameters are correctly measured

Intra-cardiac Shunts

• Due to the marked alteration in the thermodilution curve, no valid values are able to be calculated. In less severe shunts, measurements may be possible

Aortic aneurysms

• GEDI / ITBI is increased due to to the volume of the aortic aneurysm, this can be avoided by placement of the PiCCO catheter in the axillary artery.

Cardiac Arrhythmia

• The thermodilution parameters are measured correctly.
• The pulse contour analysis is correct in mild to moderate rhythm disturbances (normal rate atrial flutter / fibrillation, bigeminal –, trigeminal or incidental extra systolies)
• In severe cardiac rhythm disturbances (tacharrhythmias, supraventicular tachycardia), pulse contour analysis may be inaccurate. It is recommended to recalibrate with 3-5 thermodilution measurements.

Lung

Partial Lung Resection

• Correct calculation of the cardiac output and GEDI. The under-estimation of the ELWI is dependent on the amount of lung resected. The trend of the ELWI remains accurate.

Pulmonary perfusion disturbances (e.g. pulmonary embolism)

• The ELWI is underestimated when there are significant perfusion disturbances.

Pleural effusion

• There is no influence on the ELWI measurement because the contact area between the lung parenchyma and pleural fluid is minimal.