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Table Of Contents
12 Monitoring Cardiac Output
203
Ice-Bath Setup for RH Thermodilution C.O. Measurements
If you are using the flow-through method illustrated above, the injectate temperature is measured at
the time of injection by the temperature probe in the injectate temperature probe housing.
If you are using the ice-bath setup, the injectate temperature probe and the injectate are both placed in
an ice-bath and the probe measures the temperature of the contents of the ice bucket.
Setting the Computation Constant
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.
Performing RH C.O. Measurements
1 Enter the procedure window.
2 When you see the message Ready for new measurement, select the pop-up key Start C.O.. If the
measuring mode is set to
Auto the Start C.O. key will also enable the automatic start of
consecutive measurements.
3 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.
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.
4 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. If you perform more than six measurements without rejecting any, the oldest will
automatically be deleted when a seventh curve is stored.
Editing and Saving RH C.O. Measurements
It is important to identify and reject erroneous measurements (called "trials"), as the monitor uses all
the measurement trial values you do not reject to calculate the averaged cardiac output.
1 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.
2 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. 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.
3 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.. 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.