PiCCO Trouble Shooting Guide | For PulsioFlex with PiCCO module

Therapeutic interventions

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Intra-aortic balloon pump

A running intra-aortic balloon pump (IABP) usually alters the arterial pressure curve significantly and pulse contour analysis is most likely not possible.

Thermodilution measurements are still possible and valid.

Extracorporeal lung support
(ECLS, ECMO, ECLA)

Devices for extracorporeal lung support are running on relatively high flow rates. This will cause an indicator loss when a thermodilution bolus injection is performed, resulting in non-available or implausible measurement results.

PiCCO thermodilution measurements should only be performed when the extracorporeal lung support device is not running, means before or after this treatment.

Renal replacement therapy

Continuous renal replacement therapy (CRRT) is usually running with relatively low flow rates.
Accurate PiCCO thermodilution measurements can be expected when the following requirements are fulfilled:

  1. PiCCO thermodilution measurements should be avoided directly after the CRRT is switched on or off.
  2. Stable blood temperature baseline is required before performing PiCCO thermodilution measurements.
  3. CRRT catheter out- and in-flow should not be placed in the PiCCO indicator passage track.

Hypothermia or hyperthermia

Significant changes of the blood temperature (TB) of more than 0.15°C/min will cause inability to detect a stable baseline temperature and the message ‘Wait’ will stay on screen.

As soon as the blood temperature (TB) is stable, the message ‘Inject xx ml’ will be displayed and thermodilution measurements can be performed, independent if the blood temperature is high or low. Measurement results are valid and accurate.

In case of hypothermia cooled injectate should be used.

Partial Lung Resection

Lung resection procedures (lobectomy, bilobectomy, pneumectomy) theoretically reduce the Pulmonary Blood Volume (PBV) and may lead to an underestimation of the Extravascular Lung Water (EVLW). Clinical studies show that:

  1. The amount of extracted lung tissue and pulmonary blood volume do not correlate and thus, correction factors cannot be defined
  2. An initial effect on PBV is generally physiologically compensated latest two days post-operatively
  3. Dependent on the amount of extracted lung tissue, ELWI might be underestimated up to 2 days post-operatively.

High Frequency Oscillation Ventilation (HFOV)

High Frequency Oscillation Ventilation is used for lung protective ventilation, mainly in neonates. The high frequency and low tidal volumes are reducing volume shift effects due to the ventilation.

  1. Pulse contour cardiac index (CI), cardiac preload (GEDI) and pulmonary edema (ELWI) are measured correctly
  2. SVV and PPV are do not reflect volume responsiveness

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