PiCCO Trouble Shooting Guide | For PulsioFlex with PiCCO module

Thermodilution measurement

Signal quality improvement 

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Central venous injection not detected

1

Check connection of the injectate sensor housing and cable

2

Ensure correct positioning of the injection port stop-cock 

3

Replace injectate sensor housing 

4

Replace injectate sensor cable 

Double humped thermodilution curve
(‘Camel curve’)

Usual cause: Right-to-left heart shunt

1

Check by echocardiography 

2

Patient Situation
 

Cascaded thermodilution curve

1

Ensure bolus injection is performed smoothly and constantly 

2

In case of femoral venous injection avoid signal cross-talk by catheter repositioning 

3

Check for treatment or disease as reason  
Patient Situation

Thermodilution signal artefacts

1

Check connections PiCCO catheter-cable-device 

2

If problem persists:
Replace Arterial Connection Cable 

3

If problem persists: 
Replace PiCCO catheter 

4

Check for treatment or disease as reason 
Patient Situation

Flat and prolonged thermodilution curve (time out)

Check requirements for SVV/PPV interpretation

1

Ensure adequate indicator amount (use colder and/or more injectate, max. 20ml cold saline) 

2

Ensure fast bolus injection (< 7 seconds)

3

Check patient situation (low blood flow and/or increased pulmonary edema) and possibly improve 

4

Check for left-to-right heart shunt by echocardiography 

5

Check for treatment or disease as reason 
Patient Situation

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Remark:
Time out message appears after 90 seconds without sufficient thermodiltution signal. 

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