Flo trac

Flotrac is a monitoring platform that displays both intermittent and continuous hemodynamic measurements related to the assessment of the essential components of oxygen delivery as well as the balance of oxygen delivery against consumption

1. Flo Trac Presented by : Ms Garima ( MSc Nursing Ist year )

2. Introduction Flotrac is a monitoring platform that displays both intermittent and continuous hemodynamic measurements related to the assessment of the essential components of oxygen delivery as well as the balance of oxygen delivery against consumption . The monitor uses the patient's arterial pressure waveform to continuously measure cardiac output and stroke volume . Automatically updates advanced parameters every 20 seconds, reflecting rapid physical changes in moderate to high-risk surgery.

3. The continuous parametric measurements provided from an arterial line via an Edwards CO sensor include cardiac output (CO), stroke volume (SV), and stroke volume variation (SVV). The intermittent parametric measurements require use of a VolumeView catheter in a femoral artery, a CVC (central venous catheter) thermistor manifold, and a central venous pressure measurement . The intermittent parameters include: cardiac output ( iCO ) stroke volume ( iSV ), systemic vascular resistance ( iSVR ) global end-diastolic volume (GEDV) extravascular lung water (EVLW)

4. Mechanism of work The monitor uses the patient’s arterial pressure waveform to continuously measure cardiac output . With inputs of height, weight, age and gender, patient-specific vascular compliance is determined .

5. Flo Trac sensor It is a sterile , single use kit that monitors pressures when attached to pressure monitoring cathetars . it has a straight , flow through design across the pressure sensors with an integral flush device . Easily setup and calibrated at the bedside using the familiar skills used in pressure monitoring . It measures the variations of the arterial pressure which is proportional to stroke volume.

6. Vent Port Flushing Device / Snab Tab Device

7. Parts of flo trac SCREEN DATA BOX FLO TRAC SENSOR TUBINGS

8. Physiology Screen

9. The Physiology screen displays monitored parameters using a visual representation of the heart, lungs and circulatory system and their relevant measured volume . The lungs appear gray in continuous mode to indicate that no information is available for extravascular lung water. In the Screen the image of the beating heart is a visual representation of the pulse rate .

10. Big Numbers Screen The screen displays parameters in a larger size than the other screens . This makes it easier for clinicians and other personnel to see the values from a distance .

11. Cockpit Screen This monitoring screen displays globes with the values of the parameter being monitored. They graphically indicate target, out of range and target values with needle indicators to show where the patient’s parameter falls .

12. Patients Data Entry Screen

13. Indications Use primarily for critical care patients in which the balance between cardiac function, fluid status and vascular resistance needs continuous or intermittent assessment Assess Extra Vascular Lung Water (EVLW) as an indicator of pulmonary edema

14. The first image shows low pulmonary edema, the second shows moderate pulmonary edema, and the third shows severe pulmonary edema

15. FloTrac Continuous Parameters Cardiac output (CO) - Continuous assessment of the volume of blood pumped by the heart measured in liters per minute . Cardiac Index (CI) Cardiac output relative to body surface area (BSA). Stroke Volume (SV) Volume of blood pumped with each heart beat. Stroke Volume Index (SVI) Stroke volume relative to body surface area (BSA).

16. Systemic Vascular Resistance (SVR ) The resistance that the left ventricle must overcome to eject stroke volume with each beat . Systemic Vascular Resistance Index (SVRI) SVR relative to body surface area . Stroke Volume Variation (SVV) The percent difference between SVmin , max and mean

17. Initial Startup Connect the primed FloTrac sensor to the Databox . Connect the primed FloTrac pressure tubing to the radial or femoral arterial catheter and primed central venous pressure tubing to the CVC catheter if continuous SVR/ SVRI monitoring is desired . Patient data can be entered by touching the Settings button . Touch Patient Data and then touch each field to enter or select the patient demographic data . Touch the Home button. Touch the Monitor Screen Selection button and then select the desired monitoring screen

18. Zeroing of FloTrac for continuous monitoring : Level the transducer and sensor to the patient’s phlebostatic axis . Touch the Clinical Actions button.

19. Touch Zero & Waveform

20. Zero each transducer by touching -0- next to the pressure or -0- All to zero both. Open transducers so they are “ON” to the patient and confirm appropriate waveforms Touch the Home button to begin monitoring

21. https://youtu.be/Fie8wrf7csM

22. Volume View Intermittent TPTD Monitoring Trans pulmonary thermodilution (TPTD ) measures parameters related to blood flow, fluid volume , and organ function . It is measured when an indicator solution of known temperature and volume is injected into the central venous circulation . It then passes through the pulmonary vascular system, the left heart, and finally into the arterial system .

23. Volume View Intermittent TPTD Parameters Cardiac Function Index (CFI) is provided by transpulmonary thermodilution and serves as an indicator of left ventricular systolic function . Cardiac output ( iCO ) Intermittent assessment through thermodilution of the volume of blood pumped by the heart measured in liters per minute . Extravascular Lung Water (EVLW ) Extravascular water content of the lung tissue . Extravascular Lung Water Index (ELWI) Extravascular water content of the lung tissue relative to predicted body weight (PBW) . Global Ejection Fraction (GEF) Estimated ejection fraction using GEDV.

24. Cont.…. Global End-Diastolic Volume (GEDV) Estimated combined volume of the RAEDV, RVEDV, LAEDV, and LVEDV. Global End-Diastolic Volume Index (GEDI) Estimated combined volume of the RAEDV, RVEDV, LAEDV, and LVEDV relative to body surface Area . Intrathoracic Blood Volume (ITBV) Estimated combined volume of the heart and the pulmonary blood volume (PBV ). Pulmonary Vascular Permeability Index (PVPI) Ratio of the extravascular lung water and the estimated volume of pulmonary blood .

25. Articles required A Tray containing : Flo trac and tubings Sterile gloves 20 cc syringe Cold saline Pressure Bag Volume View femoral artery catheter Volume View sensor Central Venous catheter Volume View Manifold TruWave disposable pressure transducer (CVP transducer)

26. Procedure Insert the VolumeView femoral arterial catheter and Insert a CVC). Ensure the TruWave central venous pressure transducer and VolumeView sensor are primed and then connected to the EV1000 databox . Ensure the sensor and transducer are level to patient’s phlebostatic axis and zero transducers on monitor using Clinical Actions button. Connect the VolumeView sensor to the VolumeView femoral arterial catheter and confirm the appropriate waveforms and pressures are displayed . Connect the databox thermistor cable to the VolumeView femoral arterial thermistor and confirm appropriate temperature on the EV1000 monitor.

27. Procedure Connect a pre-chilled syringe with normal saline to the VolumeView manifold valve/port connection Touch the Clinical Actions button

28. Touch Thermodilution Touch the button next to Injectate Volume and touch the desired injectate volume (up to 20 mL) on the drop-down menu

29. Touch Start Set. Wait is highlighted. When the thermal baseline is established you will see the Inject screen . When Inject appears on the screen, use a rapid, smooth, continuous method to inject the cold solution with the volume amount previously selected .

30. If more measurements are required, replace with another pre-chilled primed syringe

31. https://youtu.be/Qjx06vrcsjY

32. Advantages Continuously computes stroke volume from the patient’s arterial pressure signal . Displays key hemodynamic parameters on a continuous basis (every 20 sec ) Requires NO manual calibration The user simply enters patient age, gender, height and weight to initiate monitoring Advanced waveform analysis compensates for . Patient-to-patient differences in vasculature Real time changes in vascular tone Differing arterial sites

33. Disadvantages No absolute contraindications but has limitations that must be taken into account. The monitoring system is only recommended for patients that are 100% mechanically ventilated and not spontaneously breathing.

34. Summary

35. Conclusion FloTrac system - a minimally invasive solution system that provides dynamic and flow-based hemodynamic parameters . Uses Patients arterial waveform for analysis . Automatically provides results every 20 secs .