PiCCO Questions & Answers
PiCCO-Technology is an easy, less invasive and cost-efficient tool for determining the main haemodynamic parameters of critically ill patients. In the following section you will find a collection of frequently asked questions and answers. If you need further help please contact us directly.
General PiCCO Technology FAQs
PiCCO stands for Pulse Contour Cardiac Output. The ‘i’ in PiCCO was added to create a pronounceable word.
PiCCO is indicated in all patients requiring cardiovascular monitoring and/or monitoring of circulatory volume status. This may include patients from various departments, such as surgical, medical, cardiac, neurological, paediatric and burn units, as well as other patients who require cardiovascular monitoring e.g. patients undergoing major surgical interventions.
In general, PiCCO is indicated in cases of unstable haemodynamic situations and unclear volume status as well as in therapeutic conflicts. Those situations are usually present in:
- Septic shock
- Cardiogenic shock
- Hypovolaemic shock
- Acute lung failure
- Severe burn injury
- High risk surgical procedures
Patients with arterial access restrictions due to femoral artery grafting or severe burns are usually not qualified for the placement of a PiCCO catheter into the femoral artery.
Note: The axillary or brachial artery can be used as an alternative site. Additionally a long radial artery catheter can be placed for short term use.
The PiCCO-Technology may give incorrect thermodilution measurements in patients with intracardiac shunts, aortic aneurysm, aortic stenosis, mitral or tricuspid insufficiency, pneumonectomy, large pulmonary embolism and extracorporeal circulation. Please refer to the section ‘Medical and Physiological Questions’ for more details.
Related to the registration (CE approval) PULSION disposables can stay in place for a maximum of 28 days. From a hygiene point of view this is not recommended for clinical practice. Based on a publication by the Commission for Hospital Hygiene and Infection Prevention of the Robert-Koch Institute, Germany (Bundesgesundheitsblatt – Gesundheitsforschung – Gesundheitsschutz 2002) the following recommendations are given:
- Exchange interval for PiCCO catheters: every 10 days (exception: long radial artery catheter PV2014L50: max. 3 days)
- Exchange interval for PiCCO monitoring kits: every 4 days
The exchange interval can be shorter in case of detection of complications associated with the application of these disposable articles, e.g. bleeding, haematoma, signs of infection, perfusion impairment, misplacement of the catheter or if local regulations or standard operating procedures overrule this recommendation.
The effect of MRI on the PiCCO-Catheter has been investigated in animal model experiments and has also been published in congress abstract books (Kampen et al, Intensivmed Notfallmed 2002, Kampen et al Anaesthesia 2004, Greco et al AnnFAR 2011). These investigations did not show any negative effects on the function of the PiCCO-Catheter during MRI.
However, there are currently no systematic tests for all available MRI systems under the various measurement conditions. Therefore PULSION cannot confirm the compatibility of the PiCCO-Catheter with MRI systems and must recommend the removal of the PiCCO-Catheter before MRI. It is the treating physician’s full responsibility if the decision is made to leave the PiCCO-Catheter in the patient during the MRI.
The PULSION Monitoring Kits have been tested for frequency response and are matched to the algorithms used in the PiCCO-Technology, in order to give maximum reliability. The most important factor to maintain reliability is the connection tubing used with the PULSION disposable pressure transducer. This tubing is very inflexible and has a certain length and inner diameter. If you use any other transducers or connection tubing, or try to modify the connection tubing (e.g. with a needleless blood sampling port) the pulse contour cardiac output may not be correct. To ensure correct pressure transfer, a square wave test has to be performed (please refer to the instructions for use for the PULSION disposable pressure transducers). The PiCCO-Technology is only validated with original, unmodified PULSION disposable pressure transducer systems.