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PRODUCT OVERVIEW

PRODUCT OVERVIEW. HANDS ON: MONITOR SET-UP. WHAT IS IT?. On-line , bedside monitoring of blood gases, sodium, potassium, and hematocrit Real-time results and trending Permits rapid clinical response to dynamic changes in the patient’s status. WHAT IS IT?.

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PRODUCT OVERVIEW

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  1. PRODUCT OVERVIEW

  2. HANDS ON: MONITOR SET-UP

  3. WHAT IS IT? • On-line, bedside monitoring of blood gases, sodium, potassium, and hematocrit • Real-time results and trending • Permits rapid clinical response to dynamic changes in the patient’s status.

  4. WHAT IS IT? • Frequent sampling with no blood loss • Sampling and re-infusion rates controlled to help prevent vessel trauma and IVH • Completely closed system to reduce risk of infection in the high risk patient

  5. HOW DOES IT WORK? MEASUREMENT INITIATION SAMPLING ANALYZING PURGING

  6. HOW DOES IT WORK? • Sampling • VIA dial changes fluid path • Monitor reverses pumping action • Withdrawal small amount blood over sensor (typ. 1.0 to 1.5 cc) within 1 minute • Analysis • Analysis performed in 75 seconds

  7. HOW DOES IT WORK? • Microflush • Returns blood sample to patient at 100cc/hr • Delivers 0.5cc flush to patient over 18 seconds • VIA dial (Bi-directional stopcock) changes fluid path

  8. HOW DOES IT WORK? • Purging • Flush/clean sensor into collection bag in three phases • First phase immediate-4 cc • Two minute wait, second phase-2 cc • Two minute wait, third phase-2 cc • Turbulent flow from curly cue, clears sensor and IV set • Continuous flush of 5 cc/hr to collection bag

  9. BENEFITS • Real time results • Better patient management • Closed loop system • Decreases risk of infection • Decreases clinician exposure to blood • Conservation of blood • Capitated cost

  10. HARDWARE COMPONENTS

  11. HARDWARE COMPONENTS • VIA Blood Gas and Chemistry Monitor • VIA Sensor Cable /Housing • VIA AutoSampler/Printer • VIA IV Bag Holder • VIA Sensor Housing Holder • VIA IV Stand

  12. MONITOR • System software • Display screen • Front panel keys • Infusion/withdraw mechanism • Battery (1 hour)

  13. MONITOR KEYS • On/Off • Sample • Purge • Alarm Quiet • Options •   Keys • Volume infused keys • Hold/Enter [*]

  14. SENSOR CABLE/HOUSING • Interfaces with sensor • Communicates with monitor • Monitors and controls temperature of fluid (37 C) • Electronic serialization - “marries” sensor to monitor • Bi-directional stopcock positioning mechanism – the VIA dial NOTE: protect from heat/cold/moisture

  15. AUTOSAMPLER / PRINTER • Prints out measured and calculated values along with date, time and patient ID (if entered) • Two types of printout • Detailed • Non Detailed NOTE: must use VIA paper

  16. AUTOSAMPLER / PRINTER • Selection of automatic sampling interval (12 - 60 minutes) • Isolated (RS-232) data output • Interface Translator for customized data display on patient monitoring systems (SpaceLabs and HP)

  17. IV BAG HOLDER • Measures ambient and bag temperature • Slows IV bag fluid temperature changes • Detects when VIA IV Bag Holder is opened

  18. SENSOR CABLE / HOLDER • Maintains sensor and tubing at an angle that maximizes blood conservation • Helps sensor maintain 37º C • Holds/routes tubing • Easy access to VIA dial during sampling • Flexibility in positioning options

  19. DISPOSABLES

  20. DISPOSABLES • Calibration (Cal) Kit • Sensor Kit

  21. CAL KIT • 500 cc of Normosol R • 10 mEq Sodium Bicarbonate (10 cc) • 50 cc vial (10 cc used - single use vial) • Total bicarb concentration = 20 mEq/L • VIA Bag # matched to CO2 gas concentration • 500 units Heparin (5cc) • Total concentration = 1u/cc; recommended to prevent clot formation in system • Necessary supplies including labels

  22. SENSOR KIT • IV set with curlique tubing (“conditioned” in CO2) • Sensor • Wally Bag containing calibration ampules and waste reservoir • Extension set with VIA dial • Collection Bag for sensor KVO and flushes

  23. SENSOR • Proven electrochemical sensor technology found in most commercial analyzers • Single patient disposable • Robust design for multiple measurements • Sterile, pyrogen-free • Biocompatible for ex-vivo use • Sensor design maximizes blood conservation

  24. THREE TYPES OF ELECTRODES • ISE (Ion Selective Electrode) • Modified Severinghaus CO2 • pH, Na+, K+ • Clark pO2 electrode • Electrical Conductivity - Hct

  25. CALIBRATION

  26. INITIAL CALIBRATION • Tests 2 points - high and a low of each analyte • Every sensor must pass initial calibration prior to use • Determines slope and intercept • Checks sensor integrity

  27. ON-GOING CALIBRATION • 1 Point calibration • After every sample • Every 10 minutes first hour • Every 30 minutes after first hour • Checks for sensor integrity • Checks for air-in-sensor

  28. CALIBRATION SOLUTION • Calibrates sensors to the values, or reference points, in the solution • Most of these reference points, ie. K+, Na+, O2, and Hct are constant • CO2 and pH reference points are dynamic • WHY? Because CO2 diffuses into the atmosphere, ex. soda going flat

  29. IV BAG pCO2 DIFFUSION

  30. CALIBRATION SOLUTION • Important Notes: • The accuracy of the results depends on correct composition of the calibration fluid • Use only VIA supplies • Gently shake Bicarb vial to mix thoroughly • Inject 10 ml of air into vial • Withdraw EXACTLY 10 ml of Bicarb • Discard unused portion • Use within 30 minutes of preparation

  31. PREPARING FOR CALIBRATION • Prime IV set including stopcock • Expel all air • Connect sensor (check expiration date) • Connect Wally bag and turn monitor on • Follow prompts and answer questions • During purge cycle, tap all connections to remove all air NOTE: Do not get sensor wet

  32. SENSOR EQUILIBRATING... • Step 1 - Sensor Equilibration(10 minutes and 24 seconds) • Stabilizes sensor temperature • Chemical equilibration to Cal Solution • Checks sensor integrity at 5 minutes • Monitor clears any air from sensor

  33. CALIBRATION PROCESS • Cal A - 14 seconds • Calibrate to calibration solution (1st point) • Cal B - 90 seconds • Calibrate to calibration ampule solution (2nd point)

  34. CALIBRATION SUCCESSFUL!!!

  35. HANDS ON: CALIBRATION

  36. CALIBRATION ERROR

  37. CALIBRATION ERROR • Initiate another attempt to calibrate the sensor • If sensor fails 2nd time, return fluid filled sensor along with printouts to VIA for credit • If two consecutive sensors fail: CALL 1-877-ASK-VIA-1 (1-877-275-8421)

  38. HOW TO PREVENT DIFFICULTY

  39. HELPFUL HINTS • Inject EXACTLY 10 ml of Bicarb and inject into the Normosol • Mix cal bag gently • Be sure to remove all air from IV set pressure disc, tubing and stopcock • Be sure to tap sensor Luers at IV Set and Wally bag during purging to remove all air • Be sure hands are dry when handling sensor • Keep Sensor Cable connections dry!

  40. CALIBRATING IN ADVANCE • Can be done at any time • Leave on STAND BY or power down • NOTE: Better to power down if attachment is delayed > 30 minutes • Be sure to answer prompts appropriately prior to attachment (i.e. sensor has passed calibration and VIA Cal Bag is not new) • Change VIA IV bag if monitor off >18 hours (monitor will prompt you)

  41. PATIENT ATTACHMENT

  42. ARTERIAL ACCESS • ARTERIAL VESSEL LOCATION • Standard arterial sites • Site must not be positional • Catheter type • Peripheral catheter 24G or larger • 2.8, 3.5 or 5.0 Fr UAC • Volume from tip to sensor must be < 1.5 cc (other blood access devices should not be located between UAC and VIA extension set)

  43. VENOUS ACCESS • VENOUS VESSEL LOCATION • May use UVC or CVC if catheter has easily flowing blood return • Ensure CVC has less than 0.3 cc fill volume • Use caution with double lumen UVC if infusing concentrated drips in other lumen of UVC • VIA microflush could give small bolus to patient

  44. ARTERIAL LINE SET UP • Verify no air in transducer set up • Attach arterial flush solution/transducer set up to port marked “TRANSDUCER” on extension set • If using vascular access for infusion instead of pressure transducing, attach infusion tubing to port marked “TRANSDUCER” • May use arterial line transducer • Flush line marked “PATIENT” including three-way stopcock

  45. PATIENT ATTACHMENT • Attach collection bag to line marked “BAG” • Attach VIA sensor to line marked “SENSOR” • Snap VIA dial on sensor housing • Only when monitor displays “Attach Sensor To PT. Then Press *”, attach port marked “PATIENT” to catheter hub • Ensure NO AIR at any connections

  46. CONNECTING WITHOUT AIR • Create a meniscus of fluid within all hubs prior to connection • Techniques • Back-bleed into female hub • Drip fluid into female hub • ALL CONNECTIONS MUST BE FLUID TO FLUID to avoid pressure waveform problems or trapped air in VIA sensor

  47. COMPATIBLE INFUSATES • Any infusate may be delivered through vascular access • Pre-Sample flush • For other than saline derivative infusate • Amount based on user entered catheter size and type • 2.8 F and PAL = 0.2 cc • 3.5 F = 0.3 cc • 5.0 F = 0.4 cc • PAL w/extension set = 0.9 cc • Avoid concentrated drips due to pre-sample flush

  48. SENSOR PLACEMENT • Keep sensor housing away from direct heat source (radiant warmer or bili lights) • May use in isolette (temp setting < 36C)

  49. HANDS ON: PATIENT ATTACHMENT

  50. CLINICAL IMPLICATIONS

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