Vigileao

[dorimar, BSN, RN]

Has anyone worked with the new Vigileo monitors? I stepped away from the bedside for 4 months, and then I go to clinical to see a monitor that is connected to an Aline to measure cardiac index. This is new to me. Also, it seems that I am seeing most of the readings as very low...and then there is the SVV (which I had never heard of before).It is the Stroke Volume Variation, which takes into account the variations that occur with inspiration & expiration (for instance pulsus paradoxis).

I was just wondering if any of you have worked with these and if the research shows accuracy and if your practice seems to show accuracy (do the readings point to the actual clinical picture of your patient?).

I just started seeing these monitors, and I do no know if it is because the hospital I was working at prior to this was behind, or that it is brand new everywhere. It seems though, that in the brief clinical rotation I have done (2 weeks), many of these Vigileo monitors are showing extremely low CI readings and SVV readings (although I never knew what an SVV reading was before this clinical rotation).... Do you think the Vigileo is accurate? What if the aline is positional or over-dampened? Surely the readings are affected in this case?

[RN1982]

I work with those monitors all the time. I do find them accurate. I've had patients with both a swan and a vigileo for Sv02 monitoring and I've gotten roughly the same cardiac output on a swan as with vigileo. Are your monitors being calibrated correctly? The patient's sex, weight and height do have to be inputed into the monitor. If the patient's weight changes, I do change the weight in the Vigileo. And when I zero my a-line, I zero on the vigileo as well as the bedside monitor. If the a-line is dampened or positional, the readings will not be as accurate. If the a-line is in the radial artery, I reposition the hand to get a better waveform on the monitor and vigileo results.

[dorimar, BSN, RN]

I went to the Eward Life-Sciences site and did some reading. The research according to them does demonstrate accuracy. These are not my monitors or alines. I was just rotating my students through a clinical rotation in a hospital I had never worked in before. In the patient I saw yesterday, the Vigileo did seem to correlate with the clinical picture (shocky, tachy, hypotensive with vigeleo showing low CI and high SVV, and patient did respond well to fluids). However, last week more than one patient had low CIs and high SVVs and did not all look the part. Nurse's ignored the alarms and readings all over that unit which has prompted me to do my research this weekend. The site says it is not effective with dampened alines--which makes sense.

The concept seems great. I printed out the pocket card. Do you know it it calculates the stroke volume index regularly too?

[dorimar, BSN, RN]

TurnLeftSide,

I don't know about changing your weight in the monitor if your patient's weight changes.... I never do that for my drip calculations, and I never did it on my Swan hemodynamics because my patient can gain 10 liters(or 10 kg) in a few days from fluid, but we don't treat water. Therapy should be based on dry weight. I don't know with Vigileo though--were you told to change the weight? I think I will email Edward Life Sciences with this question

[RN1982]

TurnLeftSide,

I don't know about changing your weight in the monitor if your patient's weight changes.... I never do that for my drip calculations, and I never did it on my Swan hemodynamics because my patient can gain 10 liters(or 10 kg) in a few days from fluid, but we don't treat water. Therapy should be based on dry weight. I don't know with Vigileo though--were you told to change the weight? I think I will email Edward Life Sciences with this question

Good point, my mistake. I don't change the weights for swans. I have been just doing it for the vigileos, I will have to stop that. Let me know what they say. I will ask my educator just to be sure. But you are right, we aren't treating water.

[dorimar, BSN, RN]

Hello TurnLeftside,

here is the response I got from Edward Life Sciences:

Thank you for your inquiry. You are correct you should not be changing the weight in the Vigileo as the patient's weight changes. We do recommend using the dry weight. Please do not hesitate to contact us with any further questions.

[detroitdano]

We had a fellow who ordered Vigileo's for almost everybody who came in. Have a cough? Hook up a Vigileo!

The clinical picture is pretty accurate from what I've seen with the patients that truly need them. I had a lady on Levo and another on dobutamine, both whose numbers reflected their status fairly well. But as been mentioned, if the line is dampened, the SVV will say like 65 and the every-5-second beeping noise because it's not picking up properly will drive you insane.

[WindwardOahuRN, RN]

Please note that SVV readings from the Vigileo are accurate only when the patient is 100% mechanically ventilated. CO and CI are considered accurate but SVV is wildly inaccurate if the patient is other than totally mechanically ventilated.

Edwards provides some really great online education on its website:

http://www.edwards.com/Products/MinInvasive/StrokeVolumeVariationWP.htm

>>What are the limitations and effects of other therapies on SVV?

• Mechanical Ventilation
  Currently, literature supports the use of SVV only on patients who are 100% mechanically (control mode) ventilated with tidal volumes of more than 8cc/kg and fixed respiratory rates.
  

[dorimar, BSN, RN]

Yes, I failed to mention that part. All tese patients were on AC mode (positive pressure ventilation allowing no spontaneous negatively inspired breaths). This is because the inspiratory and expiratory respiratory fluctuations on reversed on spontaneous breathing adn the SVV is based on variations in inspiratory and expiratory bp variations during positive pressure ventilation (a revers pulsus paradoxis so to speak)

[APNgonnabe]

thanks for the info guys, our CNS says we'll be getting these possibly in the next year or so.