Flotrac for Triple H therapy

  1. 0 We recently started using the Edwards FloTrac for our Triple H patients. The first round went really well, the second round did not go as well. The problem we are having is the variability with the numbers. We are following the Stroke Volume Variation (SVV) instead of the Stroke Volume Index (SVI). I am wondering if anyone else is using this to monitor fluid status for your Triple H patients and what are your parameters for treatment? Do you follow the SVV or the SVI? I would rather not go back to our pulmonary artery catheters, but if we can't find a solution that will be what is necessary.
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  3. Visit  bellehill} profile page

    About bellehill

    bellehill has '9' year(s) of experience and specializes in 'Neuro Critical Care'. From 'Columbus, OH'; 38 Years Old; Joined Apr '02; Posts: 578; Likes: 64.

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    15 Comments so far...

  4. Visit  old icu rn} profile page
    0
    we stopped using them because the numbers were unreliable esp in septic patients, but we also really got away from swans too. I remember when we were putting in S/Gs with CCO at a drop of the hat but every since that study come out about bad outcome with swans the numbers have dropped. i work in a teaching hospital and the last time i had a patient with a swan was at least 6 months ago
  5. Visit  bellehill} profile page
    1
    So what are you using to monitor fluid status and cardiac output? I certainly don't miss the swans, what a pain they were.
    sethmctenn likes this.
  6. Visit  MeTheRN} profile page
    0
    We use them on our unit. We look at the SVV. If it's >13%, we leave things alone. If it's less than 13% we look at the SVI. Based on the SVI, we decide to either add a vasopressor or give fluid boluses or albumin.
  7. Visit  bellehill} profile page
    0
    Thanks. We are going to be looking at the SVV, SVI and CVP. If 2 of the 3 numbers are below the parameters the patient will be bolused. This has worked well so far!
  8. Visit  futbol84} profile page
    0
    All we use are central lines for CVP. Usuall try for a CVP around 8 or so. Depends on the Doctors.
  9. Visit  soopernurs1} profile page
    0
    My Hospital System in Louisville KY uses the flotrac and we give most creedance to the SVV for volume status...the higher the drier...so, if the SVV is < or = 13% variation, then it's pressors we use (when appropriate of course), if variation is < 13% then we consider the patient to be intravascularly dry and give volume--now, my specialty is hearts, so, this may be different for neuro...but, stroke volume variation is sooooo much more accurate for intravascular volume status than CVP (which is pretty worthless if you have the flotrac capability)
    Sarah, RN , MSN, CCRN, Clinical Educator
  10. Visit  chudder} profile page
    2
    http://www.edwards.com/products/mini...ariationwp.htm

    "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"

    We rarely use control mode in our unit.
    RNDance and experienceawareness like this.
  11. Visit  soopernurs1} profile page
    0
    you are absolutely correct...I do believe studies are ongoing to validate its accuracy and consistency in the non-ventilated patients however...none published yet though...thanks for the clarification.
  12. Visit  GrnHonu99} profile page
    0
    Quote from bellehill
    We recently started using the Edwards FloTrac for our Triple H patients. The first round went really well, the second round did not go as well. The problem we are having is the variability with the numbers. We are following the Stroke Volume Variation (SVV) instead of the Stroke Volume Index (SVI). I am wondering if anyone else is using this to monitor fluid status for your Triple H patients and what are your parameters for treatment? Do you follow the SVV or the SVI? I would rather not go back to our pulmonary artery catheters, but if we can't find a solution that will be what is necessary.
    we use flo trac all the time and we love it! We use SVV and shoot for less than 9 but mainly we watch SI, SV, CI and good ol CVP via central line. We dont always set parameters besides SBP parameters for our HHH pts. sometimes we will have a cvp parameters though. We havent used swans in forever.
  13. Visit  GrnHonu99} profile page
    0
    Quote from soopernurs1
    if variation is < 13% then we consider the patient to be intravascularly dry and give volume--now, Sarah, RN , MSN, CCRN, Clinical Educator
    per the Edwards (http:;;http://www.edwards.com/products/mini...aritaionwp.htm) it says normal values are 10-15%..with a usual goal of LESS than 13%...so the higher the number the drier the pt. is how i'm taking that. I know we aim for 9 in my neuro icu. But less than 13 should be good. I mean 13 might kinda ride the line but less than 13 shouldnt be dry.
  14. Visit  bellehill} profile page
    0
    An update: we are seeing great success using the Flotrac. Our goal is SVV<13, SVI>40 and CVP>8 for non-vented and >12 for vented patients. If two of the three parameters are not in range we bolus the patient. No more swans...YEAH!

    Just recently had a patient who spasmed for the full 21 days, several trips for IA Verapamil and she walked in to visit us completely intact. Really makes you feel good about what you do!
  15. Visit  MLB55} profile page
    0
    Out large teaching hospital usually does CVP goals of 6-10 alternating between albumin and ns bolus PRN and SBP goals of 140-160. We use CVPs via a cordis or other central line.


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