Flotrac for Triple H therapy - page 2

by bellehill

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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... Read More


  1. 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.
  2. 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!
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    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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    I also work in a teaching hospital and we don't use any of that stuff! Triple H patients get a high hourly fluids rate and keep MAP >80 or 90. They don't even get a central line unless they need more than phenylephrine and fluid to keep their MAP up or there is an ICP issue and they get 7.5% NaCl. Even with the central line in place we rarely bother measuring the CVP. I have never seen a swan or a flotrac on our neurosurgery patients. We basically just give them as much fluid as possible and run vasopressors as needed to drive the MAPs up.

    We only use lidco if they are requiring multiple high dose vasoactives/are septic or in some other shock state. On triple H patients I have also used lidco because of CHF history and the risks associated with triple H for those patients.

    Most cardiothoracic surgery patients have a swan. We use them very very rarely for other types of patients who are extremely hemodynamically unstable with high PAP suspected or we need to directly measure CO. Sometimes patient who have coded or are coding will get one.

    Flotracs are used usually only for cardiac surgery patients who are done without cardiopulmonary bypass or who have a less invasive procedure (i.e. endovascular AAA repair).

    Of course we do put arterial lines in almost all of them but even that is not set in stone, if they are maintaining MAPs without pressors we'll even take the a-line out. I find it interesting that other facilities use so much invasive monitoring for triple H.
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    We use SVV >13 they get a bolus. However it isn't very useful without a good art line.

    We also don't always use the vigileo. Only in severe spasams. Mostly we use CVP.
  6. 0
    Quote from chudder
    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.
    THANK YOU for pointing this out! We use Flo-Tracs fairly frequently on the critical care units on which I work and I can't tell you how many times medical personnel (including MANY residents) will point to the SVV and declare that a patient needs or does not need fluids based soley on that number. Sometimes this will be a patient who is not even on a ventilator at all, much less 100% mechanically ventilated.
    If you watch the SVV numbers on a patient who is 100% ventilated in control mode you'll see that they are pretty steady. With a patient who is not you'll see wild SVV number variations. Just not reliable at all.
    I carry a print-out from Edwards explaining what the numbers mean and hand out copies to anyone who wants them. What the heck....I work in teaching hospitals.


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