Flotrac for Triple H therapy

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  1. This is a discussion on Flotrac for Triple H therapy in Neuro Intensive Care Nursing, part of Critical Care Nursing ... We recently started using the Edwards FloTrac for our Triple H patients. The first round went...

    by Jan 4, '11
    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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    by bellehill Jan 4, '11 9:49 pm
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  3. 15 Comments so far...

  4. Jan 10, '11 by
    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. Jan 12, '11 by
    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. Jan 25, '11 by
    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. Jan 25, '11 by
    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. Feb 16, '11 by
    All we use are central lines for CVP. Usuall try for a CVP around 8 or so. Depends on the Doctors.
  9. Feb 21, '11 by
    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. Mar 15, '11 by
    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. Mar 16, '11 by
    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. Apr 7, '11 by
    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.