HMS-C
1.5.2002
20:35
Stránka 1
The Arrow HemoSonic 100 ™
w w w. H e m o S o n i c . c o m P O W E R E D B Y I N N O VAT I O N
Comprehensive Hemodynamic Monitoring
™
HemoSonic 100 ™
HEMODYNAMIC MONITORING SYSTEM
HemoSonic 100 ™
Frequently Asked Questions
Hemodynamic Monitoring System
Specifications
How does the HemoSonic differ from other transesophageal Doppler monitors? ™
In addition to continuously monitoring aortic blood flow via Doppler, the HemoSonic M-mode transducer measures the aortic diameter and verifies the angle between the Doppler waves and the blood flow. Furthermore, an accurate measurement of blood flow via Doppler requires the accurate measurement of aortic diameter.
Ordering Information
™
Unit:
Height: 200 mm Depth: 300 mm
Width: 250 mm Weight: 4 kg
Why is fluid optimization important?
Probe:
Diameter of flexible section: < 7 mm Length of flexible section: 610 mm
Many studies show that optimizing fluid improves patient outcomes by reducing ICU stays, hospital stays, and postoperative complications.
Power:
Voltage: 90–130 Vac, 180–270 Vac Frequency: 50/60 Hz Power consumption: 100 VA Max
Product No.
Description
Per case
HSM-00100
HemoSonic 100 Includes Monitor, Probe and Accessories (Jackets sold separately)
1
HSP-02150
Probe
1
HSA-00100
Articulated Arm and Probe Holder
1
HSC-00100
Connection Cable
1
HSM-00101
Operator’s Manual
1
HSS-02150
Jacket
5
™
4,7,8,10
Why do I need the HemoSonic when I can see pressure changes with my arterial line or blood pressure cuff? ™
The HemoSonic provides a complete hemodynamic profile in real time. Because changes in flow precede changes in pressure, the HemoSonic is an early indicator of potential pressure drops, which are often delayed by the body’s compensatory mechanisms. Furthermore, the HemoSonic provides the capability of immediately differentiating volume problems from cardiac dysfunction. ™
™
Frequency:
Doppler: 5 MHz
Echo: 10 MHz
Input Connections:
™
Front Panel Base with esophageal probe input connector Back Panel Base with RS 232 connector Base with keyboard connection Base for main cable
How does the HemoSonic compare with other non-invasive cardiac output monitors currently on the market? ™
The HemoSonic is more than a cardiac output monitor. It provides a complete hemodynamic profile, including contractility, in real time. Also, the HemoSonic requires no vascular access and no administration of chemicals to obtain measurements. ™
™
Output Connections: Back Panel Base for RS 232 output parameters Base for printer port
HemoSonic vs. Thermodilution/Wedge ™
Standards: RISKS:
6
HemoSonic
Thermodilution/Wedge
Same as NG tube
Pneumothorax Hemothorax Blood Stream Infection Pericardial Tamponade Pulmonary Artery Rupture Rhythm Disturbances
™
COSTS:
5
HemoSonic
Thermodilution/Wedge
Single-use Jacket
Catheter Sheath Introducer Pressure Tubing/Stopcocks Transducer Saline/Heparin X-Ray ICU Stay
™
Chest x-ray showing thermodilution catheter.
The HemoSonic 100 is in compliance with the following standards: IEC 601-1-1 NFC 74 335 89/336/EEC ™
610.378.0131 or 800.523.8446 Toll free FAX orders 800.343.2935 Email:
[email protected] For more information and technical assistance for the Arrow HemoSonic 100, call your Arrow Critical Care Products sales representative, or contact us directly at 1-800-523-8446.
CRITICAL CARE
™
Arrow Critical Care Products 2400 Bernville Road, Reading, PA 19605, U.S.A.
References: 1. Bazett HC. An analysis of the time-relations of electrocardiograms. Heart. 1920;7:353-370. 2. Boudoulas H. Systolic time intervals. Eur Heart J. 1990;11 Suppl I:93-104. 3. Boulnois JL, Pechoux T. Non-invasive cardiac output monitoring by aortic blood flow measurement with the Dynemo 3000. J Clin Monit and Comput. 2000;16:127-140. 4. Gan TJ, et al., Intraoperative volume expansion guided by esophageal Doppler improves postoperative outcome and shortens hospital stay [abstract].. Anesthesiology. 1999;91:A537. 5. Hendrickson K. Cost-effectiveness of noninvasive hemodynamic monitoring. AACN Clin Issues. 1999:10;419-24. 6. Lake, CL (Ed). Clinical monitoring for anesthesia and critical care (2nd Ed). 1994. Saunders:Philadelphia. 7. Mythen, MG, Webb AR: Perioperative plasma volume expansion reduces the incidence of gut mucosal hypoperfusion during cardiac surgery. Arch Surg. 1995;130:423-429. 8. Poeze, et al. using esophageal Doppler ultrasonography. Crit Care Med. 1999;27:1288-1294. 9. Sabbah, et al., Noninvasive evaluation of left ventricular performance based on peak aortic blood acceleration measured with a continuous-wave Doppler velocity meter. Circulation. 1986;74:323-329. 10. Sinclair James S, Singer M: Intraoperative intravascular volume optimization and length of hospital stay after repair of proximal femoral fracture: randomized controlled trial. BMJ. 1997;315:909-912.
Licensed by INSERM under U.S. Patent 5,479,928 and European Patent 93,402.283.1 Caution: U.S. Federal Law limits this device to sale by or on order of a physician. Contents of unopened, undamaged package are sterile. Disposable. Refer to package insert for current warnings, precautions, and instructions for use.
ARROW
© 2002 Arrow International, Inc. U.S.A. All rights reserved. Printed in the Czech Republic. HMS-C 04/02 11M CZ
PRODUCTS
1.5.2002
20:36
Stránka 4
Real-time Hemodynamic Data for Better Patient Management Enjoy the benefits of a comprehensive Hemodynamic Profile. • Preload assessment
HemoSonic Data Display ™
Monitor your At-Risk Patients – Without adding risk!
The monitoring screen continuously updates flow and contractility parameters. Choose to monitor from three parameter options:
• Major surgical procedures
• Left ventricular contractility at-a-glance • Afterload assessment on demand • Fluid optimization results in optimal end tissue perfusion
• Aortic Blood Flow (measured) • Cardiac patients having non-cardiac surgery
• Cardiac Output (estimated) • Cardiac Index (adjusted for BSA & age)
• Elderly patients • Trauma
Total Systemic Vascular Resistance available upon input of MAP.
• Hemodynamically unstable patients
M-mode and Doppler tracings show dynamic changes in flow and aortic diameter.
7
Assessment of Cardiac Function Using the HemoSonic ™
HemoSonic Parameters
Invasive Monitoring Parameters
Stroke Volume Measured beat-to-beat in the descending aorta.
Stroke Volume Calculated. Not continuously measured.
Contractility Measured. Acceleration (dV/dt) of blood ejected from left ventricle. Sabbah, et al, demonstrated a linear relationship between Accpeak and Ejection Fraction (1986) .
Contractility Left Ventricular Stroke Work Index (calculated).
™
9
LVET Left Ventricular Ejection Time . Continuously measured. LVETc (corrected for heart rate). LV dysfunction, regardless of cause, shortens LVETc whereas a shortened LVETc in a healthy heart indicates a low volume status.
Wedge Pressure LVEDP (assumes pressure changes equal volume changes).
2
1
• ARDS or other pulmonary pathologies • Multi-organ system failure Monitoring Screen
• Critically burned patients The patient profile screen displays a “snapshot” of hemodynamic profile. The patient’s data appears as the yellow bars, while the highlighted box indicates published normal values.
• Postoperative/Intensive Care monitoring
Knowing real-time SV, in conjunction with real-time contractility and resistance parameters, allows for rapid evaluation of preload status. Careful attention must be paid to resistance (TSVR) to ensure accurate assessment.
Color-coded boxes facilitate rapid assessment of hemodynamics:
Continuous, Real-Time Data makes the HemoSonic your Early Warning System.
Blue = Flow Parameters
™
Green = Contractility Parameters
• By continuously monitoring flow, changes in cardiac output are detected immediately, in real time. A drop in flow precedes the subsequent pressure drop, thus allowing an increase in crucial reaction time.
Red = Afterload Parameters LV Failure – Monitoring Screen If this patient had been monitored by BP and HR only, the data would have suggested hypovolemia. The HemoSonic
• Continuous output measurement allows for immediate assessment of afterload. (Resistance = Pressure/Output)
The trend screen graphically displays data over the course of the case. Push “Event” soft key to mark the time of specific therapeutic interventions.
9
Aorta idth er W duc ans r Tr ple Dop Transesophageal probe
eam rB ple Dop
Echographic Beam
60°
TMProx
TMDist-TMProx
Unique Probe Design ensures reliability. The HemoSonic employs a patented combination of two ultrasound transducers that measure aortic parameters every twenty milliseconds! ™
LV Failure – Patient Profile Screen
• Scroll to examine trend of desired parameter. • Compare trends for any two parameters by selecting “Trend 2”.
• M-mode echo measures aortic diameter and confirms transducer position.
• Display trend of desired parameter and hemodynamic data throughout case by selecting “Data”.
• Pulsed Doppler measures blood velocity at this cross-section.
Cross-sectional Area x Velocity = Aortic Blood Flow Trend/Data Screen
™
shows that a low SV and poor contractility are present, thus alerting the physician to left ventricular failure.
Patient Profile Screen
• Acceleration provides assessment of ventricular contractility.
Blood velocity
HMS-C
Hypovolemia – Patient Profile Screen Hypovolemia in a patient with normal cardiac function. Note combination of low SV, high Acc and shortened LVETc. Monitoring MAP and HR alone could be misleading.
1.5.2002
20:36
Stránka 4
Real-time Hemodynamic Data for Better Patient Management Enjoy the benefits of a comprehensive Hemodynamic Profile. • Preload assessment
HemoSonic Data Display ™
Monitor your At-Risk Patients – Without adding risk!
The monitoring screen continuously updates flow and contractility parameters. Choose to monitor from three parameter options:
• Major surgical procedures
• Left ventricular contractility at-a-glance • Afterload assessment on demand • Fluid optimization results in optimal end tissue perfusion
• Aortic Blood Flow (measured) • Cardiac patients having non-cardiac surgery
• Cardiac Output (estimated) • Cardiac Index (adjusted for BSA & age)
• Elderly patients • Trauma
Total Systemic Vascular Resistance available upon input of MAP.
• Hemodynamically unstable patients
M-mode and Doppler tracings show dynamic changes in flow and aortic diameter.
7
Assessment of Cardiac Function Using the HemoSonic ™
HemoSonic Parameters
Invasive Monitoring Parameters
Stroke Volume Measured beat-to-beat in the descending aorta.
Stroke Volume Calculated. Not continuously measured.
Contractility Measured. Acceleration (dV/dt) of blood ejected from left ventricle. Sabbah, et al, demonstrated a linear relationship between Accpeak and Ejection Fraction (1986) .
Contractility Left Ventricular Stroke Work Index (calculated).
™
9
LVET Left Ventricular Ejection Time . Continuously measured. LVETc (corrected for heart rate). LV dysfunction, regardless of cause, shortens LVETc whereas a shortened LVETc in a healthy heart indicates a low volume status.
Wedge Pressure LVEDP (assumes pressure changes equal volume changes).
2
1
• ARDS or other pulmonary pathologies • Multi-organ system failure Monitoring Screen
• Critically burned patients The patient profile screen displays a “snapshot” of hemodynamic profile. The patient’s data appears as the yellow bars, while the highlighted box indicates published normal values.
• Postoperative/Intensive Care monitoring
Knowing real-time SV, in conjunction with real-time contractility and resistance parameters, allows for rapid evaluation of preload status. Careful attention must be paid to resistance (TSVR) to ensure accurate assessment.
Color-coded boxes facilitate rapid assessment of hemodynamics:
Continuous, Real-Time Data makes the HemoSonic your Early Warning System.
Blue = Flow Parameters
™
Green = Contractility Parameters
• By continuously monitoring flow, changes in cardiac output are detected immediately, in real time. A drop in flow precedes the subsequent pressure drop, thus allowing an increase in crucial reaction time.
Red = Afterload Parameters LV Failure – Monitoring Screen If this patient had been monitored by BP and HR only, the data would have suggested hypovolemia. The HemoSonic
• Continuous output measurement allows for immediate assessment of afterload. (Resistance = Pressure/Output)
The trend screen graphically displays data over the course of the case. Push “Event” soft key to mark the time of specific therapeutic interventions.
9
Aorta idth er W duc ans r Tr ple Dop Transesophageal probe
eam rB ple Dop
Echographic Beam
60°
TMProx
TMDist-TMProx
Unique Probe Design ensures reliability. The HemoSonic employs a patented combination of two ultrasound transducers that measure aortic parameters every twenty milliseconds! ™
LV Failure – Patient Profile Screen
• Scroll to examine trend of desired parameter. • Compare trends for any two parameters by selecting “Trend 2”.
• M-mode echo measures aortic diameter and confirms transducer position.
• Display trend of desired parameter and hemodynamic data throughout case by selecting “Data”.
• Pulsed Doppler measures blood velocity at this cross-section.
Cross-sectional Area x Velocity = Aortic Blood Flow Trend/Data Screen
™
shows that a low SV and poor contractility are present, thus alerting the physician to left ventricular failure.
Patient Profile Screen
• Acceleration provides assessment of ventricular contractility.
Blood velocity
HMS-C
Hypovolemia – Patient Profile Screen Hypovolemia in a patient with normal cardiac function. Note combination of low SV, high Acc and shortened LVETc. Monitoring MAP and HR alone could be misleading.
1.5.2002
20:36
Stránka 4
Real-time Hemodynamic Data for Better Patient Management Enjoy the benefits of a comprehensive Hemodynamic Profile. • Preload assessment
HemoSonic Data Display ™
Monitor your At-Risk Patients – Without adding risk!
The monitoring screen continuously updates flow and contractility parameters. Choose to monitor from three parameter options:
• Major surgical procedures
• Left ventricular contractility at-a-glance • Afterload assessment on demand • Fluid optimization results in optimal end tissue perfusion
• Aortic Blood Flow (measured) • Cardiac patients having non-cardiac surgery
• Cardiac Output (estimated) • Cardiac Index (adjusted for BSA & age)
• Elderly patients • Trauma
Total Systemic Vascular Resistance available upon input of MAP.
• Hemodynamically unstable patients
M-mode and Doppler tracings show dynamic changes in flow and aortic diameter.
7
Assessment of Cardiac Function Using the HemoSonic ™
HemoSonic Parameters
Invasive Monitoring Parameters
Stroke Volume Measured beat-to-beat in the descending aorta.
Stroke Volume Calculated. Not continuously measured.
Contractility Measured. Acceleration (dV/dt) of blood ejected from left ventricle. Sabbah, et al, demonstrated a linear relationship between Accpeak and Ejection Fraction (1986) .
Contractility Left Ventricular Stroke Work Index (calculated).
™
9
LVET Left Ventricular Ejection Time . Continuously measured. LVETc (corrected for heart rate). LV dysfunction, regardless of cause, shortens LVETc whereas a shortened LVETc in a healthy heart indicates a low volume status.
Wedge Pressure LVEDP (assumes pressure changes equal volume changes).
2
1
• ARDS or other pulmonary pathologies • Multi-organ system failure Monitoring Screen
• Critically burned patients The patient profile screen displays a “snapshot” of hemodynamic profile. The patient’s data appears as the yellow bars, while the highlighted box indicates published normal values.
• Postoperative/Intensive Care monitoring
Knowing real-time SV, in conjunction with real-time contractility and resistance parameters, allows for rapid evaluation of preload status. Careful attention must be paid to resistance (TSVR) to ensure accurate assessment.
Color-coded boxes facilitate rapid assessment of hemodynamics:
Continuous, Real-Time Data makes the HemoSonic your Early Warning System.
Blue = Flow Parameters
™
Green = Contractility Parameters
• By continuously monitoring flow, changes in cardiac output are detected immediately, in real time. A drop in flow precedes the subsequent pressure drop, thus allowing an increase in crucial reaction time.
Red = Afterload Parameters LV Failure – Monitoring Screen If this patient had been monitored by BP and HR only, the data would have suggested hypovolemia. The HemoSonic
• Continuous output measurement allows for immediate assessment of afterload. (Resistance = Pressure/Output)
The trend screen graphically displays data over the course of the case. Push “Event” soft key to mark the time of specific therapeutic interventions.
9
Aorta idth er W duc ans r Tr ple Dop Transesophageal probe
eam rB ple Dop
Echographic Beam
60°
TMProx
TMDist-TMProx
Unique Probe Design ensures reliability. The HemoSonic employs a patented combination of two ultrasound transducers that measure aortic parameters every twenty milliseconds! ™
LV Failure – Patient Profile Screen
• Scroll to examine trend of desired parameter. • Compare trends for any two parameters by selecting “Trend 2”.
• M-mode echo measures aortic diameter and confirms transducer position.
• Display trend of desired parameter and hemodynamic data throughout case by selecting “Data”.
• Pulsed Doppler measures blood velocity at this cross-section.
Cross-sectional Area x Velocity = Aortic Blood Flow Trend/Data Screen
™
shows that a low SV and poor contractility are present, thus alerting the physician to left ventricular failure.
Patient Profile Screen
• Acceleration provides assessment of ventricular contractility.
Blood velocity
HMS-C
Hypovolemia – Patient Profile Screen Hypovolemia in a patient with normal cardiac function. Note combination of low SV, high Acc and shortened LVETc. Monitoring MAP and HR alone could be misleading.
HMS-C
1.5.2002
20:35
Stránka 1
The Arrow HemoSonic 100 ™
w w w. H e m o S o n i c . c o m P O W E R E D B Y I N N O VAT I O N
Comprehensive Hemodynamic Monitoring
™
HemoSonic 100 ™
HEMODYNAMIC MONITORING SYSTEM
HemoSonic 100 ™
Frequently Asked Questions
Hemodynamic Monitoring System
Specifications
How does the HemoSonic differ from other transesophageal Doppler monitors? ™
In addition to continuously monitoring aortic blood flow via Doppler, the HemoSonic M-mode transducer measures the aortic diameter and verifies the angle between the Doppler waves and the blood flow. Furthermore, an accurate measurement of blood flow via Doppler requires the accurate measurement of aortic diameter.
Ordering Information
™
Unit:
Height: 200 mm Depth: 300 mm
Width: 250 mm Weight: 4 kg
Why is fluid optimization important?
Probe:
Diameter of flexible section: < 7 mm Length of flexible section: 610 mm
Many studies show that optimizing fluid improves patient outcomes by reducing ICU stays, hospital stays, and postoperative complications.
Power:
Voltage: 90–130 Vac, 180–270 Vac Frequency: 50/60 Hz Power consumption: 100 VA Max
Product No.
Description
Per case
HSM-00100
HemoSonic 100 Includes Monitor, Probe and Accessories (Jackets sold separately)
1
HSP-02150
Probe
1
HSA-00100
Articulated Arm and Probe Holder
1
HSC-00100
Connection Cable
1
HSM-00101
Operator’s Manual
1
HSS-02150
Jacket
5
™
4,7,8,10
Why do I need the HemoSonic when I can see pressure changes with my arterial line or blood pressure cuff? ™
The HemoSonic provides a complete hemodynamic profile in real time. Because changes in flow precede changes in pressure, the HemoSonic is an early indicator of potential pressure drops, which are often delayed by the body’s compensatory mechanisms. Furthermore, the HemoSonic provides the capability of immediately differentiating volume problems from cardiac dysfunction. ™
™
Frequency:
Doppler: 5 MHz
Echo: 10 MHz
Input Connections:
™
Front Panel Base with esophageal probe input connector Back Panel Base with RS 232 connector Base with keyboard connection Base for main cable
How does the HemoSonic compare with other non-invasive cardiac output monitors currently on the market? ™
The HemoSonic is more than a cardiac output monitor. It provides a complete hemodynamic profile, including contractility, in real time. Also, the HemoSonic requires no vascular access and no administration of chemicals to obtain measurements. ™
™
Output Connections: Back Panel Base for RS 232 output parameters Base for printer port
HemoSonic vs. Thermodilution/Wedge ™
Standards: RISKS:
6
HemoSonic
Thermodilution/Wedge
Same as NG tube
Pneumothorax Hemothorax Blood Stream Infection Pericardial Tamponade Pulmonary Artery Rupture Rhythm Disturbances
™
COSTS:
5
HemoSonic
Thermodilution/Wedge
Single-use Jacket
Catheter Sheath Introducer Pressure Tubing/Stopcocks Transducer Saline/Heparin X-Ray ICU Stay
™
Chest x-ray showing thermodilution catheter.
The HemoSonic 100 is in compliance with the following standards: IEC 601-1-1 NFC 74 335 89/336/EEC ™
610.378.0131 or 800.523.8446 Toll free FAX orders 800.343.2935 Email:
[email protected] For more information and technical assistance for the Arrow HemoSonic 100, call your Arrow Critical Care Products sales representative, or contact us directly at 1-800-523-8446.
CRITICAL CARE
™
Arrow Critical Care Products 2400 Bernville Road, Reading, PA 19605, U.S.A.
References: 1. Bazett HC. An analysis of the time-relations of electrocardiograms. Heart. 1920;7:353-370. 2. Boudoulas H. Systolic time intervals. Eur Heart J. 1990;11 Suppl I:93-104. 3. Boulnois JL, Pechoux T. Non-invasive cardiac output monitoring by aortic blood flow measurement with the Dynemo 3000. J Clin Monit and Comput. 2000;16:127-140. 4. Gan TJ, et al., Intraoperative volume expansion guided by esophageal Doppler improves postoperative outcome and shortens hospital stay [abstract].. Anesthesiology. 1999;91:A537. 5. Hendrickson K. Cost-effectiveness of noninvasive hemodynamic monitoring. AACN Clin Issues. 1999:10;419-24. 6. Lake, CL (Ed). Clinical monitoring for anesthesia and critical care (2nd Ed). 1994. Saunders:Philadelphia. 7. Mythen, MG, Webb AR: Perioperative plasma volume expansion reduces the incidence of gut mucosal hypoperfusion during cardiac surgery. Arch Surg. 1995;130:423-429. 8. Poeze, et al. using esophageal Doppler ultrasonography. Crit Care Med. 1999;27:1288-1294. 9. Sabbah, et al., Noninvasive evaluation of left ventricular performance based on peak aortic blood acceleration measured with a continuous-wave Doppler velocity meter. Circulation. 1986;74:323-329. 10. Sinclair James S, Singer M: Intraoperative intravascular volume optimization and length of hospital stay after repair of proximal femoral fracture: randomized controlled trial. BMJ. 1997;315:909-912.
Licensed by INSERM under U.S. Patent 5,479,928 and European Patent 93,402.283.1 Caution: U.S. Federal Law limits this device to sale by or on order of a physician. Contents of unopened, undamaged package are sterile. Disposable. Refer to package insert for current warnings, precautions, and instructions for use.
ARROW
© 2002 Arrow International, Inc. U.S.A. All rights reserved. Printed in the Czech Republic. HMS-C 04/02 11M CZ
PRODUCTS
HMS-C
1.5.2002
20:35
Stránka 1
The Arrow HemoSonic 100 ™
w w w. H e m o S o n i c . c o m P O W E R E D B Y I N N O VAT I O N
Comprehensive Hemodynamic Monitoring
™
HemoSonic 100 ™
HEMODYNAMIC MONITORING SYSTEM
HemoSonic 100 ™
Frequently Asked Questions
Hemodynamic Monitoring System
Specifications
How does the HemoSonic differ from other transesophageal Doppler monitors? ™
In addition to continuously monitoring aortic blood flow via Doppler, the HemoSonic M-mode transducer measures the aortic diameter and verifies the angle between the Doppler waves and the blood flow. Furthermore, an accurate measurement of blood flow via Doppler requires the accurate measurement of aortic diameter.
Ordering Information
™
Unit:
Height: 200 mm Depth: 300 mm
Width: 250 mm Weight: 4 kg
Why is fluid optimization important?
Probe:
Diameter of flexible section: < 7 mm Length of flexible section: 610 mm
Many studies show that optimizing fluid improves patient outcomes by reducing ICU stays, hospital stays, and postoperative complications.
Power:
Voltage: 90–130 Vac, 180–270 Vac Frequency: 50/60 Hz Power consumption: 100 VA Max
Product No.
Description
Per case
HSM-00100
HemoSonic 100 Includes Monitor, Probe and Accessories (Jackets sold separately)
1
HSP-02150
Probe
1
HSA-00100
Articulated Arm and Probe Holder
1
HSC-00100
Connection Cable
1
HSM-00101
Operator’s Manual
1
HSS-02150
Jacket
5
™
4,7,8,10
Why do I need the HemoSonic when I can see pressure changes with my arterial line or blood pressure cuff? ™
The HemoSonic provides a complete hemodynamic profile in real time. Because changes in flow precede changes in pressure, the HemoSonic is an early indicator of potential pressure drops, which are often delayed by the body’s compensatory mechanisms. Furthermore, the HemoSonic provides the capability of immediately differentiating volume problems from cardiac dysfunction. ™
™
Frequency:
Doppler: 5 MHz
Echo: 10 MHz
Input Connections:
™
Front Panel Base with esophageal probe input connector Back Panel Base with RS 232 connector Base with keyboard connection Base for main cable
How does the HemoSonic compare with other non-invasive cardiac output monitors currently on the market? ™
The HemoSonic is more than a cardiac output monitor. It provides a complete hemodynamic profile, including contractility, in real time. Also, the HemoSonic requires no vascular access and no administration of chemicals to obtain measurements. ™
™
Output Connections: Back Panel Base for RS 232 output parameters Base for printer port
HemoSonic vs. Thermodilution/Wedge ™
Standards: RISKS:
6
HemoSonic
Thermodilution/Wedge
Same as NG tube
Pneumothorax Hemothorax Blood Stream Infection Pericardial Tamponade Pulmonary Artery Rupture Rhythm Disturbances
™
COSTS:
5
HemoSonic
Thermodilution/Wedge
Single-use Jacket
Catheter Sheath Introducer Pressure Tubing/Stopcocks Transducer Saline/Heparin X-Ray ICU Stay
™
Chest x-ray showing thermodilution catheter.
The HemoSonic 100 is in compliance with the following standards: IEC 601-1-1 NFC 74 335 89/336/EEC ™
610.378.0131 or 800.523.8446 Toll free FAX orders 800.343.2935 Email:
[email protected] For more information and technical assistance for the Arrow HemoSonic 100, call your Arrow Critical Care Products sales representative, or contact us directly at 1-800-523-8446.
CRITICAL CARE
™
Arrow Critical Care Products 2400 Bernville Road, Reading, PA 19605, U.S.A.
References: 1. Bazett HC. An analysis of the time-relations of electrocardiograms. Heart. 1920;7:353-370. 2. Boudoulas H. Systolic time intervals. Eur Heart J. 1990;11 Suppl I:93-104. 3. Boulnois JL, Pechoux T. Non-invasive cardiac output monitoring by aortic blood flow measurement with the Dynemo 3000. J Clin Monit and Comput. 2000;16:127-140. 4. Gan TJ, et al., Intraoperative volume expansion guided by esophageal Doppler improves postoperative outcome and shortens hospital stay [abstract].. Anesthesiology. 1999;91:A537. 5. Hendrickson K. Cost-effectiveness of noninvasive hemodynamic monitoring. AACN Clin Issues. 1999:10;419-24. 6. Lake, CL (Ed). Clinical monitoring for anesthesia and critical care (2nd Ed). 1994. Saunders:Philadelphia. 7. Mythen, MG, Webb AR: Perioperative plasma volume expansion reduces the incidence of gut mucosal hypoperfusion during cardiac surgery. Arch Surg. 1995;130:423-429. 8. Poeze, et al. using esophageal Doppler ultrasonography. Crit Care Med. 1999;27:1288-1294. 9. Sabbah, et al., Noninvasive evaluation of left ventricular performance based on peak aortic blood acceleration measured with a continuous-wave Doppler velocity meter. Circulation. 1986;74:323-329. 10. Sinclair James S, Singer M: Intraoperative intravascular volume optimization and length of hospital stay after repair of proximal femoral fracture: randomized controlled trial. BMJ. 1997;315:909-912.
Licensed by INSERM under U.S. Patent 5,479,928 and European Patent 93,402.283.1 Caution: U.S. Federal Law limits this device to sale by or on order of a physician. Contents of unopened, undamaged package are sterile. Disposable. Refer to package insert for current warnings, precautions, and instructions for use.
ARROW
© 2002 Arrow International, Inc. U.S.A. All rights reserved. Printed in the Czech Republic. HMS-C 04/02 11M CZ
PRODUCTS
HMS-C
1.5.2002
20:36
Stránka 7
Quick, Low-Risk Probe Placement
1. Apply probe jacket as instructed (see reverse). 2. Attach connecting cable and place probe handle in articulating arm. 3. Insert probe to 4 bands (3 bands for shorter patients). 4. Advance monitor to Positioning Screen by pushing “Enter” soft key. 5. Pull back 2–3 cm to remove slack in the probe. This allows transducers to lie straight in the esophagus parallel to the descending aorta. 6. Rotate handle to align the transducers toward the spine. 7. Obtain velocity waveform by slowly withdrawing probe. 8. Rotate probe handle until the M-mode transducer tracks both the proximal and distal walls. 9. Perform Depth Check (see below). 10. Advance to Monitoring Screen by pushing “Enter” soft key. NOTE: If correct positioning is not obtained, advance probe back to original depth and repeat steps. Also, see “Troubleshooting Tips”.
Procedure for Depth Check In order to ensure optimal positioning, a Depth Check is advised. After obtaining Doppler and M-mode waveforms, continue to slowly withdraw the probe until an erratic Doppler signal is obtained, indicating a view of the arch. Then re-advance the probe slightly past the best signal (the largest peak obtained while two walls are still visualized) and withdraw to optimal position.
Correct positioning. • The two aortic walls appear on the screen as two different horizontal bright wavy lines. Aorta M-mode beam Doppler beam
• With an accurate aortic diameter measurement from the echo transducer and velocity determined by the Doppler, ABF can be precisely calculated. • A correctly positioned M-mode verifies Doppler angle.
Incorrect positioning. Aorta
M-mode beam Doppler beam
• The distal wall of the aorta is missing on the screen. Only the proximal wall is visible, which means the aorta diameter cannot be measured. • A small rotation of the probe handle will properly position the transducers. Both walls will be visible when proper rotation is achieved.
HMS-C
1.5.2002
20:36
Stránka 8
Probe Jacket Application/Removal (Reverse procedure to remove jacket)
1. Create a seal by pressing the jacket collar into the vacuum chamber adapter until tight.
2. Turn stopcock handle to 6:00 position or closed position.
3. Depress and release syringe pump. Pump until air pocket forms in gel.
4. Remove retaining rod.
5. Insert probe into jacket until silicone tip fits snugly into jacket.
6. Release vacuum by turning stopcock handle to 3:00 position.
7. Disconnect jacket collar from vacuum chamber adapter.
8. Pull probe with jacket attached out of the applicator device for patient use.
Troubleshooting Tips Can’t get a good signal? Is the probe straight? To prevent misalignment in the esophagus, it is best to obtain signal by withdrawing, rather than advancing to the desired depth, maintaining a slight tension on the probe.
Does the probe come straight out of the mouth? Curves in the probe outside the body can result in misalignment of the transducers inside the esophagus, precluding the 90° orientation of the M-mode echo toward the aorta.
After applying the probe jacket, be sure to check transducers for air bubbles. Eliminate any kinks or tight bends in the connecting cable. Manipulate the position of the NG tube so that the HemoSonic™ probe lies toward the back (posterior) of the esophagus.
HTB-M 09/01 11M CZ
