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PRODUCT OVERVIEW. HANDS ON: MONITOR SET-UP. WHAT IS IT?. On-line , bedside monitoring of blood gases, sodium, potassium, and hematocrit Real-time results and trending Permits rapid clinical response to dynamic changes in the patient’s status. WHAT IS IT?.

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slide2
HANDS ON:

MONITOR SET-UP

what is it
WHAT IS IT?
  • On-line, bedside monitoring of blood gases, sodium, potassium, and hematocrit
  • Real-time results and trending
  • Permits rapid clinical response to dynamic changes in the patient’s status.
what is it4
WHAT IS IT?
  • Frequent sampling with no blood loss
  • Sampling and re-infusion rates controlled to help prevent vessel trauma and IVH
  • Completely closed system to reduce risk of infection in the high risk patient
how does it work
HOW DOES IT WORK?

MEASUREMENT

INITIATION

SAMPLING

ANALYZING

PURGING

how does it work6
HOW DOES IT WORK?
  • Sampling
    • VIA dial changes fluid path
    • Monitor reverses pumping action
    • Withdrawal small amount blood over sensor (typ. 1.0 to 1.5 cc) within 1 minute
  • Analysis
    • Analysis performed in 75 seconds
how does it work7
HOW DOES IT WORK?
  • Microflush
    • Returns blood sample to patient at 100cc/hr
    • Delivers 0.5cc flush to patient over 18 seconds
    • VIA dial (Bi-directional stopcock) changes fluid path
how does it work8
HOW DOES IT WORK?
  • Purging
    • Flush/clean sensor into collection bag in three phases
      • First phase immediate-4 cc
      • Two minute wait, second phase-2 cc
      • Two minute wait, third phase-2 cc
    • Turbulent flow from curly cue, clears sensor and IV set
    • Continuous flush of 5 cc/hr to collection bag
benefits
BENEFITS
  • Real time results
    • Better patient management
  • Closed loop system
    • Decreases risk of infection
    • Decreases clinician exposure to blood
    • Conservation of blood
  • Capitated cost
hardware components11
HARDWARE COMPONENTS
  • VIA Blood Gas and Chemistry Monitor
  • VIA Sensor Cable /Housing
  • VIA AutoSampler/Printer
  • VIA IV Bag Holder
  • VIA Sensor Housing Holder
  • VIA IV Stand
monitor
MONITOR
  • System software
  • Display screen
  • Front panel keys
  • Infusion/withdraw mechanism
  • Battery (1 hour)
monitor keys
MONITOR KEYS
  • On/Off
  • Sample
  • Purge
  • Alarm Quiet
  • Options
  •   Keys
  • Volume infused keys
  • Hold/Enter [*]
sensor cable housing
SENSOR CABLE/HOUSING
  • Interfaces with sensor
  • Communicates with monitor
  • Monitors and controls temperature of fluid (37 C)
  • Electronic serialization - “marries” sensor to monitor
  • Bi-directional stopcock positioning mechanism – the VIA dial

NOTE: protect from heat/cold/moisture

autosampler printer
AUTOSAMPLER / PRINTER
  • Prints out measured and calculated values along with date, time and patient ID (if entered)
  • Two types of printout
    • Detailed
    • Non Detailed

NOTE: must use VIA paper

autosampler printer16
AUTOSAMPLER / PRINTER
  • Selection of automatic sampling interval (12 - 60 minutes)
  • Isolated (RS-232) data output
  • Interface Translator for customized data display on patient monitoring systems (SpaceLabs and HP)
iv bag holder
IV BAG HOLDER
  • Measures ambient and bag temperature
  • Slows IV bag fluid temperature changes
  • Detects when VIA IV Bag Holder is opened
sensor cable holder
SENSOR CABLE / HOLDER
  • Maintains sensor and tubing at an angle that maximizes blood conservation
  • Helps sensor maintain 37º C
  • Holds/routes tubing
  • Easy access to VIA dial during sampling
  • Flexibility in positioning options
disposables20
DISPOSABLES
  • Calibration (Cal) Kit
  • Sensor Kit
cal kit
CAL KIT
  • 500 cc of Normosol R
  • 10 mEq Sodium Bicarbonate (10 cc)
    • 50 cc vial (10 cc used - single use vial)
    • Total bicarb concentration = 20 mEq/L
    • VIA Bag # matched to CO2 gas concentration
  • 500 units Heparin (5cc)
    • Total concentration = 1u/cc; recommended to prevent clot formation in system
  • Necessary supplies including labels
sensor kit
SENSOR KIT
  • IV set with curlique tubing (“conditioned” in CO2)
  • Sensor
  • Wally Bag containing calibration ampules and waste reservoir
  • Extension set with VIA dial
  • Collection Bag for sensor KVO and flushes
sensor
SENSOR
  • Proven electrochemical sensor technology found in most commercial analyzers
  • Single patient disposable
  • Robust design for multiple measurements
  • Sterile, pyrogen-free
  • Biocompatible for ex-vivo use
  • Sensor design maximizes blood conservation
three types of electrodes
THREE TYPES OF ELECTRODES
  • ISE (Ion Selective Electrode)
    • Modified Severinghaus CO2
    • pH, Na+, K+
  • Clark pO2 electrode
  • Electrical Conductivity - Hct
initial calibration
INITIAL CALIBRATION
  • Tests 2 points - high and a low of each analyte
  • Every sensor must pass initial calibration prior to use
  • Determines slope and intercept
  • Checks sensor integrity
on going calibration
ON-GOING CALIBRATION
  • 1 Point calibration
    • After every sample
    • Every 10 minutes first hour
    • Every 30 minutes after first hour
  • Checks for sensor integrity
  • Checks for air-in-sensor
calibration solution
CALIBRATION SOLUTION
  • Calibrates sensors to the values, or reference points, in the solution
  • Most of these reference points, ie. K+, Na+, O2, and Hct are constant
  • CO2 and pH reference points are dynamic
    • WHY? Because CO2 diffuses into the atmosphere, ex. soda going flat
calibration solution30
CALIBRATION SOLUTION
  • Important Notes:
    • The accuracy of the results depends on correct composition of the calibration fluid
    • Use only VIA supplies
    • Gently shake Bicarb vial to mix thoroughly
    • Inject 10 ml of air into vial
    • Withdraw EXACTLY 10 ml of Bicarb
    • Discard unused portion
    • Use within 30 minutes of preparation
preparing for calibration
PREPARING FOR CALIBRATION
  • Prime IV set including stopcock
    • Expel all air
  • Connect sensor (check expiration date)
  • Connect Wally bag and turn monitor on
  • Follow prompts and answer questions
  • During purge cycle, tap all connections to remove all air

NOTE: Do not get sensor wet

sensor equilibrating
SENSOR EQUILIBRATING...
  • Step 1 - Sensor Equilibration(10 minutes and 24 seconds)
    • Stabilizes sensor temperature
    • Chemical equilibration to Cal Solution
    • Checks sensor integrity at 5 minutes
    • Monitor clears any air from sensor
calibration process
CALIBRATION PROCESS
  • Cal A - 14 seconds
    • Calibrate to calibration solution (1st point)
  • Cal B - 90 seconds
    • Calibrate to calibration ampule solution (2nd point)
slide35
HANDS ON:

CALIBRATION

calibration error37
CALIBRATION ERROR
  • Initiate another attempt to calibrate the sensor
  • If sensor fails 2nd time, return fluid filled sensor along with printouts to VIA for credit
  • If two consecutive sensors fail:

CALL 1-877-ASK-VIA-1 (1-877-275-8421)

helpful hints
HELPFUL HINTS
  • Inject EXACTLY 10 ml of Bicarb and inject into the Normosol
  • Mix cal bag gently
  • Be sure to remove all air from IV set pressure disc, tubing and stopcock
  • Be sure to tap sensor Luers at IV Set and Wally bag during purging to remove all air
  • Be sure hands are dry when handling sensor
  • Keep Sensor Cable connections dry!
calibrating in advance
CALIBRATING IN ADVANCE
  • Can be done at any time
  • Leave on STAND BY or power down
    • NOTE: Better to power down if attachment is delayed > 30 minutes
  • Be sure to answer prompts appropriately prior to attachment (i.e. sensor has passed calibration and VIA Cal Bag is not new)
  • Change VIA IV bag if monitor off >18 hours (monitor will prompt you)
arterial access
ARTERIAL ACCESS
  • ARTERIAL VESSEL LOCATION
    • Standard arterial sites
    • Site must not be positional
  • Catheter type
    • Peripheral catheter 24G or larger
    • 2.8, 3.5 or 5.0 Fr UAC
    • Volume from tip to sensor must be < 1.5 cc (other blood access devices should not be located between UAC and VIA extension set)
venous access
VENOUS ACCESS
  • VENOUS VESSEL LOCATION
    • May use UVC or CVC if catheter has easily flowing blood return
    • Ensure CVC has less than 0.3 cc fill volume
    • Use caution with double lumen UVC if infusing concentrated drips in other lumen of UVC
      • VIA microflush could give small bolus to patient
arterial line set up
ARTERIAL LINE SET UP
  • Verify no air in transducer set up
  • Attach arterial flush solution/transducer set up to port marked “TRANSDUCER” on extension set
    • If using vascular access for infusion instead of pressure transducing, attach infusion tubing to port marked “TRANSDUCER”
    • May use arterial line transducer
  • Flush line marked “PATIENT” including three-way stopcock
patient attachment45
PATIENT ATTACHMENT
  • Attach collection bag to line marked “BAG”
  • Attach VIA sensor to line marked “SENSOR”
  • Snap VIA dial on sensor housing
  • Only when monitor displays “Attach Sensor To PT. Then Press *”, attach port marked “PATIENT” to catheter hub
  • Ensure NO AIR at any connections
connecting without air
CONNECTING WITHOUT AIR
  • Create a meniscus of fluid within all hubs prior to connection
  • Techniques
    • Back-bleed into female hub
    • Drip fluid into female hub
  • ALL CONNECTIONS MUST BE FLUID TO FLUID to avoid pressure waveform problems or trapped air in VIA sensor
compatible infusates
COMPATIBLE INFUSATES
  • Any infusate may be delivered through vascular access
  • Pre-Sample flush
    • For other than saline derivative infusate
    • Amount based on user entered catheter size and type
      • 2.8 F and PAL = 0.2 cc
      • 3.5 F = 0.3 cc
      • 5.0 F = 0.4 cc
      • PAL w/extension set = 0.9 cc
    • Avoid concentrated drips due to pre-sample flush
slide48

SENSOR PLACEMENT

  • Keep sensor housing away from direct heat source (radiant warmer or bili lights)
  • May use in isolette (temp setting < 36C)
slide49
HANDS ON:

PATIENT ATTACHMENT

lab draws
LAB DRAWS
  • Laboratory testing for other analytes
    • Follow directions for paired (simultaneous) sampling to minimize blood loss and exposure
    • Draw according to hospital policy without any interference with the VIA monitor
patient transport
PATIENT TRANSPORT
  • Monitor can be transported with patient
    • 1 Hour battery life
  • If monitor not transported with patient, power monitor off and:
    • Remove VIA dial from sensor housing
    • Disconnect sensor and bag from extension set
    • Cap or connect ends
transporting tips
TRANSPORTING TIPS
  • Sensor not compatible with MRI
  • Sensor and cable must remain dry
  • If disconnected:
    • Reconnect using proper techniques
    • When turning monitor on, answer prompts appropriately i.e. sensor has passed calibration; VIA IV bag is NOT a new bag
    • Press and hold PURGE key to clear air from sensor connection to collection bag
temperature correction
TEMPERATURE CORRECTION
  • All analyzers measure at 37° C
  • Some labs correct for patient temperature
  • If temperature correction required, activate VIA temperature correction in the options menu
changing via iv bag
CHANGING VIA IV BAG

WHY?

  • Monitor prompts for new VIA IV Bag:
    • Every 24 hours
    • When approx. 50-100 cc left in bag
    • When pCO2 level is low
changing via iv bag57
CHANGING VIA IV BAG

HOW?

  • Prepare and hang VIA IV bag within 30 minutes of mixing
  • Place monitor on hold and change bag

Caution: do not drip IV fluid on printer

  • Tap spike to remove air and place in VIA IV Bag holder
changing via iv bag58
CHANGING VIA IV BAG

HOW?

  • Take off hold and follow prompts, including entering reference # and VTBI
  • Be sure monitor knows the bag was changed.

Monitor must know when bag was “new” for accurate results!

changing the tubing and sensor
CHANGING THE TUBING AND SENSOR
  • Sensor and tubing for single patient use
  • Replace sensor and tubing every 72 hours
  • Appropriate IV infection control should be observed
accuracy precision
ACCURACY & PRECISION
  • Analyzer-quality results
  • Meets “CLIA 88” proficiency test acceptance criteria
    • pH +/- 0.04 unit
    • pCO2 +/- 5.0 mmHg
    • pO2 +/- 15 mmHg (normal range)
    • Na +/- 4 mmol/L
    • K +/- 0.5 mmol/L
    • Hct +/- 6
quality control options
Quality Control Options
  • Paired Sampling
    • After initial connection to patient
    • After Daily Cal Bag Change
  • Off-Line Aqueous Control Sampling (after disconnected from patient)
  • NY, Ga., & Fla. require daily Paired Sampling
how do i draw a paired sample
HOW DO I DRAW A PAIRED SAMPLE?
  • Press SAMPLE key on VIA monitor
  • Upon ANALYZING phase
    • Turn extension set stopcock off to VIA
    • Turn VIA dial to “Waveform” position
  • Clear stopcock of fluid
  • Draw arterial line blood sample from transducer according to hospital policy
  • Clear stopcock of blood
how do i draw a paired sample65
HOW DO I DRAW A PAIRED SAMPLE?
  • Place blood in appropriate lab specimen container
  • Send to lab immediately for STAT analysis
  • Compare VIA results to the A-line blood sample just obtained (measured on whole blood)
  • Ensure blood gas results are reported at 37 degrees
slide66
HANDS ON:

PAIRED SAMPLING

causes
CAUSES
  • Timing of blood draws
    • Simultaneous lab draws
  • Possible dilution
    • Low Hct +
    • Low K
    • Normal to high Na+
  • Storage of sample at room temperature
  • Air bubble in blood sample
causes69
CAUSES
  • Inadequate discard volume
  • Temperature corrected results?
  • Flush solution
    • Saline-only with or without Heparin
  • VIA IV bag
  • Lab sample hemolysis
  • Sample drawn from CPB circuit
options menu
OPTIONS MENU
  • Patient ID
  • Patient Data Printouts
  • Standby Mode
  • Set Date and Time
  • Catheter Size
  • Temperature Correction
  • Pediatric/Neonatal Mode
  • AutoSampler Warning
  • Exit Options
demo mode
DEMO MODE
  • Used when training others
  • Access Demo Mode by pressing on/off key and * key simultaneously
  • Change prompt to “Demonstration”
  • Power off to exit Demo Mode
slide73
HANDS ON:

DEMO MODE