PRODUCT OVERVIEW - PowerPoint PPT Presentation

MONITOR SET-UP

• 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.

• 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

MEASUREMENT

INITIATION

SAMPLING

ANALYZING

PURGING

• 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

• 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

• 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

• Real time results
• Better patient management
• Closed loop system
• Decreases risk of infection
• Decreases clinician exposure to blood
• Conservation of blood
• Capitated cost

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

• System software
• Display screen
• Front panel keys
• Infusion/withdraw mechanism
• Battery (1 hour)

• On/Off
• Sample
• Purge
• Alarm Quiet
• Options
•   Keys
• Volume infused keys
• Hold/Enter [*]

• 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

• 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

• 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)

• Measures ambient and bag temperature
• Slows IV bag fluid temperature changes
• Detects when VIA IV Bag Holder is opened

• 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

DISPOSABLES

• Calibration (Cal) Kit
• Sensor 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

• 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

• 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

• ISE (Ion Selective Electrode)
• Modified Severinghaus CO2
• pH, Na+, K+
• Clark pO2 electrode
• Electrical Conductivity - Hct

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

• 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

• 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

• 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

• 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

• 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

• Cal A - 14 seconds
• Calibrate to calibration solution (1st point)
• Cal B - 90 seconds
• Calibrate to calibration ampule solution (2nd point)

CALIBRATION

• 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)

• 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!

• 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)

PATIENT ATTACHMENT

• 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 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

• 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

• 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

• 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

• 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

SENSOR PLACEMENT

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

PATIENT ATTACHMENT

CLINICAL IMPLICATIONS

• 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

• 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

• 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

• All analyzers measure at 37° C
• Some labs correct for patient temperature
• If temperature correction required, activate VIA temperature correction in the options menu

MONITOR DAILY MAINTENENCE

WHY?

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

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

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!

• Sensor and tubing for single patient use
• Replace sensor and tubing every 72 hours
• Appropriate IV infection control should be observed

RESULTS

• 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

• 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

• 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

• 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

PAIRED SAMPLING

• 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

• 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

• Patient ID
• Patient Data Printouts
• Standby Mode
• Set Date and Time
• Catheter Size
• Temperature Correction
• Pediatric/Neonatal Mode
• AutoSampler Warning
• Exit Options

USING OTHER MONITOR MODES

• 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

DEMO MODE