医疗器械培训课件：血液动力学监测的新技术

1、Title of Presentation 9/11/00 Markus Haas PMD- MarketingAgilent Restricted Title of Presentation 9/11/00 Markus Haas PMD- MarketingAgilent Restricted 锁骨下静脉锁骨下静脉 股动脉股动脉 Title of Presentation 9/11/00 Markus Haas PMD- MarketingAgilent Restricted Title of Presentation 9/11/00 Markus Haas PMD- MarketingA

2、gilent Restricted 用热稀释法的用热稀释法的C.OC.O校准校准 连续测量连续测量 每搏量每搏量 每搏量的变化每搏量的变化 心排量心排量 体循环阻力体循环阻力 心肌收缩力心肌收缩力 2424小时内和小时内和C.OC.O的测量有极好的相关性的测量有极好的相关性 Title of Presentation 9/11/00 Markus Haas PMD- MarketingAgilent Restricted 8 8小时校准小时校准 一次一次 Intra-thoracic blood bolume + extra-vascular lung water Title of Prese

3、ntation 9/11/00 Markus Haas PMD- MarketingAgilent Restricted Sturm JA, In: Practical Applications of Fiberoptics in Critical Care Monitoring, Springer Verlag Berlin - Heidelberg - NewYork 1990, pp 129-139 Title of Presentation 9/11/00 Markus Haas PMD- MarketingAgilent Restricted Mitchell JP, Schulle

4、r D, Calandrino FS, Schuster DP: Am Rev Resp Dis 145: 990-998, 1992 22 days 15 days 9 days 7 days Ventilation daysICU days RHC group RHC group EVLW group EVLW group * Title of Presentation 9/11/00 Markus Haas PMD- MarketingAgilent Restricted 三级医院三级医院 小型小型 ( (非教学非教学) ) 医院医院 小儿和新生儿病房小儿和新生儿病房 Title of

5、Presentation 9/11/00 Markus Haas PMD- MarketingAgilent Restricted 中心静脉压管路中心静脉压管路 4 4 F F 热敏导管测量动脉血压热敏导管测量动脉血压 动脉血压传感器动脉血压传感器 温度传感器温度传感器 压力管路压力管路 M1012 A # C 10M1012 A # C 10 M1006 BM1006 B Agilent CMS Rev C.OAgilent CMS Rev C.O Title of Presentation 9/11/00 Markus Haas PMD- MarketingAgilent Restrict

6、ed 注释简单注释简单 更安全更安全 可信的数值便于快速诊断可信的数值便于快速诊断 同时适用于小儿同时适用于小儿(2kg)(2kg) 不用在不用在X-X-线下操作线下操作 连续监测心输出量连续监测心输出量 不会造成对心脏瓣膜的刺激和损伤不会造成对心脏瓣膜的刺激和损伤( (心律失常心律失常) ) 低感染率低感染率 标准操作方法标准操作方法 低花费低花费 不用经常更换导管不用经常更换导管 ( 48 ( 48 小时小时) ) Title of Presentation 9/11/00 Markus Haas PMD- MarketingAgilent Restricted Agilent Techn

7、ologies 监护仪监护仪 插件插件 电缆电缆 Pulsion & Partners 应用培训应用培训 导管导管 / 附件附件 压力附件压力附件 Title of Presentation 9/11/00 Markus Haas PMD- MarketingAgilent Restricted Transpulmonary Thermodilution and Pulse Contour Analysis Licensed and marketed together with Title of Presentation 9/11/00 Markus Haas PMD- MarketingAg

8、ilent Restricted Developers of this measurement with a 10 year experience in haemodynamic monitoring Development out of medical practice Focus on special area Consumables World leader in patient monitoring Diversified product portfolio with integration of different measurements Monitor for life“ phi

9、losophy Box Business“ Title of Presentation 9/11/00 Markus Haas PMD- MarketingAgilent Restricted Application training for measurement Distribution of disposables Pulsion provides help with hardware acquisition, if necessary Pulsion has the measurement technology and can offer an integration into Agi

10、lents CMS Application training for the integration of the solution Sells system / upgrade Sells modules and supplies Agilent has integrated the technology and can, therefore, differentiate itself in the market Title of Presentation 9/11/00 Markus Haas PMD- MarketingAgilent Restricted Step 1:Intermit

11、tent measurement of C.O. Principle:Trans-pulmonary thermodilution Parameter:C.O., ITBV, Step 2:Continuous measurement of C.O. Principle:Pulse contour analysis Parameter:CCO, SV, SVV, SVR, ABP, CVP Approach (1) Title of Presentation 9/11/00 Markus Haas PMD- MarketingAgilent Restricted Approach (2) M1

12、012A #C10 M1006B M1643A PV8015 PV2014L16 ln c (I) injection At recirculation MTt t e-1 DSt c (I) Title of Presentation 9/11/00 Markus Haas PMD- MarketingAgilent Restricted Agreement Pressure Kit Pulsiocath 4 Pin Adapter Cable for Pressure Revision CMS Module M1012A C10 M1006B Supplies Application In

13、tegration Title of Presentation 9/11/00 Markus Haas PMD- MarketingAgilent Restricted United States Direct Sales Territory Alignment 1 x Director Marketing/Sales: Mike McLarty 1 x Clinical Director: Ulf Borg Northeast Shawn Papi Central Paul Sapien Southern Linda Johnson Southwest Richard Smith North

14、west Tom Howard Southeast Kevin Eskew 6 x Direct Sales Reps. 2 x Specialty Reps.: Jennifer Gardner/TBH Title of Presentation 9/11/00 Markus Haas PMD- MarketingAgilent Restricted List price Module: $ 3146 List price Option: $ 1680 Intro Promotion $ 2413 (fixed price) valid from FDA clearance (exp 12/

15、00) Future: Upgrade to option C10 CCO and Swan-Gantz method Backwards compatible Heart and “Option C10” mark CCO module Title of Presentation 9/11/00 Markus Haas PMD- MarketingAgilent Restricted List price Module: $ Title of Presentation 9/11/00 Markus Haas PMD- MarketingAgilent Restricted List pric

16、e : $ Technically like M1642A Length 2,40 m+2,40 m Backwards compatible Ice Bucket Kit 14455A $ Pole Mount14454A $ Title of Presentation 9/11/00 Markus Haas PMD- MarketingAgilent Restricted 23001B $ The “good old” one Detection of injection by temperature distinction Measurement a little prone to fa

17、ults Needs Edwards Housing 606526001 M1646ADM ?,? The better, new one Mechanical detection of injection Warmer injection fluid possible Shorter waiting time possible Available FY 2001 PULSION Housing Title of Presentation 9/11/00 Markus Haas PMD- MarketingAgilent Restricted K Options M1012A K05:4 Ic

18、e Buckets, Pole Mount$ M1012A K11:M1643A Cable$ M1012A K13:M1643A Cable and$ 23001B Temperature Probe Bundle M1038A A02: CCO Module, 2 Pressure Modules, $ 1 Temperature Module, Sensor, Cable M1038A K15: Ice Bucket Kit$ Title of Presentation 9/11/00 Markus Haas PMD- MarketingAgilent Restricted Adapte

19、r Cable PMK 206 Pressure Kits PV 8003 30 cm Pressure Line PV 8010 100 cm Pressure Line PV 8015 150 cm Pressure Line Pulsiocath PV2014L16 16 cm 4F Title of Presentation 9/11/00 Markus Haas PMD- MarketingAgilent Restricted CO set by Edwards (Baxter) ZVK dead space 48Std. Low invasiveness (CV and ART l

20、ine rather than a PAC) Title of Presentation 9/11/00 Markus Haas PMD- MarketingAgilent Restricted Cost Benefits Direct:Comparable with conventional discrete PAC, but less expensive than continuous PAC Indirect:Results not user dependent arterial catheter can be in place 10 days and more Indirect:pot

21、entially reduces ICU stay Title of Presentation 9/11/00 Markus Haas PMD- MarketingAgilent Restricted COST COMPARISON PiCCO vs. PAC TD/PCCO (PiCCO) UnitPrice PCCO/TD catheter In-line sensor Central venous catheter 2 pressure transducers (CVP, AP) Injection system/syringe $ 160.00 $ 11.00 $ 14.00 2 x

22、$ 9.50 $ 19.00 $ 1.00 Continuous cardiac output pulmonary artery catheter Unit Standard PAC Baxter VigilanceAbbott Q-vue Price $ 205.00 Pulmonary artery catheter In-line sensor Central venous catheter 3 pressure transducers (PAP, CVP, AP) Introducer kit for PAC placing Arterial catheter Injection sy

23、stem/syringe Price $ 130.00 $ 14.00 $ 14.00 3 x $ 9.50 $ 28.50 $ 22.00 $ 14.00 $ 1.00 $ 393.75(2) $ 34.00(2) $ 14.00 3 x $ 9.50 $ 28.50 $ 22.00 $ 14.00 $ 1.00 $ 50.00 $ 14.00 $ 14.00 3 x $ 9.50 $ 28.50 $ 22.00 $ 14.00 $ 1.00 $ 223.50 $ 507.25 $ 143.50 Additional costsAdditional costs(1) Medication f

24、or procedural sedation (sometimes) Medication for procedural sedation (sometimes) Additional X-ray unit (tech, time and radiologist overhead) (sometimes) $ 17 $ 17 min. $ 50 $ 17 min. $ 50 $ 17 min. $ 50 Total $ 290.50Total $ 574.25Total $ 201.50Total $ 222.00 (1) Not included: costs for additional

25、ICU days caused by PAC application (2) List price Title of Presentation 9/11/00 Markus Haas PMD- MarketingAgilent Restricted TIME COMPARISON PiCCO vs. PAC TD/PCCO (PiCCO) StepTime Insertion of PCCO/TD catheter Insertion of central venous catheter Basic system setup Triple bolus TD measurements Ident

26、ifying circulating volume status and adjusting cardiovascular drugs lung water/atelectasis 5.0min. 10.0min. 5.0min. 4.5min. 5.0min. Continuous cardiac output pulmonary artery catheterStandard pulmonary artery catheter 29.5min. StepTime Insertion of PAC incl. introducer Insertion of central venous ca

27、theter Insertion of arterial catheter Basic system setup Triple bolus TD measurements Identifying circulating volume status by volume challenge Adjusting cardiovascular drugs Identifying lung water/atelectasis by X- ray, blood gases 20.0min. 10.0min. 5.0min. 10.0min. 4.5min. 10.0min. 5.0min. 10.0min

28、. 74.5min. StepTime First setup Insertion of PAC incl. introducer Insertion of central venous catheter Insertion of arterial catheter Basic system setup Triple bolus TD measurements Identifying circulating volume status by volume challenge Adjusting cardiovascular drugs Identifying lung water/atelec

29、tasis by X- ray, blood gases 20.0min. 10.0min. 5.0min. 10.0min. 4.5min. 15.0min. 10.0min. 10.0min. 84.5min. Additional time for a 24h use 2x Triple bolus TD measurements 2x Identifying circulating volume status and adjusting cardiovascular drugs lung water/atelectasis System management (flushing, po

30、sition checks and correction) 9.0min. 10.0min. 5.0min. Triple bolus TD measurements Identifying circulating volume status by volume challenge 2x Adjusting cardiovascular drugs System management (flushing, position checks and correction) 4.5min. 10.0min. 10.0min. 10.0min. 3x Triple bolus TD measureme

31、nts Identifying circulating volume status by volume challenge 2x Adjusting cardiovascular drugs System management (flushing, position checks and correction) 13.5min. 10.0min. 20.0min. 10.0min. 24.0min. 34.5min. 53.5min. 53.5min.109.0min.138.0min. Total time needed (for a typ. 24h insert): Title of P

32、resentation 9/11/00 Markus Haas PMD- MarketingAgilent Restricted M1012A #C10: Positioning High end ICU for patients which need prolonged ( 72 h) advanced hemodynamic and volumetric monitoring Hospitals with a small turn around of PA catheters ( 100 / year) risk is higher with the inexperienced, decr

33、eased hassle factor Septic patients: the CCO technology eliminates valve injuries Ventilated patients: cardiac pre-load information is independent of ventilator settings and respiratory cycle Known history of myocardial diseases: the CCO technology eliminates induced arrhythmia Operating Theatre: qu

34、ick response on hemodynamic changes Babies and infants: appropriate catheters available Title of Presentation 9/11/00 Markus Haas PMD- MarketingAgilent Restricted Can an old M1642A cable be used for CCO? Can a new M1643A cable be used for right heart measurement (PAC)? Can any other catheters be use

35、d for arterial access? Why does the machine switch to right heart method when using a Pulsiocath catheter? What does a question mark next to the SVR value mean? Is an SVR value without consideration of the CVP accurate? Title of Presentation 9/11/00 Markus Haas PMD- MarketingAgilent Restricted Do I

36、have to use cold injection fluid? What are the reasons for problems with starting the transpulmonary measurement? What is ETVI, and where does the value show? Title of Presentation 9/11/00 Markus Haas PMD- MarketingAgilent Restricted Realtime network for display at central station C.O. CCO Blood tem

37、perature For processing in documentation systems (on demand) SVR or SVRI ITBV or ITBVI Further vital values dependent on network configuration and documentation system used Title of Presentation 9/11/00 Markus Haas PMD- MarketingAgilent Restricted M1012A #C10 M1006B M1643A PV80XX PV2014L16 23001B/M1

38、646A PMK 206 14455A PV 8003 30 cm pressure line PV 8010 100 cm pressure line PV 8015 150 cm pressure line Title of Presentation 9/11/00 Markus Haas PMD- MarketingAgilent Restricted Haemocalc Input body size Input body weight Haemodynamic calculations Alarm / Volume Title of Presentation 9/11/00 Mark

39、us Haas PMD- MarketingAgilent Restricted Continuity and additional comprehensive haemodynamic parameters Wider application spectrum due to being less invasive (for children down to 2kg) ITBV as better indicator for pre-load Cost saving through longer periods of usage of the catheters, fewer potentia

40、l problems and less costs for supplies compared to CCO-PAC Title of Presentation 9/11/00 Markus Haas PMD- MarketingAgilent Restricted Director, Marketing & Sales Michael McLarty Phone: (760)-931-0283 Mobile:(760)-415-6656 Fax:(760)-931-0289 E-mail: MMcLartyM Title of Presentation 9/11/00 Markus Haas

41、 PMD- MarketingAgilent Restricted Director of Clinical Programs Ulf Borg (Pulsion Mailing Address) PO Box 2637 20462 Chartwell Center Drive Unit A Cornelius, NC 28031 Phone:(877)-655-8844 Voice Mail Fax:(704)-655-8866 Mobile:(704)-488-0833 E-mail: Title of Presentation 9/11/00 Markus Haas PMD- MarketingAgilent Restricted Director, Marketing & Sales Michael McLarty Phone: (760)-931-0283 Mobile:(760)-415-6656 Fax:(760)-931-0289