Dräger PulmoVista 500 User Manual

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Mini-Manual Electrical Impedance Tomography (EIT)

Device handling, application tips and examples

D-30766-2017

Christian Bozsak Eckhard Teschner

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This manual is intended to provide additional guidance for the use of PulmoVista

500. The information and data provided in this manual are subject to technical changes. For the use of the Dräger products, the instructions for use enclosed with the products always apply and are not in any way replaced or otherwise superseded by this manual.

Medical knowledge is subject to constant change due to research and clinical experience. The authors of this publication have taken utmost care to ensure that all information provided, in particular concerning applications and effects, is current at the time of publication. This does not, however, absolve readers of the obligation to take clinical measures on their own responsibility.

The use of registered names, trademarks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations.

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Table of Contents

Page

INTRODUCTION 6

1. PREPARE THE DEVICE FOR THE CLINICAL USE 7

1.1. Start and Device Check

1.2. Selection and application of the electrode belt

1.2.1. Choosing the right belt size

1.2.2. Attach patient cable to electrode belt

1.2.3. Prepare the patient

1.2.4. Prepare the electrode belt

1.2.5. Positioning of the electrode belt on the thorax

1.2.6. General procedure when attaching the belt

1.3. Signal Check

1.4. Settings before starting an EIT measurement

1.5. Start the EIT session

1.6. Check the correct electrode belt position

1.7. Special Case: 15-electrode mode

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8 10 11

12 12 12 16 17 17 18 20

2. DIFFERENT VIEWS AND THEIR SPECIAL PROPERTIES 21

2.1. Main and Fullscreen view

2.1.1. Referencing

2.1.2. Regions of Interest (ROIs)

2.2. Trend views – End-inspiratory and End-expiratory

2.3. Diagnostic View

2.3.1. Conduct analysis dialogue window

2.3.2. Results of the analysis

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Table of Contents

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Page

3. USEFUL TOOLS AND TIPS 32

3.1. Contour of ventilated area

3.2. Negative impedance changes

3.3. Filtration

3.4. Save screenshot and record EIT data

3.5. Coupling of a Dräger ventilator with Pulmovista® 500

3.6. Frame rate

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4. CLINICAL APPLICATION

4.1. Identify responder or non-responder to a recruitment-maneuver (RM)

4.2. Identify possible de-recruitment and overdistension

4.3. Influence of positioning on the distribution of ventilation

4.4. Patient proning

4.5. Intubation Check

4.6. Patient with pleural effusion

4.7. ΔEELI-trend after suction

5. EIT-TERMINOLOGY

6. CONTRAINDICATIONS

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Introduction

Welcome to the world of Electrical Impedance Tomography (EIT). PulmoVista

500 is the first clinical EIT device which up to date has been used in several thousand patients. EIT is a non-invasive imaging technique that gives you a special view inside the lungs. In a cross-sectional projection, the distribution of the tidal volume in the thorax is shown. This illustration shows ventilated and non-ventilated areas of the lungs as well as their changes as a function of time. The device can be used in various situations in everyday clinical practice. You have the ability to examine at the bedside the status of your patients' lung, track and assess therapeutic measures in real time. This manual is intended to assist you in the use of this device and to provide tips and special features in order to implement the presented information in a practical way.

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Trunk cable port

Test connector

Cockpit

EIT-Module

PulmoVista® 500

Prepare the device for the clinical use

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1. Prepare the device for the clinical use

1.1. START AND DEVICE CHECK

Press the green power button in the lower left corner of the screen to turn on the device. The device check ensures that all components of the device and the trunk cable (cable from the device to the patient) function properly.

1. Make sure the device is in standby mode (Start / Standby).

2. Plug-in the trunk cable into the trunk cable port and insert the patient cable plugs into their respective test connectors → match label and color.

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Size table

Size in cm Size in inch

XXL 124 – 150 49 – 59

XL 106 – 127 42 – 50

L 92 – 110 36 – 43

M 80 – 96 31 – 38

S 70 – 85 28 – 33

3. Select ›Device Check‹.

4. Select

›Start‹ and confirm with the

Rotary Knob

5. The device check is running automatically. Wait for the test phase to finish.

The device will announce the test result.

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1.2. SELECTION AND APPLICATION OF THE ELECTRODE BELT

If the device check fails, check the message and, if necessary, the connectors. If the problem persists, stop using the device and contact customer service.

1.2.1. Choose the right belt size

The application requires an EIT patient interface. This consists of an elastic electrode belt (16 electrodes) and an attachable patient cable. In order to cover a wide patient spectrum, there are five belt sizes, from 70 cm to 150 cm chest circumference. Electrode belt and patient cable are marked in size and color. Both the electrode belt and the patient cable are reusable and can be disinfected with wipes.

Prepare the device for the clinical use

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a. Determine the proper belt size with the help of the measurement tape

– Measure about 5 cm (two inches) below the armpit from axilla to axilla

to 6th ICS).

– If the area is in the transition zone between two sizes, the next larger belt

is recommended.

Start here to measure from the left to

the right mid axilla to estimate belt size

Making ventilation visible™

www.draeger.com

measurement range 4th–6th ICS

Right Axilla Left Axilla

Mid position marker

Closure holes

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Applying an EIT electrode belt to estimate the right fit. This EIT electrode belt has the correct size.

How to find the right belt size

b. Determine the size with the electrode belt

– Choose the electrode belt which you think might possibly fit – The electrode belt has a

mid position marker

1. Hold it approx.

5 cm below the right or left axilla and place the end with the belt closure

over the thorax to the opposite side.

– The belt should fit when the closure holes, preferably the one in the

middle, are below the opposite axilla.

– Otherwise, choose the next smaller or larger belt.

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1.2.2. Attach patient cable to electrode belt

Take the electrode belt and the corresponding patient cable and attach the patient cable to the electrodes in a zigzag pattern. Attach snap 1 of the patient cable to stud 1 of the electrode belt. Pay attention to the correct orientation of the patient cable. At the electrodes 1 and 16 there are lines that serve as a guide. Ensure the orientation of the cable over the stud is maintained as illustrated and as marked on the electrode belt.

Electrode belt too short

Electrode belt too long

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Orientation of the patient cable and electrode belt

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›correct‹

›wrong‹

Prepare the device for the clinical use

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Patient cable

Right port

Electrode belt

Left port

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1.2.3. Prepare the patient

Before the electrode belt is put on, check the potential necessary preparations to position it well. For example, wound dressings, drainages, ECG electrodes, catheters, strong hair growth or surgical and disease-related problem areas may impair the placement of the belt or electrodes. If possible, the contact area should be exposed to improve skin contact. However, if one electrode has insufficient skin contact, the EIT measurement can also be started in the so-called 15-electrode mode. Further information can be found in the chapter

›Checking

signal quality

‹.

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When attaching the electrode cable avoid too tight bending radii, especially at the transition points between electrodes 4/5 and 12/13 (port left/right).

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1.2.4. Prepare the electrode belt

To be ready for use as quickly as possible, it is advisable to moisten the electrodes of the electrode belt with a small amount of liquid (e.g. sterile saline solution, water or electrode gel), in particular with dry skin.

1.2.5. Positioning of the electrode belt on the thorax

For orientation and easier alignment there is a noticeable silicone marking on the electrode belt. This

mid position marker

is located between the 8th and 9th

electrode and should be positioned on the spine between the 4

and 6th ICS.

1.2.6. General procedure when attaching the electrode belt

Apply the belt to the supine patient by

– lifting the patient’s upper body or – rolling the patient to the side.

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Mid position marker

If the patient condition allows it, it may also be advisable to bring the bed in an elevated position. This makes it easier to put on the belt. The EIT measurement can be performed regardless of the position, e.g. in seated, supine, prone or lateral position.

45° to 80°

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Prepare the device for the clinical use

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If tilting the bed or an upright patient position is not possible, the following methods for applying the electrode belt are available:

Lifting method

1. Lift the patient’s head and put the

mid position marker

of the belt to the

cervical spine.

2. Lift the upper body a bit to move the belt downwards to place it between the 4

and 6th intercostal space.

3. Ensure that the

mid position marker

is still on the spine.

4. Close the belt

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Mid position marker

4th to 6th ICS

If access from the head is restricted, lift the upper body and put on the electrode belt from the side.

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Rolling method

1. Turn the patient on one side, place one half of the belt around the chest (electrode on the left side of the patient) and hold the

mid position

marker

on the spine in the area of the 4th to 6th ICS.

2. Turn the patient over to the other side while holding the marker. Gently push the free end of the belt under the patient and place it on the chest.

3. Check the position of the

mid position marker

and the alignment of the

belt and turn the patient back to the starting position.

Close the belt:

1. The belt ends are brought together in the area of the sternum and

connected to each other via one of the six closure positions. If possible, use one of the middle closure holes.

Note: The electrode 1 is located on the left side of the patient (end with closure holes), the two connector ports from the patient cable point caudally to the right and left sides of the patient.

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Electrode orientation:

If possible, place the electrodes 1 and 16 symmetrically (equidistant) to the sternum (see picture). If possible, place the electrodes 8 and 9 symmetrically to the spine.

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Mid position marker

Prepare the device for the clinical use

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2. Connect the closure snap (C) to the closure stud (sternum).

3. Apply an ECG electrode on the abdomen and attach the reference electrode

snap to it.

Ready for use belt on the thorax

Closure snap C

Left port

Right port

4. Plug-in the trunk cable into the trunk cable port and insert the patient

cable plugs into their respective connectors.

Match label and color

Reference electrode

The belt does not have to sit too tight, it is crucial that there is sufficient contact between the electrodes and the skin. An offset of the electrodes or an asymmetrically arranged belt can lead to image rotation.

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For female patients the belt should be placed onto the breast.

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1.3. SIGNAL CHECK

1. Select Start / Stand-by screen and choose ›New patient‹.

2. Go to ›Signal check‹ page: the graph shows the skin electrode resistance for each electrode.

The Signal check page. The electrode skin resistance is shown for every electrode.

Each electrode should have sufficient skin contact: Blue bars for every electrode have to be below the red line. If one electrode has bad skin contact (skin electrode resistance > 300 Ω) the respective electrode is highlighted in red.

If the skin electrode impedance is not appropriate add tap water, use electrode gel or wait a few minutes for moisture from the skin to improve the contact. This also applies for the reference ECG electrode.

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Prepare the device for the clinical use

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1.4. SETTINGS BEFORE STARTING AN EIT MEASUREMENT

Before starting the EIT session, it is recommended to go through these steps:

1. Choose ›New Patient‹.

2. Enter patient data.

3. Set frame rate and filter.

4. Select recording mode.

5. Turn on artifact filter.

6. Switch on the contour of the ventilated area.

7. For coupling with a Dräger ventilator configure the Medibus interface.

More detailed information can be found in the instructions for use.

1.5. START THE EIT SESSION

Press the start button. After that the system performs a short calibration (about 30 s) and is then ready for the measurement.

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+ 39 hidden pages

Dräger PulmoVista 500 User Manual

Specifications and Main Features

Frequently Asked Questions

User Manual