ZOLL Thermogard XP IVTM Physician Manual - Manual (Page 32)

ZOLL IVTM™ System Physicians' Manual
600248-001 Rev 3 31
ALWAYS INVESTIGATE AIR BUBBLE ALARMS.
At a minimum, locate the source of the air or confirm that there is no breach in the
tubing circuit. If the circuit has been demonstrated to be intact, disconnect tubing set
from catheter and re-prime the circuit to exclude all air. After re-establishing IVTM
System function, verify that there is not a failure somewhere in the tubing path. If in
doubt, replace the tubing set. Ensure that there is sufficient fluid within the tubing
circuit.
Air entry into the tubing circuit does not, of itself, cause injury. A second point failure
of the catheter is required before injury can result.
Fluid Loss Detector
The IVTM System integrates its air bubble and fluid loss detection methods. Optical
sensors detect the presence of air inside a reference cylinder. Loss of fluid from the
cooling circuit sufficient to empty this cylinder will cause an air bubble detection
alarm.
ALWAYS CHECK FOR FLUID LOSS WITH AN AIR BUBBLE ALARM.
It is recommended that the bags of saline solution used to prime and run the IVTM
System tubing system be limited in volume to 500 ml or less. In the event of a fluid
leak into the patient, the maximum amount of fluid that can enter the patient is the
volume of the bag less the volume of fluid left in the tubing system after the alarm has
been triggered (i.e., in the worst case, 400ml of the 500ml fluid in the system can
enter the patient).
The cooling circuit is a closed loop system–usually fluid loss alarms indicate a breach
somewhere in this closed loop. With any fluid loss alarm, check both the integrity of
the catheter and the tubing of the Start-Up Kit (see following). PERIODICALLY
CHECK the tubing of the Start-Up Kit for significant air bubbles and replace the kit if
necessary.
To check the integrity of the catheter:
1. Stop operation of the IVTM System.
2. Using aseptic technique, disconnect the tubing set from the catheter and
properly cap both the catheter and tubing set.
3. Fill a sterile 5 ml syringe with sterile saline.
4. Connect the syringe to the INFLOW lumen of the catheter and disconnect the
outflow cap. Infuse the 5 ml of saline–it should flow out the outflow lumen.
5. Now cap the OUTFLOW lumen and pull 5 cc of vacuum and sustain this for at
least 10 seconds. Approximately 4 ml of saline, but not blood, should enter
the syringe and you should be able to maintain the vacuum.
6. Ease the vacuum and recap the INFLOW lumen.
To check the integrity of the tubing set:
1. Look for obvious leakage.
2. Remove the tubing from the pump raceway and inspect for damage (return it
to position if undamaged).
3. Check along the tubing from the pump to the patient for sources of fluid loss.
• Look for damage to the tubing and/or the presence of air within the tubing.
• Inspect, and tighten as necessary, each Luer fitting (do not use
instruments to tighten Luer fittings).