What external factors could cause the PiCCO parameters to become less accurate?


The PiCCO technology is based on transpulmonary thermodilution and arterial pulse contour analysis. Thus, the thermodilution measurement needs to be performed correctly and also the arterial pressure curve needs to be of a certain quality. The table below lists frequent errors made, causes and their solutions.

Arterial pressure measurement

Error Cause Remedy
Pressure curve absent Pressure line not attached correctly Check pressure line, stop-cock, cable and plug
  Pressure line blocked Flush pressure line
  Cable or device defect Connect pressure transducer directly to the bedside monitor for testing
Abnormal pressure curve Catheter malpositioned Check or change catheter position
  Blocked catheter lumen Flush catheter
  Arrhythmia, extra systole Regulate therapeutically
  Tachycardia (> 240 bpm) Regulate therapeutically
Flat pressure curve Inappropriate scale settings Set scale of pressure curve
  Incorrect connection of the pressure system Check and ensure pressure system is connected correctly
  Insufficient pressure flush Increase the flush pressure to 250-300 mmHg
  None or incorrect zero adjustment Perform / repeat zero adjustment
  Damped pressure transducer transmission due to:  
  Air bubbles Disconnect from patient and de-air the system
  pressure line modifications Remove any additional lines and or stop cocks
  Malpositioning of stop cocks Adjust stop cocks correctly
  Kinked catheter or pressure line Remove kinks, possibly change patient position
  Hypotonia Regulate therapeutically

Indicator injection

Error Cause Remedy
Injection was not detected CVC malpositioned Correct position
  3-way-stopcock adjusted incorrectly Adjust 3-way-stopcock
  Temperature sensor housing pin clotted Change temperature sensor housing
  Temperature sensor housing / sensor not connected correctly Check connection („click-sound“)
  Defective temperature sensor Check or change sensor

Thermodilution results 

Error Cause Remedy
Results implausible Injected amount does not correlate with the displayed amount on the device Inject correct volume

Pulse contour results

Error Cause Remedy
PCCO calibration not possible Arterial pressure curve absent or faulty Check / optimise arterial pressure measurement
Large variation in values Arrhythmia, extra systoles Regulate therapeutically

Thermodilution curve

Error Cause Remedy
Unstable temperature baseline measurement Rapid cooling or warming of patient Wait for stabilisation phase
  Massive volume loading Stop volume supply if possible
  Arterial connection cable broken or connected incorrectly Check cable connection replace if necessary
  Faulty PiCCO catheter thermistor Check temperature change when flushing catheter and replace catheter if no temperature change is seen
  Parietal thermistor Change catheter or patient position
Thermodilution curve is not displayed Incorrect central venous injection Perform a correct central venous injection
  Faulty PiCCO catheter thermistor Check temperature change when flushing catheter and replace catheter if no temperature change is seen
  Broken or failed cable connection of arterial connection cable Check cable connection and change if necessary
Thermodilution curve is displayed too late (Time limit exceeded) Injection was performed too slow Inject faster (< 7s)
  Very low cardiac output and/or very high lung water Use colder and/or more injectate volume
Flat thermodilution curve Inappropriate scale settings Adjust scaling
  Injectate too warm Use colder injectate
  Very low cardiac output and/or very high lung water Use colder and/or more injectate volume
Thermodilution curve displays more than one peak Injection not smooth Ensure smooth injection
  Existing intra-cardiac shunts Perform shunt diagnosis