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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© 2018 Drägerwerk AG & Co. KGaA
Moislinger Allee 53–55 · 23558 Lübeck
All rights, in particular the right of
reproduction, distribution and translation, reserved.
Printed in Germany
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always apply and are not in any way replaced or otherwise superseded by this manual.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
7
8
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
21
23
24
26
28
28
30

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
32
34
35
37
38
39
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
7
8
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
21
23
24
26
28
28
30
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
39
40
43
45
46
47
47
48
49
51

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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.
D-4671-2017
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.
D-2280-2010 | D-2281-2010
D-11961-2017
D-11960-2017
D-15487-2017

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Size table
Size in cm Size in inch
XXL 124 – 150 49 – 59
XL 106 – 127 42 – 50
L92 – 110 36 – 43
M80 – 96 31 – 38
S70 – 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.
D-6061-2014
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
(4th 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
1 Mid position marker
2 Closure holes
D-11923-2017 D-11924-2017
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
2 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
D-11922-2017
D-11925-2017
Orientation of the patient cable and electrode belt
D-1254-2010
›correct‹
›wrong‹

Prepare the device for the clinical use
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Patient cable
Right port
Electrode belt
Left port
D-6058-2014
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‹.
D-11932-2017 D-11931-2017
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 4th 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.
D-2284-2010
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°
D-11942-2017

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 4th and 6th intercostal space.
3. Ensure that the
mid position marker is still on the spine.
4. Close the belt
DL-18858-2015
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.
D-28332-2009
1
16
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.
D-11898-2017
Mid position marker

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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.
D-2282-2010
D-6063-2014
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.
D-15489-2017

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.
D-15488-2017

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1.6. CHECK THE CORRECT ELECTRODE BELT POSITION
The following procedure will help you to check the belt position or to find the
correct position.
The belt is to be placed between the 4th and 6th ICS. For women, the belt
should be placed onto the breast.
Case A:
If the belt is placed too far caudally, movements of the diaphragm affect
the imaging.
Effect: Negative impedance changes (see page 34) become visible
laterally in the Tidal Image. This is an indicator that the belt is
too low.
Case B:
If the belt is placed too far cranially, the ventilated lung regions may
appear smaller.
Effect: Due to the low spatial resolution, it is no longer possible to
clearly distinguish between the left and right lungs, especially
if the mediastinum can no longer be localized in the apical
region of the lungs.

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Steps to identify whether the belt was placed too low:
1. Go to the
Main View .
2. Click the ›Enhance contrast button‹.
3. If you can see purple regions (negative impedance changes) left and right
of the lung regions (blue and white) it is very likely that the belt has been
placed too low.
4. Reattach the electrode belt in a more cranial position.
5. Verify, that the purple regions dissappeared.
D-30762-2017
1 Enhance contrast
2 Negative impedance changes
2
1
2

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If one electrode fails, the message ›Check electrode contact‹
appears, but the measurement can nevertheless be carried out
without difficulty
In the so-called 15-electrode mode, the inactive electrode in the virtual
thorax contour is marked in yellow. If an electrode fails after starting the
measurement, recalibration is required. Then the message ›Electrode contact
impaired‹ is displayed, but this does not pose a significant limitation for the
measurement.
1.7. SPECIAL CASE: 15-ELECTRODE MODE
In the special case that one electrode does not have enough skin contact,
the measurement can nevertheless be carried out reliably. The device uses a
special mode for this purpose.
D-15490-2017