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FOS MAP calibration against a reference line

Procedure AC3O · fos-map-cal

Overview

AP FOS CAL adjusts the mean arterial pressure (MAP) reported by the FiberOptix™ sensor (FOS) to match the MAP from another, verified arterial pressure (AP) source. It is the fallback when the FOS was not zeroed, or not zeroed properly, before the intra-aortic balloon (IAB) was inserted, and it moves the FOS MAP in 5 mmHg steps.

When to perform

The FOS was not zeroed (or was zeroed improperly) before IAB insertion and its numeric values do not match a known accurate AP from another source.

Equipment

  • a reference AP source: a fluid-filled transducer on the IAB central lumen or another site such as the radial artery, zeroed, leveled and flushed

Steps

  1. Ensure FOS is the selected source in the AP tab.1

    The CAL adjustment applies only to the source shown in the tab, so the wrong source would be altered otherwise.

  2. Verify the reference source (the AP transducer) is accurate; the manual highly recommends that it be zeroed and leveled.1

    The FOS will be shifted to match whatever the reference reads, so any error in the reference becomes a permanent offset in the FOS.

  3. Flush the AP transducer line so the trace is not dampened.1

    A dampened line reports a distorted pressure, and bubbles or clots in the tubing corrupt the MAP being copied.

  4. Decide whether to perform the adjustment with the pump OFF or while pumping; it may be easier with the pump not pumping, but first determine whether the patient can tolerate the interruption.1

    Pump OFF removes support and starts the pump-off timer, so the convenience of a steadier reading has to be weighed against the patient's dependence on counterpulsation.

  5. Find the MAP value of the reference AP source.1

    The reference MAP is the number the FOS MAP will be matched to.

  6. Verify again that the AP source shown in the AP tab is FOS.1

    The manual repeats this check immediately before the adjustment keys are used, because the arrows act on the displayed source.

  7. Adjust the FOS MAP value up or down with the > and < arrow keys until the IABP value matches the reference as closely as possible; the adjustment moves in 5 mmHg increments, so an exact match may not be possible.1

    The CAL offset is a coarse correction, not a true zero, which is why the manual calls it an adjustment rather than a calibration of the sensor.

  8. Verify the Time Last Cal'd is correct and the MAP CAL Adjustment value displayed is correct.2

    The timestamp and offset confirm that the change was accepted and that it is the size the clinician intended.

  9. Wait 30 seconds or press DONE to return to the main display.2

    The menu closes on its own after 30 seconds; DONE closes it immediately.

  10. Verify that next to the FOS source, above the AP waveform on the left side, the FOS MAP Cal value displays as +/- XX mmHg, matching the magnitude and direction of the change made.2

    The on-screen offset is the only standing indication to later clinicians that the displayed FOS pressures carry a manual correction.

Cautions

  • Verify that the AP MAP value used to calibrate the AP FOS MAP is zeroed and leveled appropriately, and that the AP source is verified for accuracy.2
  • Follow the manufacturer's instructions for the heparinized flush; all pressure tubing, stopcocks and connections must be completely filled with fluid and free of air bubbles before zeroing or calibration.2
  • When the FOS is not zeroed, hemodynamic numeric information may not be accurate; use an alternate AP source for treatment decisions until the correction is verified.3

Related knowledge

References

  1. Arrow International Inc. AC3™ Series IABP System Service Manual. Part No. IAM-9011, Rev 00. Reading, PA: Arrow International Inc (Teleflex); 2015. p 48.
  2. Arrow International Inc. AC3™ Series IABP System Service Manual. Part No. IAM-9011, Rev 00. Reading, PA: Arrow International Inc (Teleflex); 2015. p 49.
  3. Arrow International Inc. AC3™ Series IABP System Service Manual. Part No. IAM-9011, Rev 00. Reading, PA: Arrow International Inc (Teleflex); 2015. p 120.
  4. Arrow International Inc. AC3™ Series IABP System Service Manual. Part No. IAM-9011, Rev 00. Reading, PA: Arrow International Inc (Teleflex); 2015. pp 48-49.
  5. Arrow International Inc. AC3™ Series IABP System Service Manual. Part No. IAM-9011, Rev 00. Reading, PA: Arrow International Inc (Teleflex); 2015. p 104.
  6. Arrow International Inc. AC3™ Series IABP System Service Manual. Part No. IAM-9011, Rev 00. Reading, PA: Arrow International Inc (Teleflex); 2015. pp 118-121.