Verify Flow over a Wide Dynamic Range with Non-invasive Sensor •

CP Bypass/ECMO
Verify Flow over a Wide Dynamic Range
with Non-invasive Sensor
• Measures blood, saline or cardioplegia
• Bidirectional measurement
• Stable, low-flow measurement
CP Bypass/ECMO
Verify Pump & ECMO Circuit Flows for
Critical Safety & Quality Assurance
Transonic® Clamp-on Tubing Flowsensors
complement the Transonic® HT110 Tubing
Flowmeter to provide an independent measure
of actual delivered blood flow.
The system provides noninvasive, sterile
measurements without any contact with the
fluid or interruption of tubing. It has a stable
and low zero offset and its calibration can be
adjusted on site. Measurements are stable at
the low flows used in ECMO treatment.
The Transonic® HT110 Tubing Flowsensor/
Flowmeter system is the “Gold Standard”
used throughout the biomedical industry with
which they calibrate & validate other heart/
lung pumps.
“Use of the Transonic Flowmeter allows the ECMO
specialist to monitor actual patient blood flow
and hemofilter shunt enhancing patient care
management”
Berube, MC
12th Annual CNMC Symposium on ECMO & Advanced Therapies
for Respiratory Failure, Keystone, CO, Feb 25-29, 1996.
“Using the Transonic Flowmeter, a pre determined
(partially occlusive) setting can be achieved by
first determining the point of total occlusion, then
decreasing occlusion a small percentage from this
maximum (i.e., total) occlusion. Clinical application in
35 neonatal ECMO cases has shown the practice to be
safe, reliable, and efficient.”
Synder, E
ASAIO J 1997; 43: 60-64.
• Maintains Tubing Integrity
• Sensor Clips onto Existing Tubing
• Unmatched Accuracy ± 10%
TRANSIT-TIME ULTRASOUND TECHNOLOGY
CLAMP-ON TUBING FLOWSENSOR
Transonic® XL-Series
Flowsensors are re-usable;
factory-calibrated for specific
tubing size, material, fluid
and temperature, and
available for 1/8” to 1 1/4”
OD Tubing (3.2 mm OD to
31.8 mm OD).
Four transducers pass ultrasonic signals, alternately
intersecting the vessel in upstream and downstream
directions. The difference between the four transit
times yields a measure of volume flow.
Transonic Systems Inc. is a global manufacturer of innovative biomedical measurement
equipment. Founded in 1983, Transonic sells “gold standard” transit-time ultrasound
flowmeters and monitors for surgical, hemodialysis, pediatric critical care, perfusion,
interventional radiology and research applications. In addition, Transonic provides
pressure and pressure volume systems, laser Doppler flowmeters and telemetry systems.
www.transonic.com
AMERICAS
EUROPE
ASIA/PACIFIC
JAPAN
Transonic Systems Inc.
34 Dutch Mill Rd
Ithaca, NY 14850
U.S.A.
Tel: +1 607-257-5300
Fax: +1 607-257-7256
[email protected]
Transonic Europe B.V.
Business Park Stein 205
6181 MB Elsloo
The Netherlands
Tel: +31 43-407-7200
Fax: +31 43-407-7201
[email protected]
Transonic Asia Inc.
6F-3 No 5 Hangsiang Rd
Dayuan, Taoyuan County
33747 Taiwan, R.O.C.
Tel: +886 3399-5806
Fax: +886 3399-5805
[email protected]
Transonic Japan Inc.
KS Bldg 201, 735-4 Kita-Akitsu
Tokorozawa Saitama
359-0038 Japan
Tel: +81 4-2946-8541
Fax: +81 4-2946-8542
[email protected]
ExtracorporealCover(EC-100-fly-A4)RevB 2015
CP Bypass/ECMO
HT110 Bypass Flowmeter
The Transonic HT110 Bypass Flowmeter system measures volume
flow rates of blood or perfusate in extracorporeal circuits. It
provides non-invasive volume flow measurement over a wide
dynamic range. Measurement accuracy and resolution are
unmatched.
An external clamp-on Flowsensor clips onto the tubing to
continuously monitor actual flow delivery to the patient.
Measurements are non-invasive, continuous bi-directional.
The Flowmeter/Flowsensor system
• Displays actual volume flow in mL or L/min
• Measures blood, saline, and cardioplegia
• Maintains sterility of liquids
• Custom sensor calibration is available for different fluids and
temperatures combinations
• Easily customized for specialized applications
HT110 Bypass Flowmeter
Ensure Optimal
Perfusion to Provide
Proactive Patient
Management
H-XL Tubing Flowsensors
Transonic® Clamp-on Tubing Sensors use unique ultrasonic transit
time technology to measure volume flow with highest accuracy.
Most fluids can be measured including saline, cardioplegia,
and blood. No physical contact is made with the fluid media.
HXL-Series Flowsensors can be calibrated and programmed for up
to 4 different fluid / temperature / tubing combinations and will
work with most flexible tubing types. Sensor size is determined
by outside diameter of the tubing.
Flowsensor on Tubing
Choosing Your Flowsensor
Size
Sensors are scaled in 1/16 inch
increments to clamp around standard
tubing diameters.
Tubing
CLAMP-ON FLOWSENSOR SIZES
H3XL
3/16
1/8 x 1/32
5 mm
-M5
Flexible medical grade and laboratory
tubings (PVC, silicon, polyurethane) are
generally compatible for use with -XL
Sensors. A 30 - 60 cm tubing sample is
required to calibrate the Sensor.
H4XL
1/4
1/8 x 1/16
6 mm
-M6
Optional
H5XL
5/16
3/16 x 1/16
8 mm
-M8
H6XL
3/8
1/4 x 1/16
9 mm
-M9
TUBING
SENSOR
#
OD (inches)
ID X WALL (inches)
OD (metric)
(metric tubes)
H2XL
1/8 x 5/32
3/32 x 1/32
4 mm
-M4
Cat # Suffix
H7XL
7/16
1/4 x 3/32
10 mm
-M10
H8XL
1/2
3/8 x 1/16
12 mm
-M12
H9XL
9/16
3/8 x 3/32
14 mm
-M14
H10XL
5/8
1/2 x 1/16
16 mm
-M16
H11XL
11/16
1/2 x 3/32
-
-
H12XL
3/4
1/2 x 1/8
20 mm
-M20
HT110Datasheet(EC-101-ds)RevC2015A4
Sensors are calibrated for specific
tubing densities and temperature. The
HT110s have the capability to specify,
when ordering, up to four tubing,
fluid, temperature, and flow rate
combinations. Fluid samples and MSDS
information are required for custom
calibration requests.
www.transonic.com
CP Bypass/ECMO
Flow Verification during ECMO
with Transit-time Ultrasound Technology
THEORY & METHODOLOGY
Drost CJ, “Volume Flow Measurement System,” U.S. Patent # 4,227,407, Cornell Research Foundation, Inc., Ithaca
NY, October 14, 1980. (Transonic Reference # 1T)
Drost CJ “Homogeneous Full Flow Illumination to Ultrasonic Systems,” Proceedings of the 31st Annual Conference of Engineering in Medicine and Biology, Bethesda
MD: Alliance for Engineering in Medicine and Biology
1978; 20: 183. (Transonic Reference # 2T)
Drost CJ, “Vessel Diameter-Independent Volume Flow
Measurements Using Ultrasound,” Proceedings of San
Diego Biomed. Symposium, San Diego CA: San Diego
Biomed. Soc. 1978; 17: 299-302, 1978. (Transonic Reference # 3T)
Hemisch W, “Blood Flow during Cardiovascular Surgery:
Methodological, Technical and Practical Considerations,”
Gefäßchirugie, Springer-Verlag, 1996. (Transonic Reference # 4T)
PUBLICATIONS
Labuz M, Huckaby J, Pettigano R, Heard M, Kesser K,
Clark R, Children’s Hospital, Emory University, Atlanta,
GA 7th Int’l ELSO Conference, Dearborn, MI, 1995.
(Transonic Reference # E7376R)
Akers T, Bolen G, Gomez J, Hodgson-Smith A, Merrill, J
Anderson G, Huddleson J, Moretz T, Kirvan K, Kirvan D,
Sutton RG, Riley JB, “In Vitro Comparison of ECC Blood
Flow Measurement Techniques,” Proceedings Am Soc of
Extracorporeal Technol 1990; 17-22. (Transonic Reference
# 28V)
Berube MC, Brink LW, “Ultrafiltration in the Cardiac
ECMO Patient: Use of the Transonic HT109 Flowmeter
to Determine Hemofilter Shunt and Actual Flow,”
12th Annual CNMC Symposium on ECMO & Advanced
Therapies for Respiratory Failure, Keystone, CO, February
25-29, 1996. (Transonic Reference # 715A)
Gray BW, Haft JW, Hirsch JC, Annich GM, Hirschl RB,
Bartlett RH “Extracorporeal life support: experience
with 2,000 patients.” ASAIO J. 2015 Jan-Feb;61(1):2-7.
(Transonic Reference # 10210AH)
Wiktor AJ1, Haft JW, Bartlett RH, Park PK, Raghavendran
K, Napolitano LM, “Prolonged VV ECMO (265 days) for
ARDS Without Technical Complications,” ASAIO J. 2014
Nov 24 (Transonic Reference # 10211AH)
Bartlett RH, Combes A, Peek GJ, “Extracorporeal life
support,” Ann Am Thorac Soc. 2014 Jul;11(6):992.
(Transonic Reference # 10212AHR).
Lequier L, Horton SB, McMullan DM, Bartlett RH,
“Extracorporeal membrane oxygenation circuitry,”
Pediatr Crit Care Med. 2013 Jun;14(5 Suppl 1):S7-12.
(Transonic Reference # 10216R)
Spurlock DJ, Koch K, Mazur DE, Fracz EM, Bartlett RH,
Haft JW, “ Preliminary in vivo testing of a novel pump
for short-term extracorporeal life support,” Ann Thorac
Surg. 2012 Jan;93(1): Transonic Reference # 10217A)
Macha M, Litwak P, Yamazaki K, Kameneva M, Butler
KC, Thomas DC, Taylor LP, Griffith BP, Borovetz HS,
“In Vivo Evaluation of an Extracorporeal Pediatric
Centrifugal Blood Pump,” ASAIO J 1997; 43: 284-288.
(Transonic Reference # 951A)
MacLaren G, Combes A, Bartlett RH, “Contemporary
extracorporeal membrane oxygenation for adult
respiratory failure: life support in the new era,”
Intensive Care Med. 2012; 38(2): 210-20. (Transonic
Reference # 10218R)
Tamari Y, Lee-SensibaK, Leonard EF, Tortolani AJ, “A
Dynamic Method for Setting Roller Pumps Nonocclusively
Reduces Hemolysis and Predicts Retrograde Flow,”
ASAIO J 1997; 43: 39 - 52. (Transonic Reference # 841A)
Park PK, Napolitano LM, Bartlett RH, “Extracorporeal
membrane oxygenation in adult acute respiratory
distress syndrome,” Crit Care Clin. 2011l; 27(3): 627-46.
(Transonic Reference # 10219R)
Lönn U, Wulff J, Keck K-Y, Wranne B, Ask P, Peterzén C-A
H, “Flow Characteristics of the Hemopump: An Experimental In Vitro Study,” Annals of Thorac Surg 1997; 63:
162-166. (Transonic Reference # 828A)
ECMOReferences(EC-50-ref)RevA2015A4
www.transonic.com
CP Bypass/ECMO
Verify Flow in ECMO Circuits &
Ensure Optimal Flow Delivery
The Transonic® Tubing Flowmeter and
Clamp-on Tubing Flowsensor has multiple
uses during ECMO. They include:
1. Facilitation of roller pump occlusion
setting before starting an ECMO run.
2. Confirmation of actual flow delivery to
the patient
3. Helping to maintain secondary venous
drainage catheter patency for duration
of the ECMO Run
4. Secondary bubble detection
SET ROLLER PUMP OCCLUSION
The pump output can be calibrated against
the Flowmeter to ensure an accurate
occlusion setting. One advantage of using
the Tubing Flowsensor instead of a timed
collection is that the fluid-filled circuit does
not have to be open to air.
CONFIRMATION OF ACTUAL FLOW
DELIVERY DURING ECMO RUNS
A Transonic® Flowsensor on the arterial inlet
cannula confirms actual flow delivery to
the patient when a hemofilter is used. The
hemofilter can siphon off up to 250 mL/min
(ECMO flow rates are typically 500 mlL/min).
By measuring flow rates downstream from
the shunt, the clinician can increase the
pump speed to maintain the desired level of
perfusion. The Flowsensor also provides an
early warning if the shunt starts to clot off.
(Shunt flow can be calculated by subtracting
the flowsensor reading from pump output).
If the shunt clots off, the patient will be
over perfused, as total pump output will
be directed to the patient. Over perfusion
is a greater clinical concern than under
perfusion, which can be monitored from
SVO2 levels.
ECMOMedical Note(EC-1-mn)RevC2013A4
ASSISTS IN MAINTAINING SECONDARY
MONITOR VENOUS DRAINAGE AND
CATHETER PATENCY IN V-V ECMO
Some ECMO groups use a cephalad
cannula in V-V ECMO to improve oxygen
delivery. Cephalad cannula flow rates can
vary depending on the size of the patient
and perfusion rates. For example, if the
flow in the venous cannula was 300
mL/min and suddenly dropped to 150
mL/min, the clinician would check the
cannula and reposition the patient to
restore flow. By using the Transonic®
Flowsensor to measure actual flow,
venous catheters can be kept patent for
the duration of extended ECMO runs.
SECONDARY BUBBLE DETECTION
A macro air embolus occurs rarely as a
result of a catastrophic failure such as
tubing rupture. Some ECMO centers have
purchased the equipment for its bubble
detection capability. Many ECMO centers
use the Stockert-Shiley pump with a builtin bubble detection option that triggers
an automatic pump shut-off. However,
others are not using any air bubble
detector.
SUMMARY
• Set pump occlusion
• Monitor arterial delivery throughout
long ECMO runs
• Monitor patency of venous catheter
www.transonic.com
CP Bypass/ECMO
Verify Flow in ECMO Circuits cont.
REFERENCES
Labuz M, Huckaby J, Pettigano R, Heard M, Kesser K, Clark
R, Children’s Hospital, Emory University, Atlanta, GA 7th
Int’l ELSO Conference, Dearborn, MI, 1995. (Transonic
Reference # E7376R)
Gray BW, Haft JW, Hirsch JC, Annich GM, Hirschl RB,
Bartlett RH “Extracorporeal life support: experience
with 2,000 patients.” ASAIO J. 2015 Jan-Feb;61(1):2-7.
(Transonic Reference # 10210AH)
Akers T, Bolen G, Gomez J, Hodgson-Smith A, Merrill, J
Anderson G, Huddleson J, Moretz T, Kirvan K, Kirvan D,
Sutton RG, Riley JB, “In Vitro Comparison of ECC Blood
Flow Measurement Techniques,” Proceedings Am Soc of
Extracorporeal Technol 1990; 17-22. (Transonic Reference #
28V)
Wiktor AJ1, Haft JW, Bartlett RH, Park PK, Raghavendran
K, Napolitano LM, “Prolonged VV ECMO (265 days) for
ARDS Without Technical Complications,” ASAIO J. 2014
Nov 24 (Transonic Reference # 10211AH)
Macha M, Litwak P, Yamazaki K, Kameneva M, Butler
KC, Thomas DC, Taylor LP, Griffith BP, Borovetz HS, “In
Vivo Evaluation of an Extracorporeal Pediatric Centrifugal
Blood Pump,” ASAIO J 1997; 43: 284-288. (Transonic
Reference # 951A)
Tamari Y, Lee-SensibaK, Leonard EF, Tortolani AJ, “A
Dynamic Method for Setting Roller Pumps Nonocclusively
Reduces Hemolysis and Predicts Retrograde Flow,” ASAIO J
1997; 43: 39 - 52. (Transonic Reference # 841A)
Lönn U, Wulff J, Keck K-Y, Wranne B, Ask P, Peterzén C-A
H, “Flow Characteristics of the Hemopump: An Experimental In Vitro Study,” Annals of Thorac Surg 1997; 63: 162166. (Transonic Reference # 828A)
Berube MC, Brink LW, “Ultrafiltration in the Cardiac
ECMO Patient: Use of the Transonic HT109 Flowmeter
to Determine Hemofilter Shunt and Actual Flow,” 12th
Annual CNMC Symposium on ECMO & Advanced Therapies
for Respiratory Failure, Keystone, CO, February 25-29,
1996. (Transonic Reference # 715A)
www.transonic.com
Bartlett RH, Combes A, Peek GJ, “Extracorporeal life
support,” Ann Am Thorac Soc. 2014 Jul;11(6):992.
(Transonic Reference # 10212AHR).
Lequier L, Horton SB, McMullan DM, Bartlett RH,
“Extracorporeal membrane oxygenation circuitry,” Pediatr
Crit Care Med. 2013 Jun;14(5 Suppl 1):S7-12. (Transonic
Reference # 10216R)
Spurlock DJ, Koch K, Mazur DE, Fracz EM, Bartlett RH,
Haft JW, “ Preliminary in vivo testing of a novel pump for
short-term extracorporeal life support,” Ann Thorac Surg.
2012 Jan;93(1): Transonic Reference # 10217A)
MacLaren G, Combes A, Bartlett RH, “Contemporary
extracorporeal membrane oxygenation for adult
respiratory failure: life support in the new era,” Intensive
Care Med. 2012; 38(2): 210-20. (Transonic Reference #
10218R)
Park PK, Napolitano LM, Bartlett RH, “Extracorporeal
membrane oxygenation in adult acute respiratory distress
syndrome,” Crit Care Clin. 2011l; 27(3): 627-46. (Transonic
Reference # 10219R)
Transonic Systems Inc. is a global manufacturer of innovative biomedical measurement
equipment. Founded in 1983, Transonic sells “gold standard” transit-time ultrasound
flowmeters and monitors for surgical, hemodialysis, pediatric critical care, perfusion,
interventional radiology and research applications. In addition, Transonic provides
pressure and pressure volume systems, laser Doppler flowmeters and telemetry systems.
AMERICAS
EUROPE
ASIA/PACIFIC
JAPAN
Transonic Systems Inc.
34 Dutch Mill Rd
Ithaca, NY 14850
U.S.A.
Tel: +1 607-257-5300
Fax: +1 607-257-7256
[email protected]
Transonic Europe B.V.
Business Park Stein 5
6181 MB Elsloo
The Netherlands
Tel: +31 43-407-7200
Fax: +31 43-407-7201
[email protected]
Transonic Asia Inc.
6F-3 No 5 Hangsiang Rd
Dayuan, Taoyuan County
33747 Taiwan, R.O.C.
Tel: +886 3399-5806
Fax: +886 3399-5805
[email protected]
Transonic Japan Inc.
KS Bldg 201, 735-4 Kita-Akitsu
Tokorozawa Saitama
359-0038 Japan
Tel: +81 4-2946-8541
Fax: +81 04-2946-8542
[email protected]
CP Bypass/ECMO
Specifications
HXL-Series Clamp-on Flowsensors
APPLICATIONS
• Artificial Heart & VAD Performance
• Medical Device & Pump Engineering
• Manufacturing & Compliance Flow Testing
Transit-time ultrasound technology measures volume flow in tubing with Sensors
specifically designed Tubing Flowsensors. Most non-aerated liquids can be measured,
including saline and buffer solutions, blood and water. No physical contact is made with
the fluid media. H-XL Series Flowsensors can be calibrated and programmed for up to four
different fluid/temperature/tubing combinations and will work with most flexible tubing
types (see next page). Sensor size is determined by outer tubing diameter.
TUBING
SENSOR
SIZE
H2XL
H3XL
H4XL
BIDIRECTIONAL FLOW
OUTPUTS
resolution
ID
Wall Thickness
OD
inches
inches
inches
In sizes 2XL-5XL ratio of tubing
wall thickness to OD must not
exceed 1.5 for PVC; 1:3 for
silicone
H5XL
1
max flow
SYSTEM ACCURACY
SPECIFICATIONS
offset
Absolute
Accuracy
max zero
ULTRASOUND
FREQUENCY
mL/min
5V output
in L/min
mL/min
% of reading
MHz
1/8
0.5
1
± 5.0
± 10
3.6
3/16
1.0
2
± 10.0
± 10
3.6
1/4
1.0
2
± 10.0
± 10
2.4
5/16
1.0
2
± 10.0
± 10
2.4
H6XL
1/4
1/16
3/8
2.5
5
± 30
± 10
2.4
H7XL
1/4
3/32
7/16
5
10
± 60
± 10
1.8
H8XL
3/8
1/16
1/2
5
10
± 60
± 10
1.8
H9XL
3/8
3/32
9/16
5
10
± 60
± 10
1.8
H10XL
1/2
1/16
5/8
10
20
± 120
± 10
1.2
H11XL
1/2
3/32
11/16
10
20
± 120
± 10
1.2
H12XL
1/2
1/8
3/4
10
20
± 120
± 10
1.2
H14XL
5/8
1/8
7/8
25
50
± 300
± 10
1.2
H16XL
3/4
1/8
1
25
50
± 300
± 10
1.2
H20XL
1
1/8
1 1/4
50
100
± 600
± 10
1.2
Calibration is dependent on tubing material, wall thickness, ultrasound velocity of liquid flowing through the tube & temperature.
1. Resolution represents the smallest detectable flow change at 0.1 Hz filter (average flow output).
2. Absolute accuracy is comprised of zero stability, resolution and zero-offset effects. Stated values apply when flow rate is greater than
5% of maximum range and zero offset is nulled.
HXL-FlowsensorSpecs(EC-33-tn)RevC2015A4
CP Bypass/ECMO
HXL-Series Clamp-on Flowsensor cont.
STOCK TUBING
Procedure
CAROTID SHUNTS
PED CPB, ECMO
ADULT CPB
Cat #
Tygon Stock Tubing
TUBING (inches)
Inner Wall
Diameter Thickness
If using tubing of different diameter or type, please discuss
tubing with a customer service representative.
HQ_ 2XL
3/32 x 1/32
Tygon ND 100-65; Tygon E-3603
HQ_ 3XL
1/8 x 3/32
Tygon E-3603
HQ_ 4XL
1/8 x 1/16
Tygon ND 100-65; Tygon E-3603
HQ_ 5XL
3/8 x 1/16
Tygon ND 100-65; Tygon E-3603 HQ_ 6XL
1/4 x 1/16
Tygon ND 100-65; Tygon E-3603
HQ_ 7XL
1/4 x 3/32
Tygon ND 100-65; Tygon E-3603
HQ_ 8XL
3/8 x 1/16
Tygon ND 100-65; Tygon E-3603
HQ_ 9XL
3/8 x 3/32
Tygon ND 100-65; Tygon E-3603
HQ_ 10XL
1/2 x 1/16
Tygon ND 100-65; Tygon E-3603
HQ_ 11XL
1/2 x 3/32
Tygon ND 100-65; Tygon E-3603
Transonic Systems Inc. is a global manufacturer of innovative biomedical measurement
equipment. Founded in 1983, Transonic sells “gold standard” transit-time ultrasound
flowmeters and monitors for surgical, hemodialysis, pediatric critical care, perfusion,
interventional radiology and research applications. In addition, Transonic provides
pressure and pressure volume systems, laser Doppler flowmeters and telemetry systems.
www.transonic.com
AMERICAS
EUROPE
ASIA/PACIFIC
JAPAN
Transonic Systems Inc.
34 Dutch Mill Rd
Ithaca, NY 14850
U.S.A.
Tel: +1 607-257-5300
Fax: +1 607-257-7256
[email protected]
Transonic Europe B.V.
Business Park Stein 205
6181 NB Elsloo
The Netherlands
Tel: +31 43-407-7200
Fax: +31 43-407-7201
[email protected]
Transonic Asia Inc.
6F-3 No 5 Hangsiang Rd
Dayuan, Taoyuan County
33747 Taiwan, R.O.C.
Tel: +886 3399-5806
Fax: +886 3399-5805
[email protected]
Transonic Japan Inc.
KS Bldg 201, 735-4 Kita-Akitsu
Tokorozawa Saitama
359-0038 Japan
Tel: +81 4-2946-8541
Fax: +81 04-2946-8542
[email protected]