Evolving Fluid Management Practices
PROPER FLUID MANAGEMENT MAY IMPROVE CLINICAL OUTCOMES AND HELP REDUCE COSTS1-4
Intravenous (IV) fluids are among the most commonly used interventions for hospitalised patients, yet one in five patients on IV fluid therapy suffers complications because fluids were inappropriately administered.5 The Starling system takes the guesswork out of fluid decisions with dynamic assessments to accurately identify whether or not an individual patient is fluid responsive.
FLUID RESPONSIVENESS IS DYNAMIC
Every patient has unique and constantly changing fluid needs. More than 80% of hospitalised patients receive IV fluids.6 Yet studies show that giving too little or too much fluid can lead to serious complications and contribute to rising healthcare costs.7,8
IV fluids are drugs, and fluid administration is not a one-size-fits-all approach; fluids should be dosed according to a patient's response.9 Assessing whether fluid is the right intervention and whether it may help or harm a patient is a critical step in optimising treatment for the individual patient. The Starling system can accurately aid clinical staff in determining whether a patient will benefit from IV fluids, in a 100% non-invasive way.
Starling’s advanced technology addresses the dynamic and real-time needs of fluid monitoring.
IV fluids may cause harm.
Fluid is an important predictor of mortality.10 Only ~50% of haemodynamically unstable patients will respond to IV fluid by increasing cardiac output and subsequent perfusion.11
Fluid responsiveness is dynamic.
Fluid status changes continuously. Using only blood pressure, urine output and heart rate to measure fluid responsiveness may provide limited, delayed and inconclusive information.11,12
Real-time, accurate data is needed.
The Starling system provides a full haemodynamic profile within seconds — with 94% sensitivity and 100% specificity for predicting fluid responsiveness in critical care situations.13
PATENTED AND PROVEN BIOREACTANCE TECHNOLOGY
The Starling system uses advanced, patented Bioreactance technology to take measures continuously and precisely requiring only four easy-to-place sensors. The sensors may be placed anywhere on the chest or back as long as two are positioned above the heart and two are below the heart.14
The technology works by emitting a low level of electrical current across the thorax, measuring the time delay, or "phase shift," between the applied electrical current and the voltage in the thorax. These phase shifts correlate with the amount of pulsatile blood volume change in the thorax, enabling the stroke volume to be calculated.
The Starling system uses dynamic assessments to determine fluid responsiveness: watch how it works.
DETERMINING FLUID RESPONSIVENESS
To determine fluid responsiveness, a dynamic assessment is performed, which challenges the heart with a small amount of fluid to gauge the response. Two ways of performing this dynamic assessment are to administer a fluid bolus or to perform a passive leg raise (PLR). The PLR translocates 250-300 ml of blood from lower extremities into the heart, providing a reversible challenge of the heart’s response to increased fluid load.15
Learn how to conduct a Passive Leg Raise and Fluid Bolus - the two methods of dynamic assessments - with the Starling monitor.
STARLING SYSTEM MEASUREMENT OF STROKE VOLUME VS. CONVENTIONAL PRESSURE MEASUREMENTS
The Starling system measures stroke volume, cardiac output, and other haemodynamic parameters centrally rather than measuring pressure and converting this to a volume measurement (a process that requires an estimation of cardiovascular and peripheral vascular compliance). The Starling system measures central flow and volume at the source. As a result, the Starling system measures haemodynamic events with great accuracy.13
When considering volume management needs of a patient, the central question is to determine if fluids will improve or impede the goal of optimising perfusion. The Starling system provides a direct volume answer by measuring the true volume event — stroke volume measured continuously on a beat-by-beat basis.
Clinical benefits of measuring central flow and volume directly vs. central venous pressure measurements
| Dynamic volume assessments with the Starling system | Central venous pressure measurements |
|---|---|
| Provides changes in stroke volume in response to fluid challenge | Central venous pressure (CVP) does not predict fluid responsiveness |
| Non-invasive, continuous, easy to use | Invasive |
| No central line | Invasive |
| Works on spontaneous breathing as well as mechanically ventilated patients16,17 | CVP impacted by mechanical ventilation and PEEP |
SV STARLING Monitor — Non-invasive haemodynamic monitoring system.
Intended purpose: The Starling SV system, with NIBP and SpO2 functionality, is intended for professional use in healthcare facilities. It is a portable non-invasive haemodynamic cardiac output monitor. It monitors and displays a patient's cardiac output (CO) in l/min with a non-invasive blood pressure (NIBP) function that non-invasively measures and displays blood pressure (diastolic, systolic and mean) and heart rate, and an SpO2 function that non-invasively measures and displays blood oxygen saturation (SpO2). The device displays the corresponding haemodynamic parameters based on measurements or measurement calculations already incorporated in the Starling SV.
Class IIa device. Notified body: MEDCERT - Germany (CE 0482).
Please refer to the instructions for use for information necessary for proper use.
Carefully read the instructions in the package insert.
Date of revision: 31 March 2020.
Baxter, Bioreactance and Starling are trademarks of Baxter International Inc. or its subsidiaries.