Advanced hemodynamic monitoring, simplified
The ClearSight system is a noninvasive solution that offers you proactive decision support to optimize perfusion. It provides advanced hemodynamic parameters and continuous noninvasive blood pressure (BP) from a finger cuff with a redesigned self-coiling mechanism.
The ClearSight system extends the benefits of continuous hemodynamic monitoring to a broad patient population, including patients in whom an arterial line would not typically be placed.1-3
|ClearSight Finger Cuff Small Multi Pack||CSC2S|
|ClearSight Finger Cuff Medium Multi Pack||CSC2M|
|ClearSight Finger Cuff Large Multi Pack||CSC2L|
|EV1000 Clinical Platform NI||EV1000NI|
Connectivity via IFM out through a serial connection, HL7 through an Ethernet connection or HL7 integration engine.
Continuous noninvasive blood pressure (BP) from a noninvasive finger cuff in addition to key advanced hemodynamic parameters.
Continuous advanced hemodynamic parameters
- Cardiac Output (CO)
- Stroke Volume (SV)
- Stroke Volume Variation (SVV)
- Systemic Vascular Resistance (SVR)
- Mean Arterial Pressure (MAP)
Extend the benefits of hemodynamic monitoring
Noninvasive hemodynamic monitoring offered by the ClearSight system provides information to enable you to make proactive clinical decisions across the continuum of care, including moderate- to high-risk surgery patients, and can also be utilized perioperatively to manage patients’ changing clinical situations.
A versatile approach to continuous monitoring
The ClearSight system connects to your patient’s finger. Upon starting a measurement, the finger cuff can be used and re-applied for up to 72 hours on one patient. After 8 hours of continuous monitoring on a single finger, the finger cuff should be re-applied to another finger.
To increase comfort, two ClearSight finger cuffs may be connected simultaneously to alternate the measurement between two fingers. This allows uninterrupted continuous monitoring up to 72 hours.
Heart Reference Sensor
The ClearSight Heart Reference Sensor (HRS) automatically compensates for hydrostatic pressure changes due to height differences between finger and heart. The HRS compensates for clinician repositioning of the patient’s hand during a procedure or for patient movement.
Taking noninvasive simplicity to the next level
Introducing a new design with a self-coiling mechanism within the interior of the cuff that wraps snugly around the patient’s finger.
Small, medium and large cuffs accommodate a range of patients. An easy-to-use sizing window ensures correct selection of the appropriate size.
Validated ClearSight technology
To accurately mirror arterial line output, continuous finger pressure measurements are performed 1000 times per second utilizing the proven Volume Clamp method.
Alignment markers reduce variability in cuff application
Helpful placement guides
Indicators inside the cuff denote location of photo diodes, to help ensure correct positioning. External alignment markers guide placement to simplify consistent positioning.
After application, a color-coded sizing window on the cuff itself confirms if the appropriate size cuff is in place.
The ClearSight system offers continuous clinical decision support to enable proactive clinical decisions for your moderate-to high-risk surgical patients and patients at risk for complications in your ICU and ED.
The ClearSight system gives you noninvasive access to automatically calculated, beat-to-beat hemodynamic information for a broader patient population, including patients in whom an arterial line would not typically be placed.2-4.
Noninvasive hemodynamic monitoring offered by the ClearSight system enables proactive clinical decisions across the continuum of care, including moderate-to high-risk surgery patients, and can also be utilized perioperatively to proactively manage patients’ changing clinical situations in the OR, ICU and even ED.
Hypotension can alert you to hemodynamic instability
The ClearSight system provides access to advanced hemodynamic parameters, including continuous noninvasive blood pressure, allowing you to evaluate hemodynamic instability and guide appropriate treatment.
Recent studies show associations between intraoperative hypotension and increased risk of acute kidney injury (AKI) and myocardial injury11-14 — the leading cause of post-operative mortality within 30 days after surgery.11
Prolonged exposures below mean arterial pressure (MAP) thresholds of 65 mmHg are associated with increased risk of myocardial injury and AKI after noncardiac surgery.11 Furthermore studies also show an increased risk of mortality associated with hypotension after noncardiac surgery.14,15
Episodes of hypotension may be decreased through continuous monitoring4
Cleveland Clinic researchers recently showed that continuous noninvasive monitoring reduced the amount of intraoperative hypotension by nearly half (P=0.039). The Research publication indicated early detection of hypotension by continuous hemodynamic monitoring prompts timely remedial actions, thereby reducing intraoperative hypotension.4
Enabling you to proactively manage intraoperative hypotension (IOH)
Clarity through advanced hemodynamic monitoring parameters CO, SV, SVV, SVR and BP provided by the ClearSight system can help you determine if the cause of IOH is preload, afterload or contractility.
If the underlying cause of hemodynamic instability is related to decreased flow, continuous parameters can help you determine appropriate fluid therapy.
Additionally, continuous monitoring of advanced hemodynamic parameters enables proactive clinical decisions regarding appropriate treatment to augment vascular volume, reduce anesthetic administration, or use vasopressors or inotropes.4
Access to pressure and flow parameters helps guide individualized fluid management
Frank-Starling relationship between preload and stroke volume (SV)
When managing perfusion, stroke volume (SV) can be optimized using the patient’s own Frank-Starling curve.
The patient’s response to a fluid challenge may be assessed by changes in SV, as indicated by location on the curve. Dynamic and flow-based parameters provide a comprehensive hemodynamic assessment and may help guide individualized fluid administration to avoid over and under resuscitation.5
For additional clarity into whether a ventilated patient will respond positively to fluid, stroke volume variation (SVV) has been proven to be a highly sensitive and specific indicator of preload responsiveness.5,6,16
Manage fluid administration using perioperative goal-directed therapy (PGDT)
Advanced hemodynamic parameters provided by the ClearSight system may be used in PGDT protocols. PGDT is a treatment protocol using dynamic and flow-based parameters with the objective of making the appropriate volume management decisions. PGDT can be implemented in a single procedure or as part of a larger initiative such as Enhanced Recovery After Surgery pathways.Fluid management
How does it work?
ClearSight system technology is based on two methods: the Volume Clamp method to continuously measure blood pressure (BP) and the Physiocal method for initial and frequent calibration.
Volume clamp method
- The essence is to dynamically provide equal pressures on either side of the wall of the artery by clamping the artery to a certain constant volume
- 1000 times each second the cuff pressure is adjusted to keep the diameter of the finger arteries constant
- Continuous recording of the cuff pressure results in a real-time finger pressure waveform7
The Physiocal method - Physiological Calibration
- The Physiocal method is the real-time expert system that determines the proper arterial ‘unloaded’ volume, i.e. no pressure gradient across the arterial wall
- Automatic, periodic adjustments are essential to track the unloaded volume clamp setpoint when smooth muscle tone changes (e.g. during vasoconstriction)
- Calibration interval starts at 10 beats, but it increases to every 70 beats as stability increases
- Physiocal interval >30 beats is considered reliable8
Brachial pressure reconstruction
- Clinical standard for noninvasive BP is brachial level
- The ClearSight system reconstructs the brachial arterial pressure waveform from the finger arterial pressure waveform
- The reconstruction algorithm is based on a vast clinical database9
Cardiac output calculation
- Stroke volume is calculated by an algorithm based on an improved pulse contour method using:
- The area under systolic portion of blood pressure curve (Systolic Pressure-time Integral - SPI)
- A physiological model to calculate afterload individualized by age, gender, height and weight
- Cardiac output results from stroke volume times heart rate and is updated every beat10
For blood pressure and cardiac output validation studies, download the ClearSight technology overview here.
Hemodynamic education empowering clinical advancement
With a long-term commitment to improving the quality of care for surgical and critical care patients through education, Edwards clinical education meets you no matter where you are in the learning process — with a continuum of resources and tools that continuously support you as you solve the clinical challenges facing you today, and in the future.
Watch videos, explore the Fluid Response Simulator, sign up for eLearnings, and download the Normal Hemodynamic Parameters pocket card.
OR content quick links
ICU content quick links
Intraoperative hypotension matters
Protocolized volume management
Reducing fluid variability using Perioperative Goal-Directed Therapy (PGDT)
Continuous access to your choice of parameters on the EV1000 clinical platform, when used with the noninvasive ClearSight system, enables you to ensure adequate perfusion and proactively manage fluid administration.
Clinical decision support screens allow for immediate recognition of rapidly changing clinical situations. Easy-to-use touch screens allow selection of the parameters most meaningful for each clinical situation. Simplified graphics offer clear updates of your patient’s hemodynamic status.
- Bubenek S, Craciun M, Miclea I, Perel A. Noninvasive continuous cardiac output by the Nexfin before and after preload-modifying maneuvers: a comparison with intermittent thermodilution cardiac output. Anesthesia & Analgesia 2013; 117(2):366-72
- Maguire S, Rinehart J, Vakharia S, Cannesson M. Respiratory variation in pulse pressure and plethysmographic waveforms: Intraoperative applicability in a north American academic center. Anesthesia & Analgesia 2011;112: 94-96
- Martina J. Noninvasive continuous arterial blood pressure monitoring with Nexfin. Anestheiology 2012;116: 1-12
- Maheshwari, K et al. A Randomized Trial of Continuous Noninvasive Blood Pressure Monitoring During Noncardiac Surgery. Anesthesia & Analgesia, 2018
- Berkenstadt, H., et al. (2001) Stroke Volume Variation as a Predictor of Fluid Responsiveness in Patients Undergoing Brain Surgery. Anesthesia & Analgesia, 92, 984-9
- Peng, K., Li, J., Cheng, H., Ji, FH. (2014) Goal-directed fluid therapy based on stroke volume variations improves fluid management and gastrointestinal perfusion in patients undergoing major orthopedic surgery. Medical Principles and Practice, 23(5), 413-20
- Peñáz J. Photoelectric measurement of blood pressure, volume and flow in the finger. 1973; Dresden 1973. p. 104
- Wesseling KH, Wit B, Hoeven GMA, Goudoever J, Settels JJ. Physiocal, calibrating finger vascular physiology for Finapres. Homeostasis. 1995;36:67–82
- Gizdulich P, Prentza A, Wesseling KH. Models of brachial to finger pulse wave distortion and pressure decrement. Cardiovasc Res. 1997;33:698–705. doi: 10.1016/S0008-6363(97)00003-5
- Truijen J, van Lieshout JJ, Wesselink WA, Westerhof BE. Noninvasive continuous hemodynamic monitoring. J Clin Monit.Comput. 2012 Jun 14
- Salmasi, V., Maheshwari, K., Yang, G., Mascha, E.J., Singh, A., Sessler, D.I., & Kurz, A. (2017). Relationship between intraoperative hypotension, defined by either reduction from baseline or absolute thresholds, and acute kidney injury and myocardial injury. Anesthesiology, 126(1), 47-65.
- Sun, L.Y., Wijeysundera, D.N., Tait, G.A., & Beattie, W.S. (2015). Association of Intraoperative Hypotension with Acute Kidney Injury after Elective Noncardiac Surgery. Anesthesiology, 123(3), 515-523.
- Walsh, M., Devereaux, P.J., Garg, A.X., Kurz, A., Turan, A., Rodseth, R.N., Cywinski, J., Thabane, L., & Sessler, D.I. (2013). Relationship between Intraoperative Mean Arterial Pressure and Clinical Outcomes after Noncardiac Surgery. Anesthesiology, 119(3), 507-515.
- Mascha, E.J., Yang, D., Weiss, S., & Sessler, D.I. (2015). Intraoperative Mean Arterial Pressure Variability and 30-day Mortality in Patients Having Noncardiac Surgery. Anesthesiology, 123(1), 79-91.
- Monk, T.G., Bronsert, M.R., Henderson, W.G., Mangione, M.P., Sum-Ping, S.T.J., Bentt, D.R., Nguyen, J.D., Richman, J.S., Meguid, R.A., Hammermeister, K.A., (2015). Association between Intraoperative Hypotension and Hypertension and 30-day Postoperative Mortality in Noncardiac Surgery. Anesthesiology, 123(2), 307-319.
- Li, Cheng, et al. Stroke Volume Variation for Prediction of Fluid Responsiveness in Patients Undergoing Gastrointestinal Surgery. Int J of Med Sciences. 2013; 148-155.
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