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Policies,Clinical,UWHC Clinical,Department Specific,Nursing Patient Care,Cardiovascular and Infusion

Intravascular Cooling Catheter System - Thermogard XP (Adult & Pediatric) (1.42AP)

Intravascular Cooling Catheter System - Thermogard XP (Adult & Pediatric) (1.42AP) - Policies, Clinical, UWHC Clinical, Department Specific, Nursing Patient Care, Cardiovascular and Infusion

1.42AP

NURSING PATIENT CARE POLICY & PROCEDURE





Effective Date:
January 31, 2017


Administrative Manual
Nursing Manual (Red)
Other _______________

Policy #: 1.42AP

Original
Revision

Page
1
of 6

Title: Intravascular Cooling Catheter System
– Thermogard XP® (Adult & Pediatric)

I. PURPOSE

The purpose of the intravascular cooling catheter system is to provide guidance in
continuously monitoring and adjusting the patient’s core body temperature by circulating
cooled saline through a central venous access device (CVAD) in conjunction with a
temperature probe.

The Thermogard XP® machine can be used for induced hypothermia and maintenance of
normal or otherwise ordered body temperature (known as targeted temperature
management).

II. POLICY

A. The provider is responsible for insertion of the cooling catheter and writing
temperature maintenance orders for the patient.
B. Use of the cooling catheter and the temperature monitoring system is limited to
critical care areas, operating room, and procedure areas where the nurses have been
trained to use the catheter and machine.
C. For removal of a CVAD including a cooling catheter and who can remove them, refer
to Nursing and Patient Care Policy 1.56 AP, Central Vascular Access Device Use,
Maintenance and Removal (Adult & Pediatric)
D. It is recommended by the manufacturer that the Quattro® cooling catheter remain in
place for up to four (4) days.

III. EQUIPMENT

A. Thermal regulation system (Thermogard XP® machine with two (2) temperature
cables)
B. Quattro® central venous cooling catheter (Central Service [CS] Item Number
4008876)
C. 500 mL of sterile normal saline bag
D. Start-Up Kit CoolGard 500D (CS Item Number 4008558)
E. Rectal probe or bladder catheter probe
F. Sterile central line dressing kit
G. Distilled water (as needed)





Page 2 of 6

IV. PROCEDURE

A. Perform hand hygiene according to UWHC Administrative Policy 13.08, Hand
Hygiene. Follow standard and transmission based precautions according to UWHC
Administrative Policy 13.07, Standard Precautions & Transmission-based Precautions
(Isolation) for Inpatient Settings.
B. Set-up of Thermogard XP®
1. Check the level of fluid in the coolant well.
a. If level is low, add distilled water to marked fill line. Obtain distilled water
from Clinical Engineering.
2. Plug in the power cord into a red outlet, position the machine near the patient
and turn the power switch ON. Note: This machine does not have a battery.
3. Answer the following question on the display screen:
a. System Pre-Cool?
b. Choose "YES" by pressing the knob once to begin cooling the fluid in the
coolant well (recommended).
c. Choose "NO" and press the knob.
4. Machine will ask if this is a new patient. Choose yes or no.
5. Machine will ask if you want to delete previous patient data. Select “yes”.
Machine will ask you to press “yes” again to confirm the deletion of data.
6. Set Target Temperature as ordered by the provider. Turn the knob to select the
desired patient target temperature and press the knob once.
7. Select the mode. Turn the knob to select the desired power and press the knob
once.
a. “Max Power”: Max Power quickly cools the fluid in the coolant well and is
usually used for therapeutic hypothermia.
b. “Controlled Rate”: Allows user to control rate of warming or cooling. Set
desired cooling or warming rate.
c. “Fever” Mode: Used to maintain normal body temperature. Set dial at 36.5
degrees Celsius (C) or other prescribed goal body temperature.
8. Machine will perform a self-test. Then it will show the System Set-Up Screen –
all of the components to set the machine up are listed here.
a. Items in red letters need to be completed in order to start the machine.
b. Items in black/gray letters are ready to go.
c. All items must be in black/gray for the machine to begin regulating the
patient’s body temperature.
9. Install the start-up kit tubing set into the machine as follows:
a. Insert the heat exchange coil into the coolant well.
b. Insert the air trap into the air trap holder.
c. Hang 500 mL of sterile normal saline on the hook.
d. Load the pump tubing into the pump. Firmly close the top cover of the
pump.
e. Using aseptic technique, connect the tubing to the saline container using the
spike connector.
f. Remove the air trap from the holder by holding it upside down during
priming.
g. Press and hold the PRIME switch. The pump will slowly rotate. Watch the
movement of saline through the tubing and the red pinwheel in the tubing
should be spinning. Wait until it completely fills the air trap and the entire

Page 3 of 6

length of tubing. Tap the air trap gently to dislodge bubbles. Check to ensure
all air bubbles are gone from air trap and tubing.
h. When priming is complete, release the PRIME switch.
i. Turn the filled air trap right side up and place it in the holder.
j. Slip the insulating jacket (cover) over the cooling well.
k. Route the tubing out of the machine through the notches in the front of the
console and through the channel at the rear of the console.
l. Close the top cover. The cover rests on the tubing and does not need to close
tightly.
10. Assist with insertion of intravascular cooling catheter. See UWHC
Administrative Policy 13.26, Insertion and Maintenance of Central Venous
Catheters for Prevention of Central Line Associated Bloodstream Infections
(CLABSI), for the insertion of a central line.
C. Beginning Therapy
1. Position the intravascular cooling machine near the patient's bed so that the
temperature probe cables and the tubing can easily reach the patient. Lock the
casters.
2. Place the primary and secondary patient's temperature probes in the patient. It is
highly recommended to use two (2) core temperature monitoring devices at all
times. This can be achieved by using a rectal probe and bladder catheter probe.
a. Plug the cable from the primary temperature probe into T1.
b. If you use a secondary temperature probe, plug that cable into T2.
c. T2 does not display on the screen when in use. If the difference in
temperature between T1 and T2 is greater than 1.5 degrees C, then the
machine will alert you.
3. Perform hand hygiene according to UWHC Administrative Policy 13.08, Hand
Hygiene. Connect tubing to the orange ports of the cooling catheter using
aseptic technique. The supply and return ends of the tubing are connected to
respective inflow and outflow lumens (as labeled on the catheter).
4. Ensure the tubing will not become kinked or obstructed and cannot be dislodged
by the patient's movement.
5. Adjust Hi and Lo temperature alarm parameters (found under “Settings”). Hi
temperature alarm default is 42 degrees C and Lo default is 28 degrees C.
6. The intravascular cooling machine is now ready to begin treatment. Press the
"Standby/Run" button to place the intravascular cooling machine in the run
mode.
7. When the machine is actively maintaining the patient’s body temperature (when
saline is flowing to and from the IV bag to the catheter), the red pinwheel in the
tubing will spin. The red pinwheel does not continuously spin during therapy (it
starts and stops to maintain a consistent temperature).
D. Temporary Disconnection from the Patient
1. Press the "Standby/Run" button to place the intravascular cooling machine in
standby mode.
2. Disconnect the temperature probes from their cables. Leave the temperature
probes in the patient.
3. Using aseptic technique, disconnect the saline lines from the intravascular
cooling catheter and cap all lines or connect them to each other.
4. The cooling machine must be plugged into an electrical outlet to work. It does
not have a battery back-up system.

Page 4 of 6

E. Reconnecting After a Temporary Disconnection
1. Using aseptic technique, reconnect the saline tubing to the intravascular cooling
catheter.
2. Reconnect the temperature probes to their cables.
3. Restart treatment by pressing the "Standby/Run" button.
F. Administering Mannitol
1. Mannitol may be infused through the central line cooling catheter, however, the
machine must be put on standby for two (2) minutes and the lumen must be
flushed after Mannitol has infused. This is to ensure the mannitol does not
crystallize due to the cold fluid. The cooling machine does not need to be placed
in standby if mannitol is infused through an intravenous catheter other than the
one for cooling.
G. Ending Treatment
1. Press the "Standby/Run" button. The pump stops turning and standby screen
appears.
2. Perform hand hygiene according to UWHC Administrative Policy 13.08, Hand
Hygiene. Using aseptic technique, disconnect both tubing connectors from the
cooling catheter.
3. Connect the ends of the catheter used for cooling to each other (orange-colored).
4. Disconnect the primary and secondary patient temperature probes.
5. Press the knob once to select end procedure and press knob again.
6. Wipe down the machine and temperature cables with hospital disinfectant and
return the machine and cables to unit storage area.

V. CATHETER REMOVAL

A. For removal of a CVAD including a cooling catheter and who can remove them, refer
to Nursing and Patient Care Policy 1.56 AP, Central Vascular Access Device Use,
Maintenance and Removal (Adult & Pediatric)
B. Just prior to removing the cooling catheter from the patient, disconnect the orange
ends and leave them open to air. This will allow the enclosed cooling lumen of the
catheter to decompress of saline during removal. Refer to Nursing Patient Care Policy
1.56AP Central Vascular Access Device Use, Maintenance and Removal, for central
line catheter removal procedure.

VI. TROUBLESHOOTING

A. Air Trap Fault: There is probably air in the air trap. Tap the air trap to propel the air
into the saline bag.
B. Coolant Low: Refill coolant well to designated line with distilled water.
C. Coolant Empty: Contact Clinical Engineering to refill coolant well with mixture of
propylene glycol and distilled water.
D. Patient Temperature is Above Control Range: Alarm will reset when the patient's
temperature reaches the target temperature plus one (1) degree Celsius when cooling
the patient, or plus 0.5 degree Celsius when heating the patient.
E. Patient Temperature is Below Control Range: Alarm will reset when the patient's
temperature reaches the target temperature minus 0.5 degree Celsius.
F. Patient Temperature is Too High: Alarm will reset when the patient's temperature
falls below the programmed Hi patient temperature alarm value.

Page 5 of 6

G. Patient Temperature is Too Low: Alarm will reset when the patient's temperature
rises above the programmed Lo patient temperature alarm value.
H. Disconnected Probe: Verify position of probe. Assure primary probe is plugged into
T1.
I. Pump Failure: Inspect the pump. Clear any obvious faults and restart. If the problem
persists, discontinue use and contact Clinical Engineering or Alsius (Zoll).
J. Balloon Breakage: The system will alarm and display a message that the catheter has
ruptured. Air will partly fill the air trap, which causes the system to automatically go
on standby.
K. Patient temperature not changing as expected:

Patient
Troubleshooting
Machine
Troubleshooting
Catheter Troubleshooting
Verify that two (2)
temperature probes are
positioned appropriately
and reading same value.
• Verify that system is
running and not on
standby.
• Verify that coolant is
filled to designated
line.
• Verify that red wheel
turns when machine is
on. If not:
o Trace tubing to
patient, check for
kinks under lid,
and reload tubing
in roller clamp.

• Assess if there is a kink
in the catheter (red
wheel not spinning
when machine running).
• If patient’s position has
changed, try
repositioning patient.
• Assess catheter by
placing machine on
standby, disconnect teal
outflow port from
tubing, and run the
machine. Saline should
gush out of port, if it
only drips, catheter may
need to be
repositioned/changed.

VII. RESOURCE

http://www.zoll.com/medical-products/temperature-management-systems/thermogard-xp/

VIII. UWHC CROSS REFERENCES

A. UWHC Administrative Policy 13.07, Standard Precautions & Transmission-based
Precautions (Isolation) for Inpatient Settings
B. UWHC Administrative Policy 13.08, Hand Hygiene
C. UWHC Administrative Policy 13.26, Insertion and Maintenance of Central Venous
Catheters for Prevention of Central Line Associated Bloodstream Infections
(CLABSI)
D. Nursing and Patient Care Policy 1.56 AP, Central Vascular Access Device Use,
Maintenance and Removal (Adult & Pediatric)





Page 6 of 6

IX. REFERENCES

A. Choi, H. A., Ko, S., Presciutti, M., & et.al. (2011). Prevention of shivering during
therapeutic temperature modulation: the columbia anti-shivering protocol. Neurocrit
Care, 14, 389-394.
B. Diringer, M. (2004). Treatment of fever in the neurologic intensive care unit with a
catheter-based heat exchange system. Crit Care Med, 32, 1-6.
C. Hoedemaekers, C. W., Ezzahti, M., Gerritsen, A., & van der Hoeven, J. G. (2007).
Comparison of cooling methods to induce and maintain normo- and hypothermia in
intensive care unit patients: a prospective intervention study. Critical Care, 11.
D. Jodicke, A., Hubner, F., & Boker, D. K. (2003). Monitoring of brain tissue
oxygenation during aneurysm surgery: prediction of procedure-related ischemic
events. Journal of Neurosurgery, 98(3), 515-523.
E. Linares, G., & Mayer, S. A. (2009). Hypothermia for the treatment of ischemic and
hemorrhagic strokes. Critical Care Medicine, 37(7), S243-S249.
F. Mcilvoy, L. (2004). Comparison of brain temperature to core temperature: a review
of the literature. Journal of Neuroscience Nursing, 36(1), 23-31.
G. Nolan, J. P., Morley, P. T., Vanden Hoek, T. L., & et al. (2003). Therapeutic
hypothermia after cardiac arrest. Circulation, 108, 118-121. Retrieved on September
18, 2013 from www.circ.ahajournals.org/content/108/1/118.full.
H. Oddo, M., Schaller, M. D., Ribordy, V., & Liadet, L. (2006). From evidence to
clinical practice: effective implementation of therapeutic hypothermia to improve
patient outcome after cardiac arrest. Crit Care Med, 34(7), 1865-73.
I. Pichon, N., Amiel, J. B., Francois, B., & et al. (2007). Efficacy of and tolerance to
mild induced hypothermia after out-of-hospital cardiac arrest using an endovascular
cooling system. Critical Care, 11, R71.
J. Polderman, K. H. (2004). Application of therapeutic hypothermia in the intensive
care unit. Opportunities and pitfalls of a promising treatment modality-part 2:
practical aspects and side effects. Intensive Care Medicine, 30(5), 757-69.
K. Polderman, K. H. (2009). Mechanisms of action, physiological effects, and
complications of hypothermia. Critical Care Medicine, 37(7 Suppl), S186-202.
L. ZOLL Circulation, Inc. (2012). ZOLL Circulation Operation Manual. Sunnyvale, CA:
ZOLL Circulation, Inc. http://www.zoll.com/medical-products/product-
manuals/?pid=12576

X. REVIEWED BY

Clinical Nurse Specialist, Medical Cardiology
Clinical Nurse Specialist, Neurosciences
Clinical Nurse Specialist, Trauma Life Support Center
Clinical Nurse Specialist, Pediatric ICU
Nurse Manager, Neurosciences
Nursing Patient Care Policy and Procedure Committee, January 2017

SIGNED BY

Beth Houlahan, DNP, RN, CENP
Senior Vice President Patient Care Services, Chief Nurse Executive