picco常见技术问题_ppt课件

PiCCO常见技术问题 PiCCO故障排除经验分享 病人 情况 导管 位置 设备 连接 操作 规范 耗材 损坏 缆线 损坏 设备 故障 问题 解决 病人 情况 PiCCO技术的热稀释参数在以下病人身上可 能不准确: 瓣膜返流，室间隔缺损 主动脉瘤 肺切除病人 巨大肺栓塞 体外循环期间 严重心率紊乱 严重气胸 病人 情况 PiCCO参数影响因素 序号 疾病或治疗方法影响参数原因 1心律失常 SVV、PPV参数为星 号 SVV和PPV是30S计算一次 2血温(TB)变化0.1 注射冰盐水后所有 参数不出 由于患者自身TB变化过大，机器分不出 是注射盐水后引起的TB变化，还是患者 自身TB变化，无法纳入计算。 3使用IABP所有连续参数 由于使用IABP会对患者的压力波形造成 影响，所有通过动脉压力波形测得参数 都无法显示。非连续参数无影响。 4应用CRRT基本无影响 但注意如血透管在股静脉，应不要把 PiCCO导管置入同侧。同时注意TB变 化。 5肺大部切除、栓塞血管外肺水偏小 由于肺切除或栓塞后，热稀释容积变小 ，血管外肺水偏小，建议参看趋势。 PiCCO and Dialysis 1 Heise D, Faulstich M, Morer O, Brauer, Quintel M Influence of continuous renal replacement therapy on cardiac output measurement using thermodilution techniques Minerva Anestesiol 2012; 78(3): 315-21 32 ICU pts. who had either PAC (20) or PiCCO (12) and CRRT 5 thermodilution injections during CRRT, 5 after CRRT stopped and 5 after CRRT restarted Injections were 20mls at 8 C (46.4 F). Blood flow rate was 183 35mL/min Vascular access for CRRT catheter was femoral (27), subclavian (3) or internal jugular vein (2) PiCCO placed in femoral artery 1 TDCIon was same as PCoff and TDCIoff regardless of blood flow (250 or 350 mls) No change in GEDI whether pump was on or off or set at 250 or 350mls EVLW decreased from 12.1 to 11.8 in pts. with femoral dialysis catheter from TDon to TDoff Measurements of CI, GEDI and EVLWI by PiCCO are not influenced to a clinically relevant extent by CVVH even at high pump flow rate and high filtration flow. 4 PiCCO and Dialysis 4 5 VA ECMO cardiac and respiratory support VV ECMO respiratory support PiCCO and ECMO Can you use the PiCCO in patients with ECMO? ECMO has a much higher blood flow compared to RRT (6-7 l/min vs 250 mls/min) Because of this and where the catheters are placed thermodilution is not possible whilst ECMO is running as the injectate is partly lost Suggest doing TD prior to starting ECMO Continuous numbers are not effected by ECMO 导管 位置 PiCCO位置 CVC位置 设备 连接 操作 规范 操作 规范 注射液温度电缆线检查方法：导线连上机器后，往金属探针 哈口气，观察机器上Tinj是否有变化 T型管检查方法：观察金属弹簧在注射后是否复位 压力传感器检查方法：向芯片端注射生理盐水。观察屏幕上 是否显示“平台压” 动脉热稀释导管及电缆检查方法：通过压力测量腔注射少量 冰的生理