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,.,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,.,.,PiCCOandDialysis1HeiseD,FaulstichM,MorerO,Brauer,QuintelMInfluenceofcontinuousrenalreplacementtherapyoncardiacoutputmeasurementusingthermodilutiontechniquesMinervaAnestesiol2012;78(3):315-21,32ICUpts.whohadeitherPAC(20)orPiCCO(12)andCRRT5thermodilutioninjectionsduringCRRT,5afterCRRTstoppedand5afterCRRTrestartedInjectionswere20mlsat8C(46.4F).Bloodflowratewas18335mL/minVascularaccessforCRRTcatheterwasfemoral(27),subclavian(3)orinternaljugularvein(2)PiCCOplacedinfemoralartery1,.,PiCCOandDialysis2,ThefirstmeasurementsineachseriesafterswitchingCRRTOFForONdeviatedthemostfromtheaverageWhenthesefirstmeasurementswereexcludedCOdifferedby7%SubsequentCOmeasurementsdidnotdependonCRRTstatus.InterruptingCRRTbeforemeasuringCOisnotgenerallyrecommended.However,ifinterruptedWAITforthebloodtemperaturetoreachasteadystatebeforeinitiatingmeasurements2,.,3,69pts.onCVVH(femoral=62orjugularvein=7)andPiCCO2(femoralartery)Bloodpumpflowrate250mL/minor350mL/minFiltrationflow6000mL/hr,PiCCOandDialysis3DufourN,DelvilleM,TeboulJL,CamousL,FavierduNoyerA,RichardC,MonnetXTranspulmonarythermodilutionmeasurementsarenotaffectedbycontinuousveno-venoushemofiltrationathighbloodpumpflowIntensiveCareMed2012;38(7):116976,.,TDCIonwassameasPCoffandTDCIoffregardlessofbloodflow(250or350mls)NochangeinGEDIwhetherpumpwasonorofforsetat250or350mlsEVLWdecreasedfrom12.1to11.8inpts.withfemoraldialysiscatheterfromTDontoTDoff,MeasurementsofCI,GEDIandEVLWIbyPiCCOarenotinfluencedtoaclinicallyrelevantextentbyCVVHevenathighpumpflowrateandhighfiltrationflow.4,PiCCOandDialysis4,.,5,VAECMOcardiacandrespiratorysupport,VVECMOrespiratorysupport,PiCCOandECMOCanyouusethePiCCOinpatientswithECMO?,ECMOhasamuchhigherbloodflowcomparedtoRRT(6-7l/minvs250mls/min)BecauseofthisandwherethecathetersareplacedthermodilutionisnotpossiblewhilstECMOisrunningastheinjectateispartlylostSuggestdoingTDpriortostartingECMOContinuousnumbersarenoteffectedbyECMO,.,PiCCO位置,CVC位置,.,.,.,.,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