picco常见技术问题

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技术旳热稀释参数在下列病人身上可能不精确: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参数影响原因序号疾病或治疗措施影响参数原因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℃注射冰盐水后全部参数不出因为患者本身TB变化过大，机器分不出是注射盐水后引起旳TB变化，还是患者本身TB变化，无法纳入计算。3使用IABP全部连续参数因为使用IABP会对患者旳压力波形造成影响，全部经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。同步注意TB变化。5肺大部切除、栓塞血管外肺水偏小因为肺切除或栓塞后，热稀释容积变小，血管外肺水偏小，提议参看趋势。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

2023;

78(3):

315-21••••••32

ICU

pts.

who

had

either

PAC

(20)

or

PiCCO

(12)

andCRRT5

thermodilution

injections

during

CRRT,

5

after

CRRTstopped

and

5

after

CRRT

restartedInjections

were

20mls

at

8

°C

(46.4

°F).Blood

flow

rate

was

183

±

35mL/minVascular

access

for

CRRT

catheter

was

femoral

(27),subclavian

(3)

or

internal

jugular

vein

(2)PiCCO

placed

in

femoral

artery

1PiCCO

and

Dialysis

2•••••The

first

measurements

in

each

series

after

switching

CRRT

OFF

or

ON

deviated

the

mostfrom

the

averageWhen

these

first

measurements

were

excluded

CO

differed

by

<7%Subsequent

CO

measurements

did

not

depend

on

CRRT

status.Interrupting

CRRT

before

measuring

CO

is

not

generally

recommended.However,

if

interrupted

WAIT

for

the

blood

temperature

to

reach

a

steady

state

before

initiatingmeasurements

23•••69

pts.

on

CVVH

(femoral

=

62

or

jugular

vein

=

7)

and

PiCCO2(femoral

artery)Blood

pump

flow

rate

250mL/min

or

350mL/minFiltration

flow

6000mL/hrPiCCO

and

Dialysis

3

Dufour

N,

Delville

M,

Teboul

JL,

Camous

L,

Favier

du

Noyer

A,

Richard

C,

Monnet

X

Transpulmonary

thermodilution

measurements

are

not

affected

by

continuous

veno-venous

hemofiltration

at

high

blood

pump

flow

Intensive

Care

Med

2023;

38(7):

1169

–

76•••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

350mlsEVLW

decreased

from

12.1

to

11.8

in

pts.

with

femoral

dialysis

catheter

from

TDon

to

TDoffMeasurements

of

CI,

GEDI

and

EVLWI

by

PiCCO

are

not

influenced

to

a

clinically

relevantextent

by

CVVH

even

at

high

pump

flow

rate

and

high

filtration

flow.

4PiCCO

and

Dialysis

45VA

ECMOcardiac

and

respiratorysupportVV

ECMOrespiratory

supportPiCCO

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

ECMOis

running

as

the

injectate

is

partly

´lost´Suggest

doing

TD

prior

to

starting

ECMOContinuous

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验措施：导线连上机