PiCCO常见技术问题-课件

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2PiCCO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3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: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。4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PiCCOandDialysis1

HeiseD,FaulstichM,MorerO,Brauer,QuintelM

Influence

of

continuous

renal

replacement

therapy

on

cardiac

output

measurement

using

thermodilution

techniques

MinervaAnestesiol2012;78(3):315-21••••••32ICUpts.whohadeitherPAC(20)orPiCCO(12)andCRRT5thermodilutioninjectionsduringCRRT,5afterCRRTstoppedand5afterCRRTrestartedInjectionswere20mlsat8°C(46.4°F).Bloodflowratewas183±35mL/minVascularaccessforCRRTcatheterwasfemoral(27),subclavian(3)orinternaljugularvein(2)PiCCOplacedinfemoralartery

15PiCCOandDialysis1•32ICUptPiCCOandDialysis2•••••ThefirstmeasurementsineachseriesafterswitchingCRRT

OFF

or

ONdeviatedthemostfromtheaverageWhenthesefirstmeasurementswereexcludedCOdifferedby<7%SubsequentCOmeasurementsdidnotdependonCRRTstatus.InterruptingCRRTbeforemeasuringCOisnotgenerallyrecommended.However,ifinterruptedWAITforthebloodtemperaturetoreachasteadystatebeforeinitiatingmeasurements

26PiCCOandDialysis2•Thefirst3•••69pts.onCVVH(femoral=62orjugularvein=7)andPiCCO2(femoralartery)Bloodpumpflowrate250mL/minor350mL/minFiltrationflow6000mL/hrPiCCOandDialysis3

DufourN,DelvilleM,TeboulJL,CamousL,FavierduNoyerA,RichardC,MonnetX

Transpulmonary

thermodilution

measurements

are

not

affected

by

continuous

veno-venous

hemofiltration

at

high

blood

pump

flow

IntensiveCareMed2012;38(7):1169–7673•69pts.onCVVH(femoral=6•••TDCIonwassameasPCoffandTDCIoffregardlessofbloodflow(250or350mls)NochangeinGEDIwhetherpumpwasonorofforsetat250or350mlsEVLWdecreasedfrom12.1to11.8inpts.withfemoraldialysiscatheterfromTDontoTDoffMeasurements

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.

4PiCCOandDialysis48•TDCIonwassameasPCoffand大家学习辛苦了，还是要坚持继续保持安静9大家学习辛苦了，还是要坚持继续保持安静95VA

ECMOcardiacandrespiratorysupportVV

ECMOrespiratorysupportPiCCOandECMO

Can

you

use

the

PiCCO

in

patients

with

ECMO?••••ECMOhasamuchhigherbloodflowcomparedtoRRT(6-7l/minvs250mls/min)BecauseofthisandwherethecathetersareplacedthermodilutionisnotpossiblewhilstECMOisrunningastheinjectateispartly´lost´SuggestdoingTDpriortostartingECMOContinuousnumbersarenoteffectedbyECMO105VAECMOVVECMOPiCCOandECMO•导管位置PiCCO位置CVC位置11导管位置PiCCO位置CVC位置11设备连接12设备连接12操作规范13操作规范13操作规范14操作规范14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