PiCCO常见技术问题PPT课件

1、.,1,PiCCO常见技术问题,.,2,PiCCO故障排除经验分享,.,3,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,.,4,.,5,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 technique

2、s 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

3、 femoral (27), subclavian (3) or internal jugular vein (2) PiCCO placed in femoral artery 1,.,6,PiCCO and Dialysis 2, ,The first measurements in each series after switching CRRT OFF or ON deviated the most from the average When these first measurements were excluded CO differed by 7% Subsequent CO m

4、easurements 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 initiating measurements 2,.,7,3, ,69 pts. on CVVH (femoral = 62 or jugular vein = 7) and PiCCO2(femoral

5、 artery) Blood pump flow rate 250mL/min or 350mL/min Filtration flow 6000mL/hr,PiCCO 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 pum

6、p flow Intensive Care Med 2012; 38(7): 1169 76,.,8, ,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,Measurem

7、ents 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,.,9,5,VA ECMO cardiac and respiratory support,VV ECMO respiratory support,PiCCO and ECMO Can you use the PiCCO in patients with

8、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,.,10,PiCCO位置,CVC位置,.,11,.,12,.,13,.,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