PiCCO临床价值以及护理.ppt

* Picco技术提供的参数可以对。。。。儿科病人同样适用，烧伤科 Haemodynamic monitoring with PiCCO technology can be used in a large number of intensive care conditions. Early use is particularly beneficial so that the causes of the haemodynamic disorder can be identified as soon as possible and organ damage can be avoided as far as possible. PiCCO is also ideally suited for perioperative monitoring of high risk patients and/or high risk surgery. * PiCCO is a method with few complications and is not subject to any special limitations of use, in contrast to other monitoring methods such as lithium dilution and the pulmonary arterial catheter. The method can also be used without restriction in children (above 5kg) and pregnant women. * The risks include the usual risks of puncturing arteries or central veins. Since intensive care patients usually require these vascular accesses anyway, use of PiCCO does not involve any additional risk. In general, the same principles apply regarding the duration the catheter can be left in situ or should be removed if infection is suspected as for other intravascular catheters. For safety reasons, the manufacturer recommends that it should remain in situ for a maximum of 10 days. * In this case the CVP value is useless for therapuetic decisioon making. When preload and pulmonary oedema are measured the apprpriate therapy is easily decided. * * * * 病情观察密切观察生命体征的变化，严密观察病人意 识、体温、脉搏、呼吸、血压、血氧饱和度及心电图变化并记录。 观察监视屏上各种数值及肺动脉压力及股动脉压力波形变化， 发现异常迅速查明原因并及时通知医生处理。持续监测 )、 CI、SV、SⅥt、胸腔内血容量(rrBv)和血管外肺水(EVI )、 CVP等变化，据监测结果调整输液量l和l血管活性药物剂量。 3．3 穿刺侧肢体护理病人取平卧位，术侧肢体保持伸直、制 动，必要时予约束带约束或药物镇静；按时按摩，促进血液循环； 妥善固定导管，防止病人翻身或躁动时导管移位。观察穿刺局 部有无渗血、渗液、肿胀或淤斑，保持穿刺部位清洁、 r燥，发现 渗血、渗液及时更换敷料。密切观察穿刺侧肢体温度及颜色、足 背动脉搏动情况，必要时应用多普勒血管超声仪测试穿刺侧下 肢动脉血流及搏动情况，并准确记录，如发现肢体温度低、颜色 发绀，说明有栓塞的危险，肢体表现疼痛、肌肉痉挛、颜色苍白、 变凉、足背动脉搏动消失等，立即通知医生处置。 3 4 动脉压力监测E2] 密切观察管路连接处装置有无松动。 监测期问应用加压袋，压力保持在300 mmtlg(i mnftg=0．133 kPa)。持续给予肝素盐水(肝素12 500 U加入生l舜盐水5()0 mL)冲洗管道，保持管道通畅，每班较零点1次，每小时手动冲 洗1次，观察动脉插管内有无回血，压力表的指针是否在绿区。 同时注意观察皮肤黏膜、穿刺伤口、胃肠道以及颅内有