PiCCO常见技术问题 .pptx

PiCCO常见技术问题2020/11/24PiCCO故障排除经验分享2020/11/242020/11/24精品资料你怎么称呼老师？如果老师最后没有总结一节课的重点的难点，你是否会认为老师的教学方法需要改进？你所经历的课堂，是讲座式还是讨论式？教师的教鞭“不怕太阳晒，也不怕那风雨狂，只怕先生骂我笨，没有学问无颜见爹娘 ……”“太阳当空照，花儿对我笑，小鸟说早早早……”2020/11/24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2020/11/24PiCCO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。病人情况2020/11/24PiCCO 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 2012; 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 12020/11/24PiCCO 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 22020/11/24PiCCO 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 2012; 38(7): 1169 – 76???69 pts. on CVVH (femoral = 62 or jugular vein = 7) and PiCCO2(femoral artery)Blood pump flow rate 250mL/min or 350mL/minFiltration f