血液净化原理,模式及治疗的选择PPT课件.ppt

Catheter Characteristics * Copyright ? 2015 NIKKISO Co., LTD. All rights reserved. Ease of insertion: to avoid vessel trauma Good flow characteristics: to optimise blood flow Kink resistant: to avoid access pressure problems Biocompatible: to reduce complication risks Amenability to guide wire change: to optimise therapy Side-by-Side Polyurethane Catheters * Copyright ? 2015 NIKKISO Co., LTD. All rights reserved. Coaxial Polyurethane Catheters * Copyright ? 2015 NIKKISO Co., LTD. All rights reserved. Triple lumen Catheters * Copyright ? 2015 NIKKISO Co., LTD. All rights reserved. Silicone Catheters * Copyright ? 2015 NIKKISO Co., LTD. All rights reserved. Reversing the Lines * Copyright ? 2015 NIKKISO Co., LTD. All rights reserved. 1 Lewington A, Kanagasundaram S. Acute Kidney Injury. Renal Association guidelines: Guideline 8.1 – AKI: Vascular access for RRT. Guideline 8.2, Page 45 of 59, Para 3 ‘Rationale for 8.1-8.9’ lines 7-9 /Clinical/GuidelinesSection/AcuteKidneyInjury.aspx Vascular Access * Copyright ? 2015 NIKKISO Co., LTD. All rights reserved. Vascular Access is continuously tested during CRRT treatment Practical understanding about vascular access is necessary for optimal treatment Catheter site, size, type and patient preparation may be considered Inadequacies in vascular access may limit delivered therapy Troubleshooting choices Vascular Access Troubleshooting * Copyright ? 2015 NIKKISO Co., LTD. All rights reserved. Starting blood flow Gradual increase Optimising blood flow rates Starting treatment Using Aquarius History Using Recirculation Troubleshooting choices 预防滤器内的凝血(Recirculation) 重复循环模式：连接病人之前重复循环 20 - 40 /min ， 重复循环可以侵泡滤器的纤维，同时排空纤维中的 空气 . 滤器的纤维经过侵泡更加的饱满，改善血流通过 纤维的流量，排除极小的气泡防止早期的凝血. 一个循环时间在20– 20/ minutes . 滤器和管路基本可以 72 小时使用, 但这包括重复使用的时间. * Copyright ? 2015 NIKKISO Co., LTD. All rights reserved. Filtration Fraction（滤过分数） Filtration Fraction 滤过分数是 总液体通过 滤器的量与超滤量的相比 滤过分数通常是尽可能的低，理想