PiCCO常見技術(shù)問題PiCCO常見技術(shù)問題PiCCO故障排除經(jīng)驗分享病人情況導(dǎo)管位置設(shè)備連接操作規(guī)范耗材損壞纜線損壞設(shè)備故障問題解決PiCCO常見技術(shù)問題病人情況PiCCO技術(shù)的熱稀釋參數(shù)在以下病人身上可能不準確:瓣膜返流，室間隔缺損主動脈瘤肺切除病人巨大肺栓塞體外循環(huán)期間嚴重心率紊亂嚴重氣胸PiCCO常見技術(shù)問題病人情況PiCCO參數(shù)影響因素序號疾病或治療方法影響參數(shù)原因1心律失常SVV、PPV參數(shù)為星號SVV和PPV是30S計算一次2血溫(TB)變化>0.1℃注射冰鹽水后所有參數(shù)不出由于患者自身TB變化過大，機器分不出是注射鹽水后引起的TB變化，還是患者自身TB變化，無法納入計算。3使用IABP所有連續(xù)參數(shù)由于使用IABP會對患者的壓力波形造成影響，所有通過動脈壓力波形測得參數(shù)都無法顯示。非連續(xù)參數(shù)無影響。4應(yīng)用CRRT基本無影響但注意如血透管在股靜脈，應(yīng)不要把PiCCO導(dǎo)管置入同側(cè)。同時注意TB變化。5肺大部切除、栓塞血管外肺水偏小由于肺切除或栓塞后，熱稀釋容積變小，血管外肺水偏小，建議參看趨勢。PiCCO常見技術(shù)問題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

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

1PiCCO常見技術(shù)問題PiCCO

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

2PiCCO常見技術(shù)問題3???69

pts.

on

CVVH

(femoral

=

62

or

jugular

vein

=

7)

and

PiCCO2(femoral

artery)Blood

pump

flow

rate

250mL/min

or

350mL/minFiltration

flow

6000mL/hrPiCCO

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

–

76PiCCO常見技術(shù)問題???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

350mlsEVLW

decreased

from

12.1

to

11.8

in

pts.

with

femoral

dialysis

catheter

from

TDon

to

TDoffMeasurements

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.

4PiCCO

and

Dialysis

4PiCCO常見技術(shù)問題5VA

ECMOcardiac

and

respiratorysupportVV

ECMOrespiratory

supportPiCCO

and

ECMO

Can

you

use

the

PiCCO

in

patients

with

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

ECMOis

running

as

the

injectate

is

partly

′lost′Suggest

doing

TD

prior

to

starting

ECMOContinuous

numbers

are

not

effected

by

ECMOPiCCO常見技術(shù)問題導(dǎo)管位置PiCCO位置CVC位置PiCCO常見技術(shù)問題設(shè)備連接PiCCO常見技術(shù)問題操作規(guī)范PiCCO常見技術(shù)問題操作規(guī)范PiCCO常見技術(shù)問題注射液溫度電纜線檢查方法：導(dǎo)線連上機器后，往金屬探針哈口氣，觀察機器上Tinj是否有變化T型管檢查方法：觀察金屬彈簧在注射后是