picco的介绍

PiCCO plus Standalone Monitor
PiCCO-Technology
PiCCO ...
...Simple – Safe – Speedy - Specific
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Contents 1. What is the PiCCO-Technology?.................................................................................... 3 2. What are the advantages of the PiCCO-Technology?.................................................... 4 3. How does the PiCCO-Technology work?....................................................................... 6 4. How to use the PiCCO-Technology?............................................................................. 19 5. Which disposables do I need for the PiCCO-Technology?............................................ 22 6. References…………………………………………………………………………………….. 24 7. Where can I get what I need?..........................................................................................25
The PiCCO measures the following main parameters:
Thermodilution Parameters Cardiac Output Global Enddiastolic Volume Intrathoracic Blood Volume Extravascular Lung Water CO GEDV ITBV EVLW*
R F
Arterial pressure transducer
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a. Transpulmonary Thermodilution Transpulmonary thermodilution measurement simply requires the central venous injection of a cold (< 8°C) or room-tempered (< 24°C) saline bolus…
CV Bolus Injection
Lungs Right Heart Left Heart
PiCCO Catheter e.g. in femoral artery
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PiCCO Thermodilution Cardiac Output After central venous injection of the indicator, the thermistor in the tip of the arterial catheter measures the downstream temperature changes The cardiac output is calculated by analysis of the thermodilution curve using a modified Stewart-Hamilton algorithm:
The striking advantage of ITBV and GEDV is that they are not wrongly influenced by mechanical ventilation and give correct information on the preload status under any condition. 2,3,6,7,8,9,12,13, 22
Short Set-up Time
Dynamic, Continuous Measurement - Cardiac Output, Afterload and Volume Responsiveness are measured beat-by-beat No Chest X-ray Cost Effective - To confirm correct catheter position no x-ray is necessary - Less expensive than pulmonary artery catheter technique - Arterial PiCCO catheter can be in place for 10 days or more - Potential to reduce ICU stay and costs - PiCCO parameters are easy to use and interpret even for less experienced clinical staff - Lung edema can be excluded or quantified at the bed-side
Central venous line Arterial line
(e.g. for vasoactive agents administration…)
(accurate monitoring of arterial pressure, blood samples…)
The PiCCO-Technology uses any standard CV-line and a thermistor-tipped arterial PiCCO-catheter instead of the standard arterial line.
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Extravascular Lung Water* Extravascular Lung Water (EVLW)* is the amount of water content in the lungs. It allows bedside quantification of the degree of pulmonary edema.
Global Enddiastolic Volume Global Enddiastolic Volume (GEDV) is the volume of blood contained in the 4 chambers of the heart.
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Intrathoracic Blood Volume Intrathoracic Blood Volume (ITBV) is the volume of the 4 chambers of the heart + the blood volume in the pulmonary vessels.
* not available in USA 13
PiCCO Preload Indicators Intrathoracic Blood Volume, ITBV and Global Enddiastolic Volume, GEDV have shown to be far more sensitive and specific to cardiac preload than the standard cardiac filling pressures CVP + PCWP but also than right ventricular enddiastolic volume. 2,3,5,6,8,9,12,13,22
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Extravascular Lung Water* Extravascular Lung Water, EVLW* assessment by transpulmonary thermodilution has been validated against dye dilution and the reference gravimetric method.11,16,21,23
a. Transpulmonary thermodilution
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b. Arterial pulse contour analysis
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see also page 8tsee also page 16
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2. What are the advantages of the PiCCO-Technology?
Pulse Contour Parameters Pulse Continuous Cardiac Output PCCO Systemic Vascular Resistance SVR Stroke Volume Variation SVV
* not available in USA 4
2. What are the advantages of the PiCCO-Technology?
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Configuration Central venous line (CV) CV A Thermodilution catheter with lumen for arterial pressure measurement Axillary (A) Brachial (B) Femoral (F) Radial (R), long catheter B
* not available in USA 5
More Specific Parameters Extravascular Lung Water*
3. How does the PiCCO-Technology work? Most of hemodynamic unstable and/or severely hypoxemic patients are instrumented with: