PiCCO常见技术问题 PPT

• Injections were 20mls at 8 °C (46.4 °F). • Blood flow rate was 183 ± 35mL/min • Vascular access for CRRT catheter was femoral (27),
subclavian (3) or internal jugular vein (2) • PiCCO placed in femoral artery
• 32 ICU pts. who had either PAC (20) or PiCCO (12) and CRRT
• 5 thermodilution injections during CRRT, 5 after CRRT stopped and 5 after CRRT restarted
measurements
2
6
PiCCO 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
1
5
PiCCO and Dialysis 2
• The first measurements in each series after switching CRRT OFF or ON deviated the most from the average
• When 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 initiating
4
8
大家学习辛苦了，还是要坚持
继续保持安静
9
PiCCO 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 ECMO
3
7
PiCCO and Dialysis 4
• 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 350mls • EVLW decreased from 12.1 to 11.8 in pts. with femoral dialysis catheter from TDon to TDoff Measurements of CI, GEDI and EVLWI by PiCCO are not influenced to a clinically relevant extent by CVVH even at high pump flow rate and high filtration flow.
3
病人
情况
PiCCO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
PiCCO常见技术问题
PiCCO故障排除经验分享
病人 导管 设备 操作 耗材 缆线 设备 问题 情况 位置 连接 规范 损坏 损坏 故障 解决
2
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
• 69 pts. on CVVH (femoral = 62 or jugular vein = 7) and PiCCO2(femoral artery) • Blood pump flow rate 250mL/min or 350mL/min • Filtration flow 6000mL/hr
4
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
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。