1、PiCCO常见技术问题PiCCO故障排除经验分享病人情况导管位置设备连接操作规范耗材损坏缆线损坏设备故障问题解决2PiCCO技术的热稀释参数在以下病人身上可技术的热稀释参数在以下病人身上可能不准确能不准确: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3PiCCO参数影响因素参数影响因素序号 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
2、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。4PiCCO and Dialysis 1Heise D, Faulstich M, Morer O, Brauer, Quintel MInfluence of continuous renal replacement therapy on cardiac output measurementusing t
3、hermodilution techniquesMinerva Anestesiol 2012; 78(3): 315-2132 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
4、 catheter was femoral (27),subclavian (3) or internal jugular vein (2)PiCCO placed in femoral artery15PiCCO and Dialysis 2The 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 m
5、easurements 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 initiatingmeasurements26369 pts. on CVVH (femoral = 62 or jugular vein = 7) and PiCCO2(femoral artery)Blo
6、od pump flow rate 250mL/min or 350mL/minFiltration flow 6000mL/hrPiCCO and Dialysis 3Dufour N, Delville M, Teboul JL, Camous L, Favier du Noyer A, Richard C, Monnet XTranspulmonary thermodilution measurements are not affected by continuousveno-venous hemofiltration at high blood pump flowIntensive C
7、are Med 2012; 38(7): 1169 767TDCIon 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
8、by PiCCO are not influenced to a clinically relevantextent by CVVH even at high pump flow rate and high filtration flow.4PiCCO and Dialysis 4895VA ECMOcardiac and respiratorysupportVV ECMOrespiratory supportPiCCO and ECMOCan you use the PiCCO in patients with ECMO?ECMO has a much higher blood flow c
9、ompared 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 lostSuggest doing TD prior to starting ECMOContinuous numbers are not effected by ECMO10PiCCO位置位置CVC位置位置11121314注射液温度电缆线检查方法：导线连上机器后，往金属探针哈口气，观察机器上Tinj是否有变化T型管检查方法：观察金属弹簧在注射后是否复位压力传感器检查方法：向芯片端注射生理盐水。观察屏幕上是否显示“平台压”动脉热稀释导管及电缆检查方法：通过压力测量腔注射少量冰的生理盐水，观察机器上TB是否变化灵敏15联系联系16
