1、2021/3/91PiCCO常見技術問題2021/3/92PiCCO故障排除經驗分享2021/3/93病人情況PiCCO技術的熱稀釋參數在以下病人身上技術的熱稀釋參數在以下病人身上可能不準確可能不準確: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期間嚴重心率紊亂嚴重氣胸2021/3/94病人情況PiCCO參數影響因素參數影響因素序號 疾病或治療方法影響參數原因1心律失常SVV、PPV參數為星號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

2、所有連續參數由于使用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都無法顯示。非連續參數無影響。4應用CRRT基本無影響但注意如血透管在股靜脈，應不要把PiCCO導管置入同側。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。2021/3/95PiCCO and Dialysis 1Heise D, Faulstich M, Morer O, Brauer, Quintel MInfluence of continuous renal replacement therapy on cardiac output

3、measurementusing thermodilution 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/minVascul

4、ar access for CRRT catheter was femoral (27),subclavian (3) or internal jugular vein (2)PiCCO placed in femoral artery12021/3/96PiCCO 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 dif

5、fered 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 initiatingmeasurements22021/3/97369 pts. on CVVH (femoral = 62 or jugular vein

6、= 7) and PiCCO2(femoral artery)Blood 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

7、at high blood pump flowIntensive Care Med 2012; 38(7): 1169 762021/3/98TDCIon 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 t

8、o 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 42021/3/995VA ECMOcardiac and respiratorysupportVV ECMOrespiratory supportPiCCO and ECMOCan you use the PiCCO in patie

9、nts 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 lostSuggest doing TD prior to starting ECMOContinuous numbers are not effected by ECMO2021/3/910導管位置PiCCO位位置置CVC位位置置2021/3/911設備連接2021/3/912操作規范2021/3/913操作規范2021/3/914注射液溫度電纜線檢查方法：導線連上機器后，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否復位壓力傳感器檢查方法：向芯片端注射生理鹽水。觀察屏幕上是否顯示