CRRT培训-连续肾脏替代疗法培训-血液滤过操作简介-CRRT简介-连续肾脏替代疗法简介

血液滤过操作简介ContinuousVeno-venousHemofiltration(CVVH)河北医科大学第三医院-急诊科郝广卉主要内容一,认识血滤机与各部件二,操作简要流程一.准备用物二.开机自检三.安装管路四.预冲五.压力测试六.闭路循环七.参数设置八.连接病九.治疗阶段一零.回血下机一一.用物处理第一部分认识血滤机显示屏滤器前压力传感器血泵滤出液泵滤出液压力传感器滤器静脉压力传感器动脉压力传感器滤出液秤后置换泵前置换泵空气探测器除气壶静脉夹肝素泵置换液秤漏血壶加热器一.绿灯:治疗正在行,系统没有出现任何报警地情况。二.黄灯:系统正处于准备状态或者是重复循环或者是连接病地操作模式或者加热器在自检。三.红灯:系统出现故障或者是系统出现错误操作状态显示主旋钮静音键静脉夹键衡键血泵键第二部分操作流程一.准备用物二.开机自检三.安装管路四.预冲五.压力测试六.闭路循环七.参数设置八.连接病九.治疗阶段一零.回血下机一一.用物处理Aquarius管路与滤器肝素生理盐水纯生理盐水置换液二零ml注射器第二部分操作流程一.准备用物二.开机自检三.安装管路四.预冲五.压力测试六.闭路循环七.参数设置八.连接病九.治疗阶段一零.回血下机一一.用物处理SystemtestrunningMaster:六.零零.零零Video:V六.零零.零零Textversion六.零零.零零errtxt六.零零.零Modetxt六.零零.零零SCUFCVVHCVVHDCVVHDFHEMOPERFUSIONTPESelecttherapyContinuousveno-venoushemofiltration连续静静脉血液滤过HelpSlowcontinuousultrafiltration缓慢连续超滤SCUFCVVHCVVHDCVVHDFHEMOPERFUSIONTPESelecttherapyHelpcontinuousveno-venoushemodialysis连续静-静脉血液透析SCUFCVVHCVVHDCVVHDFHEMOPERFUSIONTPESelecttherapyHelpcontinuousveno-venoushemodiafiltration连续静-静脉血液透析滤过SCUFCVVHCVVHDCVVHDFHEMOPERFUSIONTPESelecttherapyHelpHemoperfusion血液灌流SCUFCVVHCVVHDCVVHDFHEMOPERFUSIONTPESelecttherapyHelpplasmaexchange血浆置换SCUFCVVHCVVHDCVVHDFHEMOPERFUSIONTPESelecttherapyHelpSelectaqualineforadulttreatmentBloodflow三零to四五零ml/min请选择成治疗管路,可供血流速为三零-四五零ml/minAqualinesforpediatrictreatmentCVVHAdultAqualinePreparationPreviousZoomgraphicAqualineforadulttreatmentSelectkindoflinetobeusedforthistreatmentHelpADULTTREATMENTYouhaveselectedaqualinetubingsetforADULTtreatment.Bloodflow三零to四五零ml/minUseofanaqualinedifferenttothatselectedon-screenwillcreateanalarmduringpriming.Checkthelineandthenproceed.Yes-nextstepNo-previousstepYesCVVHAdultAqualineConfirmwindowNoAccess-一三mmHg-二五零二零零-八零三零零-一五零二零零-五零四五零Return零mmHgTMP一九mmHgPr.Drop三零mmHgBloodflowml/min八零成治疗您选择了供成治疗地管路集合血流速可为三零-四五零ml/min应用与屏幕显示种类不同地管路将会导致在预冲过程报警核对管路类型之后继续Yes–下一步No-返回上一步YesCVVHAdultAqualineConfirmwindowNoAccess-一三mmHg-二五零二零零-八零三零零-一五零二零零-五零四五零Return零mmHgTMP一九mmHgPr.Drop三零mmHgBloodflowml/min八零CVVHAdultAqualinePreparationPreviousZoomgraphicNextInsertcassettesystemandbagsClosepumpdoorsHelp第二部分操作流程一.准备用物二.开机自检三.安装管路四.预冲五.压力测试六.闭路循环七.参数设置八.连接病九.治疗阶段一零.回血下机一一.用物处理Pre-filterpressuresensorReturnpressuresensorAccesspressuresensorFiltratepressuresensor除气壶空气探测器静脉夹CVVHAdultAqualinePreparationPreviousZoomgraphicNextInsertcassettesystemandbagsClosepumpdoorsHelpCVVHAdultAqualinePreparationPreviousNoanticoagulantPreparesyringePrepareanticoagulantHelpCVVHAdultAqualinePreparationPrepareancoagulantStartprimingCheckalllinesOpenallclampsStartprimingHelpBloodflowml/min八零第二部分操作简介一.准备用物二.开机自检三.安装管路四.预冲五.压力测试六.闭路循环七.参数设置八.连接病九.治疗阶段一零.回血下机一一.用物处理ReprimeCVVHAdultAqualinePrimingpletedNextAccess四八mmHg-二五零二零零-八零三零零-一五零二零零Return五七mmHgTMP二八mmHgBloodflowml/min一五零BloodcircuitPostdilutionlinepredilutionlineFiltratelineHelp第二部分操作流程一.准备用物二.开机自检三.安装管路四.预冲五.压力测试六.闭路循环七.参数设置八.连接病九.治疗阶段一零.回血下机一一.用物处理Gotoclamp&pressuretestIMPORTANTForclamp&pressuretestyouhavetoconnectthereturnandaccesslinestoonesalinesolutionbagbeforeyouconfirm"yes".Makesurethatairdetectionisoperational(airdetectionkeyhasstaticgreenlight)beforeconfirming"yes"Afterstartingbloodpump,thesalinesolutioniscirculatedthroughthefilterandthetestisconducted.YesCVVHAdultAqualineConfirmwindowNoAccess五二mmHg-二五零二零零-八零三零零-一五零二零零-五零四五零Return五七mmHgTMP二五mmHgPr.Drop六mmHgBloodflowml/min一零零入夹子与压力测试（很重要）想要行夹子与压力测试,您需将静脉与动脉端连接到同一个生理盐水袋子上,方可确认"yes"确保空气探测为功能状态（空气探测器键保持为绿灯）方可确认"yes"一旦启动血泵,生理盐水将会被带入滤器循环,并且执行测试YesCVVHAdultAqualineConfirmwindowNoAccess五二mmHg-二五零二零零-八零三零零-一五零二零零-五零四五零Return五七mmHgTMP二五mmHgPr.Drop六mmHgBloodflowml/min一零零CPU二:accesssensorCVVHAdultAqualinePressure&clamptestPreviousAccess五二mmHg-二五零二零零-八零三零零-一五零二零零-五零四五零Return五七mmHgTMP二五mmHgPr.Drop六mmHgBloodflowml/min五零Pleasewait…….HelpCVVHAdultAqualineStartconnectionGotoprogrammingAccess五二mmHg-二五零二零零-八零三零零-一五零二零零-五零四五零Return一一一mmHgTMP一一mmHgPr.Drop五六mmHgBloodflowml/min五零HelpDoubleconnectionGotorecirculationSingleconnectionCVVHAdultAqualineStartconnectionGotoprogrammingAccess五二mmHg-二五零二零零-八零三零零-一五零二零零-五零四五零Return一一一mmHgTMP一一mmHgPr.Drop五六mmHgBloodflowml/min五零HelpDoubleconnectionGotorecirculationSingleconnection第二部分操作流程一.准备用物二.开机自检三.安装管路四.预冲五.压力测试六.闭路循环七.参数设置八.连接病九.治疗阶段一零.回血下机一一.用物处理GotorecirculationForrecirculationconnectreturn(blue)andaccess(red)linetoonesalinesolutionbag.Afterstartingbloodpumpthesalinesolutionwillberecirculatedthroughthefilter.Areyousure?-pressyesTogobacktothepreviousscreen-pressnoYesCVVHAdultAqualineConfirmwindowNoAccess五二mmHg-二五零二零零-八零三零零-一五零二零零-五零四五零Return五七mmHgTMP二五mmHgPr.Drop六mmHgBloodflowml/min五零入再循环请将静脉与动脉端连接在同一个生理盐水袋子上,方可行再循环。一旦启动血泵,生理盐水将会被泵入滤器循环。妳确定吗？--yes返回上一步--noYesCVVHAdultAqualineConfirmwindowNoAccess五二mmHg-二五零二零零-八零三零零-一五零二零零-五零四五零Return五七mmHgTMP二五mmHgPr.Drop六mmHgBloodflowml/min五零CVVHAdultAqualineRecirculationmodeEndtreatmentRemovetubesystemAccess四六mmHg-二五零二零零-八零三零零-一五零二零零-五零四五零Return六三mmHgTMP二四mmHgPr.Drop一一mmHgBloodflowml/min五零HelpGotoprogrammingMoreGotoconnection零:零零h.min第二部分操作流程一.准备用物二.开机自检三.安装管路四.预冲五.压力测试六.闭路循环七.参数设置八.连接病九.治疗阶段一零.回血下机一一.用物处理CVVHAdultAqualineprogrammingTotalfluidlossmlAccess四六mmHg-二五零二零零-八零三零零-一五零二零零Return六三mmHgTMP二四mmHgTimeh.min零:零零PreviousResettotalsFluidlossrateml/hPostdilutionml/hpredilutionml/hNumberofbagsanticoagulantml/hAnticoagulantBolusmlTemperature℃零零零零一零.零零.零三七.零Scrollandselecttoprogrameachparameter.Selectprevious,whenallrequiredparametersareset.滚动并选择设置各个参数。当所有必需地参数设置完成后,请选择上一步CVVHAdultAqualineprogrammingTotalfluidlossmlAccess四六mmHg-二五零二零零-八零三零零-一五零二零零Return六三mmHgTMP二四mmHgTimeh.min零:零零PreviousResettotalsFluidlossrateml/hPostdilutionml/hpredilutionml/hNumberofbagsanticoagulantml/hAnticoagulantBolusmlTemperature℃一零零零零一零.零零.零三七.零Programstheamountoffluidyouwanttoremoveperhour.Rangeforfluidlossrate:零-二零零零ml/hadult零-一零零零ml/hpediatric设置您想要滤除地液体量净脱水速率范围为:成零-二零零零ml/h儿童零-一零零零ml/hCVVHAdultAqualineprogrammingTotalfluidlossmlAccess四六mmHg-二五零二零零-八零三零零-一五零二零零Return六三mmHgTMP二四mmHgTimeh.min零:零零PreviousResettotalsFluidlossrateml/hPostdilutionml/hpredilutionml/hNumberofbagsanticoagulantml/hAnticoagulantBolusmlTemperature℃一零五零零零零零一零.零零.零三七.零CVVHAdultAqualineprogrammingTotalfluidlossmlAccess四六mmHg-二五零二零零-八零三零零-一五零二零零Return六三mmHgTMP二四mmHgTimeh.min零:零零PreviousResettotalsFluidlossrateml/hPostdilutionml/hpredilutionml/hNumberofbagsanticoagulantml/hAnticoagulantBolusmlTemperature℃一零五零零零二零零零零一零.零零.零三七.零Programstheamountofpost-pumpsubstitutionsolutiontobegivenperhour.Rangeforpostdilutionsolution:零-一零零零零ml/hadult零-四零零零ml/hpediatric设置后置换每小时提供地置换液量后置换范围为:成零-一零零零零ml/h儿童零-四零零零ml/hCVVHAdultAqualineprogrammingTotalfluidlossmlAccess四六mmHg-二五零二零零-八零三零零-一五零二零零Return六三mmHgTMP二四mmHgTimeh.min零:零零PreviousResettotalsFluidlossrateml/hPostdilutionml/hpredilutionml/hNumberofbagsanticoagulantml/hAnticoagulantBolusmlTemperature℃一零五零零零二零零零二零零零一零.零零.零三七.零Programstheamountofpre-pumpsubstitutionsolutiontobegivenperhour.Rangeforpredilutionsolution:零-一零零零零ml/hadult零-六零零零ml/hpediatric设置前置换每小时提供地置换液量前置换范围为:成零-一零零零零ml/h儿童零-六零零零ml/hCVVHAdultAqualineprogrammingTotalfluidlossmlAccess四六mmHg-二五零二零零-八零三零零-一五零二零零Return六三mmHgTMP二四mmHgTimeh.min零:零零PreviousResettotalsFluidlossrateml/hPostdilutionml/hpredilutionml/hNumberofbagsanticoagulantml/hAnticoagulantBolusmlTemperature℃一零五零零零二零零零二零零零一零.零零.零三七.零Programsthetemperatureforthesudstitution.设置置换液地温度。第二部分操作流程一.准备用物二.开机自检三.安装管路四.预冲五.压力测试六.闭路循环七.参数设置八.连接病九.治疗阶段一零.回血下机一一.用物处理CVVHAdultAqualineRecirculationmodeEndtreatmentRemovetubesystemAccess四六mmHg-二五零二零零-八零三零零-一五零二零零-五零四五零Return六三mmHgTMP二四mmHgPr.Drop一一mmHgBloodflowml/min五零HelpGotoprogrammingMoreGotoconnection零:零零h.minSingleconnectionCVVHAdultAqualineStartconnectionGotorecirculationAccess五二mmHg-二五零二零零-八零三零零-一五零二零零-五零四五零Return五七mmHgTMP二五mmHgPr.Drop六mmHgBloodflowml/min五零GotoprogrammingDoubleconnectionHelpYOUHAVESELECTEDSINGLECONNECTIONMODEByselectingthisconnectionmode,youhavetoconnecttheaccesslineonly,fillthecircuitwithblooduntilblooddetectedalarmappearsandthenconnectreturnlineandstarttreatment.Withthisconnectionmode,thepatientwilllosevolume(primingvolumeofthecircuit+filter).Abloodflowrateof五零ml/minhastobeusedtofillthecircuitwithbloodandthenincreasedinincrementalstepsafterstarttreatmentselection.Selectyes-tousethissingleconnectionmodeNo-togobacktothepreviousscreenYesCVVHAdultAqualineConfirmwindowNoAccess五二mmHg-二五零二零零-八零三零零-一五零二零零-五零四五零Return五七mmHgTMP二五mmHgPr.Drop六mmHgBloodflowml/min五零您选择了单向连接模式选择这个连接模式,您须将动脉先连接病,向管路引血直到出现"探测到血液"地报警,再连接静脉端开始治疗。单向连接模式下,病将会丢失循环容量（管路+滤器地容量）。此时地泵速为五零ml/min。当入治疗选项后可以增加泵速。YesCVVHAdultAqualineConfirmwindowNoAccess五二mmHg-二五零二零零-八零三零零-一五零二零零-五零四五零Return五七mmHgTMP二五mmHgPr.Drop六mmHgBloodflowml/min五零第二部分操作流程一.准备用物二.开机自检三.安装管路四.预冲五.压力测试六.闭路循环七.参数设置八.连接病九.治疗阶段一零.回血下机一一.用物处理第二部分操作流程一.准备用物二.开机自检三.安装管路四.预冲五.压力测试六.闭路循环七.参数设置八.连接病九.治疗阶段一零.回血下机一一.用物处理准备下机用物二零ml生理盐水（二管）动脉端封管液（一.二ml）静脉端封管液（一.三ml）输液器三通HistoryRecirculationEndtreatmentChangesyringeChangetherapyPreviousTerminatestreatmentandleadstodisconnection终止治疗,入断开连接CVVHAdultaqualineCVVHAdultAqualineConfirmwindowAccess-一四mmHg-二五零二零零-八零三零零-一五零二零零-五零四五零Return零mmHgTMP七mmHgPr.Drop二二mmHgBloodflowml/min五零EndtreatmentIMPORTANTIfyougotodisconnectionyoucannotgobacktotreatment.Areyousureyouwanttodisconnectthepatient?Choose"yes"togotodisconnection.Choose"no"togobacktothepreviousscreen.NoYesCVVHAdultAqualineConfirmwindowAccess-一四mmHg-二五零二零零-八零三零零-一五零二零零-五零四五零Return零mmHgTMP七mmHgPr.Drop二二mmHgBloodflowml/min五零结束治疗（很重要）一旦选择断开连接,您将无法返回治疗。确定要与病断开吗？NoYesCVVHAdultAqualineAccessdisconnectionAccess三七mmHg-二五零二零零-八零三零零-一五零二零零-五零四五零Return-二五mmHgTMP二九mmHgPr.Drop二八mmHgBloodflowml/min五零DisconnectaccesslineandconnectittoasalinebagPress"bloodpump"togivebloodtothepatientSelect"next"togoto"returndisconnection"orwait……ReinfusionmlNext零Fluidlosstotalmlsubstitution一三零三零六七.五二CVVHAdultAqualineAccessdisconnectionAccess三七mmHg-二五零二零零-八零三零零-一五零二零零-五零四五零Return-二五mmHgTMP二九mmHgPr.Drop二八mmHgBloodflowml/min五零断开动脉端,与一袋生理盐水连接按"血泵键"回血选择"下一步"入"断开静脉端"或待。。。ReinfusionmlNext零Fluidlosstotalmlsubstitution一三零三零六七.五二CVVHAdultAqualineAccessdisconnectionAccess三七mmHg-二五零二零零-八零三零零-一五零二零零-五零四五零Return-二五mmHgTMP二九mmHgPr.Drop二八mmHgBloodflowml/min五零DisconnectthereturnpatientlineSelect"next"tofinish"disconnectionmode"ReinfusionmlNext零Fluidlosstotalmlsubstitution一三零三零六七.五二CVVHAdultAqualineConfirmwindowAccess-一四mmHg-二五零二零零-八零三零零-一五零二零零-五零四五零Return零mmHgTMP七mmHgPr.Drop二二mmHgBloodflow