血液滤过操作简介

血液滤过操作简介Continuous￿Veno-venous￿Hemofiltration(CVVH)河北医科大学第三医院-急诊科郝广卉主要内容一、认识血滤机及各部件二、操作简要流程1.准备用物2.开机自检3.安装管路4.预冲5.压力测试6.闭路循环7.参数设置8.连接病人9.治疗阶段10.回血下机11.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1.绿灯：治疗正在进行中，系统没有出现任何报警的情况。2.黄灯：系统正处于准备状态或者是重复循环或者是连接病人的操作模式或者加热器在自检。3.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平衡键血泵键第二部分操作流程1.准备用物2.开机自检3.安装管路4.预冲5.压力测试6.闭路循环7.参数设置8.连接病人9.治疗阶段10.回血下机11.用物处理Aquarius管路与滤器肝素生理盐水纯生理盐水置换液20ml注射器第二部分操作流程1.准备用物2.开机自检3.安装管路4.预冲5.压力测试6.闭路循环7.参数设置8.连接病人9.治疗阶段10.回血下机11.用物处理System￿test￿runningMaster:6.00.00Video:V6.00.00Textversion6.00.00errtxt6.00.0Modetxt6.00.00SCUF￿CVVH￿CVVHD￿CVVHDF￿HEMOPERFUSION￿TPE￿Select￿therapy￿Continuous￿veno-venous￿hemofiltration连续性静静脉血液滤过Help￿Slow￿continuous￿ultrafiltration缓慢连续性超滤SCUF￿CVVH￿CVVHD￿CVVHDF￿HEMOPERFUSION￿TPE￿Select￿therapy￿Help￿continuous￿veno-venous￿hemodialysis连续性静-静脉血液透析SCUF￿CVVH￿CVVHD￿CVVHDF￿HEMOPERFUSION￿TPE￿Select￿therapy￿Help￿continuous￿veno-venous￿hemodiafiltration连续性静-静脉血液透析滤过SCUF￿CVVH￿CVVHD￿CVVHDF￿HEMOPERFUSION￿TPE￿Select￿therapy￿Help￿Hemoperfusion血液灌流SCUF￿CVVH￿CVVHD￿CVVHDF￿HEMOPERFUSION￿TPE￿Select￿therapy￿Help￿plasma￿exchange血浆置换SCUF￿CVVH￿CVVHD￿CVVHDF￿HEMOPERFUSION￿TPE￿Select￿therapy￿Help￿Select￿aqualine￿for￿adult￿treatment￿Blood￿flow￿30￿to￿450￿ml/min请选择成人治疗管路，可供血流速为30-450ml/minAqualines￿for￿pediatric￿￿treatment￿CVVH￿Adult￿AqualinePreparation￿￿Previous￿￿Zoom￿graphic￿Aqualine￿for￿adult￿￿treatmentSelect￿kind￿of￿line￿to￿be￿used￿for￿this￿treatment￿Help￿ADULT￿TREATMENTYou￿have￿selected￿aqualine￿tubing￿set￿for￿ADULT￿treatment.Blood￿flow￿30￿to￿450￿ml/minUse￿of￿an￿aqualine￿different￿to￿that￿selected￿on-screen￿will￿create￿an￿alarm￿during￿priming.Check￿the￿line￿and￿then￿proceed.Yes-next￿stepNo-previous￿step￿Yes￿CVVH￿Adult￿AqualineConfirm￿window￿￿No￿Access-13mmHg-250200-80300-150200-50450Return0mmHgTMP19mmHgPr.Drop30mmHgBlood￿flowml/min￿80成人治疗您选择了供成人治疗的管路集合血流速可为30-450ml/min应用与屏幕显示种类不同的管路将会导致在预冲过程中报警核对管路类型之后继续Yes–下一步No-返回上一步Yes￿CVVH￿Adult￿AqualineConfirm￿window￿￿No￿Access-13mmHg-250200-80300-150200-50450Return0mmHgTMP19mmHgPr.Drop30mmHgBlood￿flowml/min￿80CVVH￿Adult￿AqualinePreparation￿￿Previous￿￿Zoom￿graphic￿Next￿•Insert￿cassette￿system￿and￿bags•Close￿pump￿doorsHelp￿第二部分操作流程1.准备用物2.开机自检3.安装管路4.预冲5.压力测试6.闭路循环7.参数设置8.连接病人9.治疗阶段10.回血下机11.用物处理Pre-filterpressuresensorReturnpressuresensorAccesspressuresensorFiltratepressuresensor除气壶空气探测器静脉夹CVVH￿Adult￿AqualinePreparation￿￿Previous￿￿Zoom￿graphic￿Next￿•Insert￿cassette￿system￿and￿bags•Close￿pump￿doorsHelp￿CVVH￿Adult￿AqualinePreparation￿￿Previous￿￿No￿anticoagulantPrepare￿syringe￿Prepare￿anticoagulantHelp￿CVVH￿Adult￿AqualinePreparation￿￿Prepare￿ancoagulant￿￿Start￿priming•Check￿all￿lines•Open￿all￿clamps•Start￿primingHelp￿Blood￿flowml/min￿80第二部分操作简介1.准备用物2.开机自检3.安装管路4.预冲5.压力测试6.闭路循环7.参数设置8.连接病人9.治疗阶段10.回血下机11.用物处理Reprime￿￿CVVH￿Adult￿AqualinePriming￿completed￿￿Next￿Access48mmHg-250200-80300-150200Return57mmHgTMP28mmHgBlood￿flowml/min￿150Blood￿circuit￿￿Postdilution￿line￿￿predilution￿line￿￿Filtrate￿line￿￿Help￿第二部分操作流程1.准备用物2.开机自检3.安装管路4.预冲5.压力测试6.闭路循环7.参数设置8.连接病人9.治疗阶段10.回血下机11.用物处理Go￿to￿clamp￿&￿pressure￿testIMPORTANTFor￿clamp￿&￿pressure￿test￿you￿have￿to￿connect￿the￿return￿and￿access￿lines￿to￿one￿saline￿solutionbag￿before￿you￿confirm￿“yes”.Make￿sure￿that￿air￿detection￿is￿operational(air￿detection￿key￿has￿static￿green￿light)before￿confirming￿“yes”After￿starting￿blood￿pump,￿the￿saline￿solution￿is￿circulated￿through￿the￿filter￿and￿the￿test￿is￿conducted.￿Yes￿CVVH￿Adult￿AqualineConfirm￿window￿￿No￿Access52mmHg-250200-80300-150200-50450Return57mmHgTMP25mmHgPr.Drop6mmHgBlood￿flowml/min￿100进入夹子和压力测试（很重要）想要进行夹子和压力测试，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Yes￿CVVH￿Adult￿AqualineConfirm￿window￿￿No￿Access52mmHg-250200-80300-150200-50450Return57mmHgTMP25mmHgPr.Drop6mmHgBlood￿flowml/min￿100CPU2:￿access￿sensorCVVH￿Adult￿AqualinePressure￿&￿clamp￿￿test￿Previous￿￿Access52mmHg-250200-80300-150200-50450Return57mmHgTMP25mmHgPr.Drop6mmHgBlood￿flowml/min￿50Please￿wait…….Help￿CVVH￿Adult￿AqualineStart￿connectionGo￿to￿programming￿Access52mmHg-250200-80300-150200-50450Return111mmHgTMP11mmHgPr.Drop56mmHgBlood￿flowml/min￿50Help￿Double￿connection￿Go￿to￿recirculation￿￿Single￿connection￿CVVH￿Adult￿AqualineStart￿connectionGo￿to￿programming￿Access52mmHg-250200-80300-150200-50450Return111mmHgTMP11mmHgPr.Drop56mmHgBlood￿flowml/min￿50Help￿Double￿connection￿Go￿to￿recirculation￿￿Single￿connection￿第二部分操作流程1.准备用物2.开机自检3.安装管路4.预冲5.压力测试6.闭路循环7.参数设置8.连接病人9.治疗阶段10.回血下机11.用物处理Go￿to￿recirculationFor￿recirculation￿connect￿return(blue)￿and￿access(red)￿line￿to￿one￿saline￿solution￿bag.After￿starting￿blood￿pump￿the￿saline￿solution￿will￿be￿recirculated￿through￿the￿filter.Are￿you￿sure?￿￿￿￿￿￿￿￿￿￿￿￿￿￿￿￿￿￿￿￿￿￿￿￿￿￿￿￿￿￿￿￿￿￿￿￿￿￿￿￿-press￿yesTo￿go￿back￿to￿the￿previous￿screen￿￿-press￿noYes￿CVVH￿Adult￿AqualineConfirm￿window￿￿No￿Access52mmHg-250200-80300-150200-50450Return57mmHgTMP25mmHgPr.Drop6mmHgBlood￿flowml/min￿50进入再循环请将静脉和动脉端连接在同一个生理盐水袋子上，方可进行再循环。一旦启动血泵，生理盐水将会被泵入滤器循环。你确定吗？--yes返回上一步--noYe