血滤操作流程(简图)—急诊科CRRT培训课件

血液滤过操作简介血液滤过操作简介ContinuousVeno-venousHemofiltration(CVVH)急诊科急诊科CRRTCRRT培训培训血液滤过操作简介Continuous Veno-venous主要内容主要内容一、认识血滤机及各部件一、认识血滤机及各部件二、操作简要流程二、操作简要流程1.1.准备用物准备用物2.2.开机自检开机自检3.3.安装管路安装管路4.4.预冲预冲5.5.压力测试压力测试6.6.闭路循环闭路循环7.7.参数设置参数设置8.8.连接病人连接病人9.9.治疗阶段治疗阶段10.10.回血下机回血下机11.11.用物处理用物处理主要内容一、认识血滤机及各部件1.准备用物第一部分第一部分认识血滤机认识血滤机第一部分血滤操作流程(简图)急诊科CRRT培训课件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1.绿灯：治疗正在进行中，系统没有出现任何报警的情况。操作状主旋钮主旋钮静音键静音键静脉夹键静脉夹键平衡键平衡键血泵键血泵键第二部分第二部分操作流程操作流程1.1.准备用物准备用物2.2.开机自检开机自检3.3.安装管路安装管路4.4.预冲预冲5.5.压力测试压力测试6.6.闭路循环闭路循环7.7.参数设置参数设置8.8.连接病人连接病人9.9.治疗阶段治疗阶段10.10.回血下机回血下机11.11.用物处理用物处理第二部分1.准备用物AquariusAquarius管路与滤器管路与滤器肝素生理盐水肝素生理盐水纯生理盐水纯生理盐水置换液置换液20ml 20ml 注射器注射器Aquarius管路与滤器肝素生理盐水置换液20ml 注射器第二部分第二部分操作流程操作流程1.1.准备用物准备用物2.2.开机自检开机自检3.3.安装管路安装管路4.4.预冲预冲5.5.压力测试压力测试6.6.闭路循环闭路循环7.7.参数设置参数设置8.8.连接病人连接病人9.9.治疗阶段治疗阶段10.10.回血下机回血下机11.11.用物处理用物处理第二部分1.准备用物血滤操作流程(简图)急诊科CRRT培训课件SystemtestSystemtestrunningrunningMaster:6.00.00Video:V6.00.00Text version 6.00.00errtxt 6.00.0Modetxt 6.00.00System test Master:6.00.00TextSCUFSCUFCVVHCVVHCVVHDCVVHDCVVHDFCVVHDFHEMOPERFUSIONHEMOPERFUSIONTPETPESelecttherapySelecttherapyContinuousveno-venoushemofiltration连续性静静脉血液滤过连续性静静脉血液滤过HelpHelpSCUF CVVH CVVHD CVVHDF HEMOPERSlowcontinuousultrafiltration缓慢连续性超滤缓慢连续性超滤SCUFSCUFCVVHCVVHCVVHDCVVHDCVVHDFCVVHDFHEMOPERFUSIONHEMOPERFUSIONTPETPESelecttherapyHelpHelpSlow continuous ultrafiltratiocontinuousveno-venoushemodialysis连续性静连续性静-静脉血液透析静脉血液透析SCUFSCUFCVVHCVVHCVVHDCVVHDCVVHDFCVVHDFHEMOPERFUSIONHEMOPERFUSIONTPETPESelecttherapyHelpHelpcontinuous veno-venous hemodiacontinuousveno-venoushemodiafiltration连续性静连续性静-静脉血液透析滤过静脉血液透析滤过SCUFSCUFCVVHCVVHCVVHDCVVHDCVVHDFCVVHDFHEMOPERFUSIONHEMOPERFUSIONTPETPESelecttherapyHelpHelpcontinuous veno-venous hemodiaHemoperfusion血液灌流血液灌流SCUFSCUFCVVHCVVHCVVHDCVVHDCVVHDFCVVHDFHEMOPERFUSIONHEMOPERFUSIONTPETPESelecttherapyHelpHelpHemoperfusionSCUF CVVH CVVHD Cplasmaexchange血浆置换血浆置换SCUFSCUFCVVHCVVHCVVHDCVVHDCVVHDFCVVHDFHEMOPERFUSIONHEMOPERFUSIONTPETPESelecttherapyHelpHelpplasma exchangeSCUF CVVH CVVHDSelectaqualineforadulttreatmentBloodflow30to450ml/min请选择成人治疗管路，可供血流速为30-450ml/minAqualinesforAqualinesforpediatrictreatmentpediatrictreatmentCVVHCVVHAdultAqualineAdultAqualinePreparationPreparationPreviousPreviousZoomgraphicZoomgraphicAqualineforAqualineforadulttreatmentadulttreatmentSelectkindoflineSelectkindoflinetobeusedtobeusedforthistreatmentforthistreatmentHelpHelpSelect aqualine for Aqualines ADULTTREATMENTYouhaveselectedaqualinetubingsetforADULTtreatment.Bloodflow30to450ml/minUseofanaqualinedifferenttothatselectedon-screenwillcreateanalarmduringpriming.Checkthelineandthenproceed.Yes-nextstepNo-previousstepYesYesCVVHCVVHAdultAqualineAdultAqualineConfirmwindowConfirmwindowNoNoAccess -13 mmHg-250 200-80 300-150 200-50 450Return 0 mmHgTMP 19 mmHgPr.Drop 30 mmHgBloodflowBloodflowml/minml/min80ADULT TREATMENTYes CVVH Confir成人治疗成人治疗您选择了供成人治疗的管路集合您选择了供成人治疗的管路集合血流速可为血流速可为30-450ml/min30-450ml/min应用与屏幕显示种类不同的管路将会导致在预冲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过程中报警核对管路类型之后继续核对管路类型之后继续YesYes下一步下一步No-No-返回上一步返回上一步YesYesCVVHCVVHAdultAqualineAdultAqualineConfirmwindowConfirmwindowNoNoAccess -13 mmHg-250 200-80 300-150 200-50 450Return 0 mmHgTMP 19 mmHgPr.Drop 30 mmHgBloodflowBloodflowml/minml/min80成人治疗Yes CVVH Confirm window NCVVHCVVHAdultAqualineAdultAqualinePreparationPreparationPreviousPreviousZoomgraphicZoomgraphicNextNextInsertcassetteInsertcassettesystemandbagssystemandbagsClosepumpdoorsClosepumpdoorsHelpHelpCVVH Preparation Previous Zo第二部分第二部分操作流程操作流程1.1.准备用物准备用物2.2.开机自检开机自检3.3.安装管路安装管路4.4.预冲预冲5.5.压力测试压力测试6.6.闭路循环闭路循环7.7.参数设置参数设置8.8.连接病人连接病人9.9.治疗阶段治疗阶段10.10.回血下机回血下机11.11.用物处理用物处理第二部分1.准备用物血滤操作流程(简图)急诊科CRRT培训课件血滤操作流程(简图)急诊科CRRT培训课件血滤操作流程(简图)急诊科CRRT培训课件血滤操作流程(简图)急诊科CRRT培训课件Pre-filter Pre-filter pressure sensorpressure sensorReturn pressure Return pressure sensorsensorAccess pressure Access pressure sensorsensorFiltrate Filtrate pressure sensorpressure sensorPre-filter pressure sensorRetu除气壶除气壶空气探测器空气探测器静脉夹静脉夹除气壶空气探测器静脉夹血滤操作流程(简图)急诊科CRRT培训课件血滤操作流程(简图)急诊科CRRT培训课件血滤操作流程(简图)急诊科CRRT培训课件血滤操作流程(简图)急诊科CRRT培训课件血滤操作流程(简图)急诊科CRRT培训课件CVVHCVVHAdultAqualineAdultAqualinePreparationPreparationPreviousPreviousZoomgraphicZoomgraphicNextNextInsertcassetteInsertcassettesystemandbagssystemandbagsClosepumpdoorsClosepumpdoorsHelpHelpCVVH Preparation Previous ZoCVVHCVVHAdultAqualineAdultAqualinePreparationPreparationPreviousPreviousNoanticoagulantNoanticoagulantPreparesyringePreparesyringePreparePrepareanticoagulantanticoagulantHelpHelpCVVH Preparation Previous NoCVVHCVVHAdultAqualineAdultAqualinePreparationPreparationPrepareancoagulantPrepareancoagulantStartprimingStartprimingCheckalllinesCheckalllinesOpenallclampsOpenallclampsStartprimingStartprimingHelpHelpBloodflowBloodflowml/minml/min80CVVH Preparation Prepare anco第二部分第二部分操作简介操作简介1.1.准备用物准备用物2.2.开机自检开机自检3.3.安装管路安装管路4.4.预冲预冲5.5.压力测试压力测试6.6.闭路循环闭路循环7.7.参数设置参数设置8.8.连接病人连接病人9.9.治疗阶段治疗阶段10.10.回血下机回血下机11.11.用物处理用物处理第二部分1.准备用物血滤操作流程(简图)急诊科CRRT培训课件ReprimeReprimeCVVHCVVHAdultAqualineAdultAqualinePrimingPrimingcompletedcompletedNextNextAccess 48 mmHg-250 200-80 300-150 200Return 57 mmHgTMP 28 mmHgBloodflowBloodflowml/minml/min150BloodcircuitBloodcircuitPostdilutionlinePostdilutionlinepredilutionlinepredilutionlineFiltratelineFiltratelineHelpHelpReprime CVVH Priming complete第二部分第二部分操作流程操作流程1.1.准备用物准备用物2.2.开机自检开机自检3.3.安装管路安装管路4.4.预冲预冲5.5.压力测试压力测试6.6.闭路循环闭路循环7.7.参数设置参数设置8.8.连接病人连接病人9.9.治疗阶段治疗阶段10.10.回血下机回血下机11.11.用物处理用物处理第二部分1.准备用物Gotoclamp&pressuretestIMPORTANTForclamp&pressuretestyouhavetoconnectthereturnandaccesslinestoonesalinesolutionbagbeforeyouconfirm“yes”.Makesurethatairdetectionisoperational(airdetectionkeyhasstaticgreenlight)beforeconfirming“yes”Afterstartingbloodpump,thesalinesolutioniscirculatedthroughthefilterandthetestisconducted.YesYesCVVHCVVHAdultAqualineAdultAqualineConfirmwindowConfirmwindowNoNoAccess 52 mmHg-250 200-80 300-150 200-50 450Return 57 mmHgTMP 25 mmHgPr.Drop 6 mmHgBloodflowBloodflowml/minml/min100Go to clamp&pressure testYes进入夹子和压力测试（很重要）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，方可确脉端连接到同一个生理盐水袋子上，方可确认认“yesyes”确保空气探测为功能状态（空气探测器键保确保空气探测为功能状态（空气探测器键保持为绿灯）方可确认持为绿灯）方可确认“yesyes”一旦启动血泵，生理盐水将会被带入滤器循一旦启动血泵，生理盐水将会被带入滤器循环，并且执行测试环，并且执行测试YesYesCVVHCVVHAdultAqualineAdultAqualineConfirmwindowConfirmwindowNoNoAccess 52 mmHg-250 200-80 300-150 200-50 450Return 57 mmHgTMP 25 mmHgPr.Drop 6 mmHgBloodflowBloodflowml/minml/min100进入夹子和压力测试（很重要）Yes CVVH ConfirmCPU2:accesssensorCPU2:accesssensorCVVHCVVHAdultAqualineAdultAqualinePressure&clampPressure&clamptesttestPreviousPreviousAccess 52 mmHg-250 200-80 300-150 200-50 450Return 57 mmHgTMP 25 mmHgPr.Drop 6 mmHgBloodflowBloodflowml/minml/min50Pleasewait.Pleasewait.HelpHelpCPU2:access sensorCVVH PressuCVVHCVVHAdultAqualineAdultAqualineStartconnectionStartconnectionGotoprogrammingGotoprogrammingAccess 52 mmHg-250 200-80 300-150 200-50 450Return 111 mmHgTMP 11 mmHgPr.Drop 56 mmHgBloodflowBloodflowml/minml/min50HelpHelpDoubleconnectionDoubleconnectionGotorecirculationGotorecirculationSingleconnectionSingleconnectionCVVH Start connectionGo to proCVVHCVVHAdultAqualineAdultAqualineStartconnectionStartconnectionGotoprogrammingGotoprogrammingAccess 52 mmHg-250 200-80 300-150 200-50 450Return 111 mmHgTMP 11 mmHgPr.Drop 56 mmHgBloodflowBloodflowml/minml/min50HelpHelpDoubleconnectionDoubleconnectionGotorecirculationGotorecirculationSingleconnectionSingleconnectionCVVH Start connectionGo to pro第二部分第二部分操作流程操作流程1.1.准备用物准备用物2.2.开机自检开机自检3.3.安装管路安装管路4.4.预冲预冲5.5.压力测试压力测试6.6.闭路循环闭路循环7.7.参数设置参数设置8.8.连接病人连接病人9.9.治疗阶段治疗阶段10.10.回血下机回血下机11.11.用物处理用物处理第二部分1.准备用物GotorecirculationForrecirculationconnectreturn(blue)andaccess(red)linetoonesalinesolutionbag.Afterstartingbloodpumpthesalinesolutionwillberecirculatedthroughthefilter.Areyousure?-pressyesTogobacktothepreviousscreen-pressnoYesYesCVVHCVVHAdultAqualineAdultAqualineConfirmwindowConfirmwindowNoNoAccess 52 mmHg-250 200-80 300-150 200-50 450Return 57 mmHgTMP 25 mmHgPr.Drop 6 mmHgBloodflowBloodflowml/minml/min50Go to recirculationYes CVVH Co进入再循环进入再循环请将静脉和动脉端连接在同一个生理盐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。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一旦启动血泵，生理盐水将会被泵入滤器循环。器循环。你确定吗？你确定吗？-yes-yes返回上一步返回上一步-no-noYesYesCVVHCVVHAdultAqualineAdultAqualineConfirmwindowConfirmwindowNoNoAccess 52 mmHg-250 200-80 300-150 200-50 450Return 57 mmHgTMP 25 mmHgPr.Drop 6 mmHgBloodflowBloodflowml/minml/min50进入再循环Yes CVVH Confirm window CVVHCVVHAdultAqualineAdultAqualineRecirculationRecirculationmodemodeEndtreatmentEndtreatmentRemovetubesystemRemovetubesystemAccess 46 mmHg-250 200-80 300-150 200-50 450Return 63 mmHgTMP 24 mmHgPr.Drop 11 mmHgBloodflowBloodflowml/minml/min50HelpHelpGotoprogrammingGotoprogrammingMoreMoreGotoconnectionGotoconnection0:00h.min0:00h.minCVVH Recirculation modeEnd tre第二部分第二部分操作流程操作流程1.1.准备用物准备用物2.2.开机自检开机自检3.3.安装管路安装管路4.4.预冲预冲5.5.压力测试压力测试6.6.闭路循环闭路循环7.7.参数设置参数设置8.8.连接病人连接病人9.9.治疗阶段治疗阶段10.10.回血下机回血下机11.11.用物处理用物处理第二部分1.准备用物CVVHCVVHAdultAqualineAdultAqualineprogrammingprogrammingTotalfluidlossTotalfluidlossmlmlAccess 46 mmHg-250 200-80 300-150 200Return 63 mmHgTMP 24 mmHgTimeTimeh.minh.min0:00PreviousPreviousResettotalsResettotalsFluidlossrateFluidlossrateml/hml/hPostdilutionPostdilutionml/hml/hpredilutionpredilutionml/hml/hNumberofbagsNumberofbagsanticoagulantanticoagulantml/hml/hAnticoagulantAnticoagulantBolusmlBolusmlTemperatureTemperature000010.00.037.0Scrollandselecttoprogrameachparameter.Selectprevious,whenallrequiredparametersareset.滚动并选择设置各个参数。滚动并选择设置各个参数。当所有必需的参数设置完成后，请当所有必需的参数设置完成后，请选择上一步选择上一步CVVH programmingTotal fluid loCVVHCVVHAdultAqualineAdultAqualineprogrammingprogrammingTotalfluidlossTotalfluidlossmlmlAccess 46 mmHg-250 200-80 300-150 200Return 63 mmHgTMP 24 mmHgTimeTimeh.minh.min0:00PreviousPreviousResettotalsResettotalsFluidlossrateFluidlossrateml/hml/hPostdilutionPostdilutionml/hml/hpredilutionpredilutionml/hml/hNumberofbagsNumberofbagsanticoagulantanticoagulantml/hml/hAnticoagulantAnticoagulantBolusmlBolusmlTemperatureTemperature1000010.00.037.0Programstheamountoffluidyouwanttoremoveperhour.Rangeforfluidlossrate:0-2000ml/hadult0-1000ml/hpediatric设置您想要滤除的液体量设置您想要滤除的液体量净脱水速率范围为：净脱水速率范围为：成人成人0-2000ml/h0-2000ml/h儿童儿童0-1000ml/h0-1000ml/hCVVH programmingTotal fluid loCVVHCVVHAdultAqualineAdultAqualineprogrammingprogrammingTotalfluidlossTotalfluidlossmlmlAccess 46 mmHg-250 200-80 300-150 200Return 63 mmHgTMP 24 mmHgTimeTimeh.minh.min0:00PreviousPreviousResettotalsResettotalsFluidlossrateFluidlossrateml/hml/hPostdilutionPostdilutionml/hml/hpredilutionpredilutionml/hml/hNumberofbagsNumberofbagsanticoagulantanticoagulantml/hml/hAnticoagulantAnticoagulantBolusmlBolusmlTemperatureTemperature1050000010.00.037.0CVVH programmingTotal fluid loCVVHCVVHAdultAqualineAdultAqualineprogrammingprogrammingTotalfluidlossTotalfluidlossmlmlAccess 46 mmHg-250 200-80 300-150 200Return 63 mmHgTMP 24 mmHgTimeTimeh.minh.min0:00PreviousPreviousResettotalsResettotalsFluidlossrateFluidlossrateml/hml/hPostdilutionPostdilutionml/hml/hpredilutionpredilutionml/hml/hNumberofbagsNumberofbagsanticoagulantanticoagulantml/hml/hAnticoagulantAnticoagulantBolusmlBolusmlTemperatureTemperature1050002000010.00.037.0Programstheamountofpost-pumpsubstitutionsolutiontobegivenperhour.Rangeforpostdilutionsolution:0-10000ml/hadult0-4000ml/hpediatric设置后置换每小时提供的置换液量设置后置换每小时提供的置换液量后置换范围为：后置换范围为：成人成人0-10000ml/h0-10000ml/h儿童儿童0-4000ml/h0-4000ml/hCVVH programmingTotal fluid loCVVHCVVHAdultAqualineAdultAqualineprogrammingprogrammingTotalfluidlossTotalfluidlossmlmlAccess 46 mmHg-250 200-80 300-150 200Return 63 mmHgTMP 24 mmHgTimeTimeh.minh.min0:00PreviousPreviousResettotalsResettotalsFluidlossrateFluidlossrateml/hml/hPostdilutionPostdilutionml/hml/hpredilutionpredilutionml/hml/hNumberofbagsNumberofbagsanticoagulantanticoagulantml/hml/hAnticoagulantAnticoagulantBolusmlBolusmlTemperatureTemperature1050002000200010.00.037.0Programstheamountofpre-pumpsubstitutionsolutiontobegivenperhour.Rangeforpredilutionsolution:0-10000ml/hadult0-6000ml/hpediatric设置前置换每小时提供的置换液量设置前置换每小时提供的置换液量前置换范围为：前置换范围为：成人成人0-10000ml/h0-10000ml/h儿童儿童0-6000ml/h0-6000ml/hCVVH programmingTotal fluid loCVVHCVVHAdultAqualineAdultAqualineprogrammingprogrammingTotalfluidlossTotalfluidlossmlmlAccess 46 mmHg-250 200-80 300-150 200Return 63 mmHgTMP 24 mmHgTimeTimeh.minh.min0:00PreviousPreviousResettotalsResettotalsFluidlossrateFluidlossrateml/hml/hPostdilutionPostdilutionml/hml/hpredilutionpredilutionml/hml/hNumberofbagsNumberofbagsanticoagulantanticoagulantml/hml/hAnticoagulantAnticoagulantBolusmlBolusmlTemperatureTemperature1050002000200010.00.037.0Programsthetemperatureforthesudstitution.设置置换液的温度。设置置换液的温度。CVVH programmingTotal fluid lo第二部分第二部分操作流程操作流程1.1.准备用物准备用物2.2.开机自检开机自检3.3.安装管路安装管路4.4.预冲预冲5.5.压力测试压力测试6.6.闭路循环闭路循环7.7.参数设置参数设置8.8.连接病人连接病人9.9.治疗阶段治疗阶段10.10.回血下机回血下机11.11.用物处理用物处理第二部分1.准备用物血滤操作流程(简图)急诊科CRRT培训课件CVVHCVVHAdultAqualineAdultAqualineRecirculationRecirculationmodemodeEndtreatmentEndtreatmentRemovetubesystemRemovetubesystemAccess 46 mmHg-250 200-80 300-150 200-50 450Return 63 mmHgTMP 24 mmHgPr.Drop 11 mmHgBloodflowBloodflowml/minml/min50HelpHelpGotoprogrammingGotoprogrammingMoreMoreGotoconnectionGotoconnection0:00h.min0:00h.minCVVH Recirculation modeEnd treSingleconnectionSingleconnectionCVVHCVVHAdultAqualineAdultAqualineStartconnectionStartconnectionGotorecirculationGotorecirculationAccess 52 mmHg-250 200-80 300-150 200-50 450Return 57 mmHgTMP 25 mmHgPr.Drop 6 mmHgBloodflowBloodflowml/minml/min50GotoprogrammingGotoprogrammingDoubleconnectionDoubleconnectionHelpHelpSingle connection CVVH Start cYOUHAVESELECTEDSINGLECONNECTIONMODEByselectingthisconnectionmode,youhavetoconnecttheaccesslineonly,fillthecircuitwithblooduntilblooddetectedalarmappearsandthenconnectreturnlineandstarttreatment.Withthisconnectionmode,thepatientwilllosevolume(primingvolumeofthecircuit+filter).Abloodflowrateof50ml/minhastobeusedtofillthecircuitwithbloodandthenincreasedinincrementalstepsafterstarttreatmentselection.Selectyes-tousethissingleconnectionmodeNo-togobacktothepreviousscreenYesYesCVVHCVVHAdultAqualineAdultAqualineConfirmwindowConfirmwindowNoNoAccess 52 mmHg-250 200-80 300-150 200-50 450Return 57 mmHgTMP 25 mmHgPr.Drop 6 mmHgBloodflowBloodflowml/minml/min50YOU HAVE SELECTED SINGLE CONNE您选择了单向连接模式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人，选择这个连接模式，您须将动脉先连接病人，向管路中引血直到出现向管路中引血直到出现“探测到血液探测到血液”的报的报警，再连接静脉端开始治疗。警，再连接静脉端开始治疗。单向连接模式下，病人将会丢失循环容量单向连接模式下，病人将会丢失循环容量（管路（管路+滤器的容量）。此时的泵速为滤器的容量）。此时的泵速为50ml/min50ml/min。当进入治疗选项后可以增加泵速。当进入治疗选项后可以增加泵速。YesYesCVVHCVVHAdultAqualineAdultAqualineConfirmwindowConfirmwindowNoNoAccess 52 mmHg-250 200-80 300-150 200-50 450Return 57 mmHgTMP 25 mmHgPr.Drop 6 mmHgBloodflowBloodflowml/minml/min50您选择了单向连接模式Yes CVVH Confirm win血滤操作流程(简图)急诊科CRRT培训课件血滤操作流程(简图)急诊科CRRT培训课件第二部分第二部分操作流程操作流程1.1.准备用物准备用物2.2.开机自检开机自检3.3.安装管路安装管路4.4.预冲预冲5.5.压力测试压力测试6.6.闭路循环闭路循环7.7.参数设置参数设置8.8.连接病人连接病人9.9.治疗阶段治疗阶段10.10.回血下机回血下机11.11.用物处理用物处理第二部分1.准备用物血滤操作流程(简图)急诊科CRRT培训课件血滤操作流程(简图)急诊科CRRT培训课件第二部分第二部分操作流程操作流程1.1.准备用物准备用物2.2.开机自检开机自检3.3.安装管路安装管路4.4.预冲预冲5.5.压力测试压力测试6.6.闭路循环闭路循环7.7.参数设置参数设置8.8.连接病人连接病人9.9.治疗阶段治疗阶段10.10.回血下机回血下机11.11.用物处理用物处理第二部分1.准备用物准备下机用物准备下机用物20ml生理盐水（生理盐水（2管）管）动脉端封管液动脉端封管液（1.2ml）静脉端封管液静脉端封管液（1.3ml）输输液液器器三三通通准备下机用物20ml生理盐水（2管）动脉端封管液（1.2ml血滤操作流程(简图)急诊科CRRT培训课件血滤操作流程(简图)急诊科CRRT培训课件HistoryHistoryRecirculationRecirculationEndtreatmentEndtreatmentChangesyringeChangesyringeChangetherapyChangetherapyPreviousPreviousTerminatestreatmentandleadstodisconnection终止治疗，进入断开连接终止治疗，进入断开连接CVVHCVVHAdultaqualineAdultaqualineHistory Recirculation End trCVVHCVVHAdultAqualineAdultAqualineConfirmwindowConfirmwindowAccess -14 mmHg-250 200-80 300-150 200-50 450Return 0 mmHgTMP 7 mmHgPr.Drop 22 mmHgBloodflowBloodflowml/minml/min50EndtreatmentIMPORTANTIfyougotodisconnectionyoucannotgobacktotreatment.Areyousureyouwanttodisconnectthepatient?Choose“yes”togotodisconnection.Choose“no”togobacktothepreviousscreen.NoNoYesYesCVVH Confirm windowAccess CVVHCVVHAdultAqualineAdultAqualineConfirmwindowConfirmwindowAccess -14 mmHg-250 200-80 300-150 200-50 450Return 0 mmHgTMP 7 mmHgPr.Drop 22 mmHgBloodflowBloodflowml/minml/min50结束治疗（很重要）结束治疗（很重要）一旦选择断开连接，您将无法返回治疗。一旦选择断开连接，您将无法返回治疗。确定要与病人断开吗？确定要与病人断开吗？NoNoYesYesCVVH Confirm windowAccess CVVHCVVHAdultAqualineAdultAqualineAccessAccessdisconnectiondisconnectionAccess 37 mmHg-250 200-80 300-150 200-50 450Return -25 mmHgTMP 29 mmHgPr.Drop 28 mmHgBloodflowBloodflowml/minml/min50DisconnectaccesslineandconnectittoasalinebagPress“bloodpump”togivebloodtothepatientSelect“next”togoto“returndisconnection”orwaitReinfusionReinfusionmlmlNextNext0FluidlossFluidlosstotalmltotalmlsubstitutionsubstitution1303067.52CVVH Access disconnectionAccesCVVHCVVHAdultAqualineAdultAqualineAccessAccessdisconnectiondisconnectionAccess 37 mmHg-250 200-80 300-150 200-50 450Return -25 mmHgTMP 29 mmHgPr.Drop 28 mmHgBloodflowBloodflowml/minml/min50u断开动脉端，与一断开动脉端，与一袋生理盐水连接袋生理盐水连接u按按“血泵键血泵键”回血回血u选择选择“下一步下一步”进进入入“断开静脉端断开静脉端”或或等待。等待。ReinfusionReinfusionmlmlNextNext0FluidlossFluidlosstotalmltotalmlsubstitutionsubstitution1303067.52CVVH Access disconnectionAcces血滤操作流程(简图)急诊科CRRT培训课件血滤操作流程(简图)急诊科CRRT培训课件血滤操作流程(简图)急诊科CRRT培训课件血滤操作流程(简图)急诊科CRRT培训课件CVVHCVVHAdultAqualineAdultAqualineAccessAccessdisconnectiondisconnectionAccess 37 mmHg-250 200-80 300-150 200-50 450Return -25 mmHgTMP 29 mmHgPr.Drop 28 mmHgBloodflowBloodflowml/minml/min50DisconnectthereturnpatientlineSelect“next”tofinish“disconnectionmode”ReinfusionReinfusionmlmlNextNext0FluidlossFluidlosstotalmltotalmlsubstitutionsubstitution1303067.52CVVH Access disconnectionAcces血滤操作流程(简图)急诊科CRRT培训课件血滤操作流程(简图)急诊科CRRT培训课件CVVHCVVHAdultAqualineAdultAqualineConfirmwindowConfirmwindowAccess -14 mmHg-250 200-80 300-150 200-50 450Return 0 mmHgTMP 7 mmHgPr.Drop 22 mmHgBloodflowBloodflowml/minml/min50DisconnectionfinishedThedisconnectionphaseiscomplete.DuringthenextstepthebloodpumpisstoppedandnofurtherbloodcanbereturntothepatientAreyousuretocontinue?Yes-nextstepNo-previousstepNoNoYesYesCVVH Confirm windowAccess CVVHCVVHAdultAqualineAdultAqualineConfirmwindowConfirmwindowAccess -14 mmHg-250 200-80 300-150 200-50 450Return 0 mmHgTMP 7 mmHgPr.Drop 22 mmHgBloodflowBloodflowml/minml/min50断开完成断开完成断开阶段已经完成。断开阶段已经完成。接下来血泵停止，回血即停。接下来血泵停止，回血即停。确定继续吗？确定继续吗？NoNoYesYesCVVH Confirm windowAccess CVVHCVVHAdultAqualineAdultAqualineAccess -14 mmHg-250 200-80 300-150 200-50 450Return 0 mmHgprefilter 7 mmHgFiltrate 22 mmHgBloodflowBloodflowml/minml/min50Beforeremovingaqualineanddisconnectingpressuredomes,controlandmakesurethatnohighpressurelevelremainsinsidetubes(4pressuredisplayedshouldbelessthan400mmHg)Incasepressureisover400mmHg,useasyringetoremovepressurefromthetube.Removingaqualineunderpressureconditionscancreatebloodleakfrompressuredomesandburstofpressuredomemembranes.AquariusoffAquariusoffCVVH Access -14 mmHgCVVHCVVHAdultAqualineAdultAqualineAccess -14 mmHg-250 200-80 300-150 200-50 450Return 0 mmHgprefilter 7 mmHgFiltrate 22 mmHgBloodflowBloodflowml/minml/min50u请在拆除管路和压力扣之前，确请在拆除管路和压力扣之前，确保管路中没有高压（显示的保管路中没有高压（显示的4 4个压个压力值均低于力值均低于400mmHg400mmHg）u如果压力超过如果压力超过400mmHg400mmHg，用注射，用注射器抽出液体为其减压。器抽出液体为其减压。u在高压条件下拆除管路将会导致在高压条件下拆除管路将会导致压力扣漏血和压力扣膜部爆裂。压力扣漏血和压力扣膜部爆裂。AquariusoffAquariusoffCVVH Access -14 mmHg第二部分第二部分操作流程操作流程1.1.准备用物准备用物2.2.开机自检开机自检3.3.安装管路安装管路4.4.预冲预冲5.5.压力测试压力测试6.6.闭路循环闭路循环7.7.参数设置参数设置8.8.连接病人连接病人9.9.治疗阶段治疗阶段10.10.回血下机回血下机11.11.用物处理用物处理第二部分1.准备用物血滤操作流程(简图)急诊科CRRT培训课件血滤操作流程(简图)急诊科CRRT培训课件血滤操作流程(简图)急诊科CRRT培训课件更换血滤置管贴膜与纱布血滤操作流程(简图)急诊科CRRT培训课件感谢聆听感谢聆听感谢聆听感谢聆听