Prisma-报警与报警解除操作PPT课件.ppt

Great team in Greater China to achieve greatest success!PRISMA的报警系统与报警解除 Alarm System&Alarm Handling 2007,Gambro Lundia AB1Great team in Greater China to achieve greatest success!WARNING 警告性警报-病人危险程度最高需要操作者迅速采取措施治疗处于暂停状态MALFUNCTION 故障性警报-安全系统故障需要操作者迅速采取措施治疗处于暂停状态CAUTION 警示性警报-需要采取措施使治疗继续需要操作者采取相应措施血泵和抗凝剂泵仍然正常工作ADVISORY 建议性警报-安全系统的信息提示一种安全系统认为操作者应当了解的状况治疗正常进行PRISMAPRISMA警报分级警报分级 2007,Gambro Lundia AB2Great team in Greater China to achieve greatest success!内容目录PRISMA PRISMA 报警系统介绍报警系统介绍PRISMA PRISMA 的压力监测系统及相关报警的压力监测系统及相关报警PRISMA PRISMA 的空气监测系统及相关报警的空气监测系统及相关报警PRISMA PRISMA 的漏血探测系统及相关报警的漏血探测系统及相关报警PRISMA PRISMA 液体平衡系统及相关报警液体平衡系统及相关报警PRISMAPRISMA使用过程中的自检及相关报警使用过程中的自检及相关报警 2007,Gambro Lundia AB3Great team in Greater China to achieve greatest success!PRISMA的压力监测系统及相关报警 2007,Gambro Lundia AB4Great team in Greater China to achieve greatest success!动脉压-50 to 150滤器压+100 to 250废液压+50 to-150静脉压+50 to 150压力监测 实时监测的压力 2007,Gambro Lundia AB5Great team in Greater China to achieve greatest success!TMP 跨膜压反应治疗过程中作用在血滤器膜上的压力计算公式 TMP=（滤器压+静脉压）/2 废液压 P 血滤器压力下降反映血液通过血滤器时的阻力计算公式 P=滤器压 静脉压压力监测 通过系统计算的压力 2007,Gambro Lundia AB6Great team in Greater China to achieve greatest success!压力监测范围-250-150015025045035050010-10动脉压(-250 to 50)静脉压(-50 to 350)滤器压(10 to 500)废液压(-350 to 50)-350 2007,Gambro Lundia AB7Great team in Greater China to achieve greatest success!压力相关报警-50压力操作点+50劝告报警:Access Pressure is Rising(Access Initial 50mmHg)劝告报警:Access Too Negative(Access Initial -50mmHg)劝告报警:Return Pressure is Dropping(Return Initial 50mmHg)2007,Gambro Lundia AB8Great team in Greater China to achieve greatest success!压力相关报警警告报警:Filter Pressure Extremely Positive(500mmHg)警告报警:Return Pressure Extremely Positive(350mmHg)警告报警:Access Pressure Extremely Negative(-250mmHg)警告报警：Return Disconnection(-10mmHg)-250-150015025045035050010-10-350警告报警:Pressure zero test failure注意报警:Effluent Pressure Too Negative(TPE Mode)(50 Return:348STOP SET FLOW RATES MUTE CONTINUEHELP 2007,Gambro Lundia AB12Great team in Greater China to achieve greatest success!WARNING :RETURN PRESSURE警告 报警 警告：静脉压 静脉压力呈极端正压状态 1.确认静脉管道没有被夹住或扭结。2.降低静脉管道的过度压力：(a)沿逆时针方向手动转动废液泵，或者(b)拔开静脉 管道上的夹子，按“继续”键。其它可能引起警告的原因：静脉采血导管内凝血，或导管在静脉内位置偏移；病人 正在移动身体或身体被移动；血液流速太快；静脉压力感受器失灵。-参见操作手册中“难点释疑”。目前压力:动脉压:-13 滤器压:335 (mmHg)废液压:50 静脉压:348停止设置流速消音 继续帮助 2007,Gambro Lundia AB13Great team in Greater China to achieve greatest success!压力相关报警警告报警:Filter is clotted:(2 conditions)1:滤器压力下降 250mmHg2:滤器压力下降 初始值 100mmHg&TMP 450mmHg3:TMP 初始值 150 mmHg&TMP 450mmHg 劝告报警:Filter is Clotting(2 conditions)1:滤器压力下降 初始值 100mmHg2:TMP 初始值 150mmHg-250-150015025045035050010-10-350警告报警:Plasma Filter is clotted:1:滤器压力下降 初始值 100mmHg劝告报警:Plasma Filter is Clotting1:滤器压力下降 初始值=100mmHg劝告报警:TMP too high(350mmHg)劝告报警:TMPa too high(100mmHg)注意报警:TMP Excessive(450mmHg)注意报警:TMPa Excessive(100mmHg)2007,Gambro Lundia AB14Great team in Greater China to achieve greatest success!滤器压力报警分级ADVISORY-Filter is clotting建议-滤器正在阻塞中ADVISORY-TMP Too High建议-跨膜压太高CAUTION-TMP Excessive当心-跨膜压过度WARNING-Filter Clotted警告-滤器凝血严重凝血轻度阻塞 2007,Gambro Lundia AB15Great team in Greater China to achieve greatest success!滤器正在阻塞中ADVISORY ALARM ADVISORY :FILTER IS CLOTTING TMP and/or P filter is rising.TMP can be lowered by:-Decreasing the replacement and/or patient fluid removal rates.-Increasing the blood flow rate.Rising filter may be due to:-Kinked lines in blood flowpath.-Inadequate anticoagulant delivery.-Air leak or failure at return or filter pressure sensor.For other possible causes,see Troubleshooting,Operators Manual.PRESSURES(mmHg):P Filter:30 Access:-65 Filter:130 TMP:250 Effluent:-135 Return:100STOPSET FLOWRATES MUTE OVERRIDE HELP 2007,Gambro Lundia AB16Great team in Greater China to achieve greatest success!FILTER IS CLOTTING 建议 报警 建议：滤器正在阻塞中 TMP和/或P滤器压力差正在續步升高 可通过以下措施降低TMP:-减低置换液流速/或减低病人脱水流速。-增加血流速。可能引起P滤器压力差升高的原因:-血液管道被夹住或扭结。-抗凝剂输注不足。-漏气或静脉压力及滤器压力传感器失去功能。其它可能的原因，参见操作手册中“难点释疑”。压力(mmHg):P 滤器压力差:30 动脉压:-65 滤器压:130 TMP:250 废液压:-135 静脉压:100停止设置流速消音 忽略帮助 2007,Gambro Lundia AB17Great team in Greater China to achieve greatest success!滤器凝血WARNING ALARM WARNING :FILTER IS CLOTTED Clots have formed in the filter.Press STOP and change the set.Other possible causes:Clamped lines in blood flow path;anticoagulant syringe Improperly installed or syringe pump failed.PRESSURE(mmHg):P Filter:30 Access:-65 Filter:130 TMP:450 Effluent:-335 Return:100STOPMUTE CONTINUE HELP 2007,Gambro Lundia AB18Great team in Greater China to achieve greatest success!FILTER IS CLOTTED 警告 报警 警告：滤器凝血 滤器内已有血栓形成。按“停止”键并更换消耗品配套。其它可能的原因:血液管道被夹住；抗凝剂注射器安装不当 或注射泵故障。压力(mmHg):P 滤器压力差:30 动脉压:-65 滤器压:130 TMP:450 废液压:-335 静脉压:100停止消音 继续帮助 2007,Gambro Lundia AB19Great team in Greater China to achieve greatest success!横膈膜复位（一）按 STOP夹住压力传感器及取样口两端移开压力传感器从取样口注入1毫升生理盐水装上压力传感器取下夹子按Resume恢复治疗检查压力值是否正常动脉压和废液压力传感器 (负压)2007,Gambro Lundia AB20Great team in Greater China to achieve greatest success!滤器压和静脉压力传感器(正压)横膈膜复位（二）按 STOP夹住压力传感器和取样口的两端移开压力传感器从取样口抽出1毫升的液体装上压力传感器取下夹子按Resume恢复治疗检查压力值是否恢复正常 2007,Gambro Lundia AB21Great team in Greater China to achieve greatest success!压力监测索引ACCESSRETURNFILTERTMP PEFFLUENT监控部位病人动脉血液通路病人静脉血液通路透析器（血液侧）透析器（透析液侧）透析器（血液侧）透析器（透析液侧）正常值（mmHg）-50 -15050 150100 250 50 -150报警上限-250350500600250病人动脉血液通路阻塞 -10病人静脉血液通路阻塞 350病人静脉针脱落 350 100血液凝固（clotted）450250血液凝固（膜孔阻塞）450 2007,Gambro Lundia AB22Great team in Greater China to achieve greatest success!PRISMA的空气监测系统及相关报警 2007,Gambro Lundia AB23Great team in Greater China to achieve greatest success!探测器类型：超声波气泡探测器探测器位置：位于静脉管路上警报激活标准:3mm 气泡=血里有空气0.58mm 气泡=少量空气空气探测器 2007,Gambro Lundia AB24Great team in Greater China to achieve greatest success!警告：血液中有气泡WARNING ALARM WARNING :AIR IN BLOODReturn Pressure is:100 mmHg.To Remove Air:1.Clamp return line(blue)above blue sample site.2.Insert 20-gauge(or smaller diameter)needle with syringe into sample site.Aspirate air/blood until return pressure is negative.3.Remove needle;pull return clamp open.4.Repeat until all air is removed,then unclamp return line and press CONTINUE.DISCONNECT MUTE CONTINUE HELP 2007,Gambro Lundia AB25Great team in Greater China to achieve greatest success!WARNING :AIR IN BLOOD警告 报警 警告：血液中有气泡静脉压力:100 mmHg 清除气泡：1.在(蓝色)取样部位以上夹住静脉管道。2.将连接注射器的20号（或更小）针头插入取样口，抽出气泡直到静脉压力降至负值。3.拔出针头，拔开静脉管道的夹子。4.重复以上操作，直到空气排净。然后打开静脉管道，按“继续”键。人机分离 消音 继续帮助WARNING :AIR IN BLOOD 2007,Gambro Lundia AB26Great team in Greater China to achieve greatest success!警告：血液中有微量气泡WARNING ALARM WARNING :MICRO AIR IN BLOODReturn Pressure is:26 mmHg.To Remove Micro Air:1.Clamp return line(blue)above blue sample site.2.Insert 20-gauge(or smaller diameter)needle with syringe into sample site.Aspirate air/blood until return pressure is negative.3.Remove needle;pull return clamp open.4.Repeat until all air is removed,then unclamp return line.OVERRIDE override alarm for 60 sec.Watch closely.STOPMUTE OVERRIDE HELP 2007,Gambro Lundia AB27Great team in Greater China to achieve greatest success!WARNING :MICRO AIR IN BLOOD警告 报警 警告：血液中有微量气泡静脉压力:26 mmHg 清除微量气泡：1.在(蓝色)样品部位以上夹住静脉管道。2.将连接注射器的20号（或更小）针头插入取样口，抽出气泡直到静脉压力 降至负值。3.拔出针头，拔开静脉管道的夹子。4.重复以上操作，直到空气排净。然后打开静脉管道，按“继续”键。“忽略”忽略报警60秒，密切观察。停止消音 忽略帮助 2007,Gambro Lundia AB28Great team in Greater China to achieve greatest success!气泡清除图解(只针对血液中气泡警报)2007,Gambro Lundia AB29Great team in Greater China to achieve greatest success!清除体外循环中的气泡（一）1.夹住蓝色取样口上端2.用空注射器(20G)插入蓝色取样口 3.抽出空气/血液知道静脉压为负压4.移开注射器Warning:Air in BloodReturn Pres-50mmHg 2007,Gambro Lundia AB30Great team in Greater China to achieve greatest success!5.向外拉出静脉夹，泻压6.若仍有空气，重复步骤157.按 CONTINUE或OVERRIDE清除体外循环中的气泡（二）2007,Gambro Lundia AB31Great team in Greater China to achieve greatest success!PRISMA 漏血探测系统及相关报警 2007,Gambro Lundia AB32Great team in Greater China to achieve greatest success!探测器类型：红外线探测器 探测器位置：废液管路上 警报激活标准：0.35ml/min,25%Hct废液管漏血探测器（BLD）2007,Gambro Lundia AB33Great team in Greater China to achieve greatest success!WARNING ALARM警告 :BLOOD LEAK DETECTOR 漏血检测 超控报警60秒。(密切监控).1.按 OVERRIDE。2.进入 NORMALIZE BLD 视窗，查看 BLD-signal value 是否介于167184 之间。3.若不在范围内，请将废液管拉出，重装入BLD 内，执行 RENORMALIZE BLD EXAMINE ALARM MUTE OVERRIDE HELP STOP 2007,Gambro Lundia AB34Great team in Greater China to achieve greatest success!WARNING ALARM警告 :BLOOD LEAK DETECTOR 漏血探测器.1.按 RETEST。2.若失败，请将废液管拉出，重装入BLD内，执行 RENORMALIZE BLD EXAMINE ALARM MUTE RETEST HELP DISCONNECT 2007,Gambro Lundia AB35Great team in Greater China to achieve greatest success!STATUS 治疗状况 SETUP STANDBY RUN ENDSCUF CVVH CVVHD CVVHDF TPECURRENT:11:3011 Sep 1996 CURRENT FLOW RATES Blood:150 ml/min Replace:1000 ml/hr Dialysate:500 ml/hr Pt Removal:200 ml/hr Anticoag:continuous 0.0 ml/hrI/O DATA Elapsed:30 of 60 min Replacement Sol.Input:500 ml Dialysate used:250 ml Effluent:850 ml Actual Pt.Fluid removed:100 ml CURRENT PRESSURES Access:-80 mmHg Filter :180 mmHg Effluent:40 mmHg Return:130 mmHg TMP :115 mmHg P Filt:50 mmHgNext intervention in approx:4 hr20 minDue to:Dialysate bag emptySTOPSET FLOWRATESMORESOFTKEYSHELP 2007,Gambro Lundia AB36Great team in Greater China to achieve greatest success!安裝 等待 治療 結束SCUF CVVH CVVHD CVVHDF TPEMORE SOFTKEYS 其它软按键CHANGEBAGSTATUSTREATMENTHISTORYNORMALIZEBLDMODIFYSETTINGSHELP更换液袋治疗历史重调漏血探测器更改设定 治疗状况 帮助1.按 NORMALIZE BLD 2007,Gambro Lundia AB37Great team in Greater China to achieve greatest success!WARNING ALARM TEST EFFLUENT LINE FOR BLOOD 检测废液管中血液成分 .BLD -signal value:150 以上 1.按 CONTINUE。CANCEL CONTINUE 2007,Gambro Lundia AB38Great team in Greater China to achieve greatest success!WARNING ALARMNORMALIZE BLOOD LEAK DETECTOR漏血探测器格式化.BLD-normalize value:-signal value:171 1.按 START NORMALIZE。2.按 STATUS。STATUS STARTNORMALIZE 2007,Gambro Lundia AB39Great team in Greater China to achieve greatest success!PRISMA液体平衡系统及相关报警 2007,Gambro Lundia AB40Great team in Greater China to achieve greatest success!PRISMA液体管理透析液废液秤置换液秤 2007,Gambro Lundia AB41Great team in Greater China to achieve greatest success!电子秤相关报警故障报警:Scale Out of Calibration故障报警:Scale Zero test 注意报警:Incorrect Weight Change解决方法:1.Retest（重新测试）2.校秤解决方法:1.检查有无妨碍称重的物品,Retest.2.校秤解决方法:1.按Continue,2.移开妨碍称重的物品3.校秤4.检查液袋是否漏水劝告报警:Bag PlacementIncorrect placement解决方法:1.检查秤2.确认秤上所挂液袋3.是否正确 2007,Gambro Lundia AB42Great team in Greater China to achieve greatest success!进入服务屏同时按住4和9键，然后开机，直到屏幕出现服务屏后，松开4和9键。112211310456789 2007,Gambro Lundia AB43Great team in Greater China to achieve greatest success!进入服务屏同时按住4和9键，然后开机，直到屏幕出现服务屏后，松开4和9键。112211310456789 2007,Gambro Lundia AB44Great team in Greater China to achieve greatest success!服务屏serviceSERVICENOTE:To exit Service Mode,press RESTARTCRC Values:Monitor:#Controller:#English:#Italian:#French:#Spanish:#German:#Swedish:#Dutch:#CALIBRATEDIAGNOSEEXAMINE ALARMSRESTART 2007,Gambro Lundia AB45Great team in Greater China to achieve greatest success!服务屏serviceSERVICENOTE:To exit Service Mode,press RESTARTCRC Values:Monitor:#Controller:#English:#Italian:#French:#Spanish:#German:#Swedish:#Dutch:#CALIBRATEDIAGNOSERESTART 2007,Gambro Lundia AB46Great team in Greater China to achieve greatest success!调校屏CALIBRATEDIAGNOSESERVICE-CALIBRATENOTE:EXIT key returns unit to main SERVICE screen.SCALEPRESSUREFILTER CLOTTING LIMITSSET CLOCKPRISMA IDEXIT 2007,Gambro Lundia AB47Great team in Greater China to achieve greatest success!平衡秤调校CALIBRATEDIAGNOSESERVICE-SCALE3-point Calibration ProcedureNOTE:1.EXIT key return unit to SERVICE-CALIBRATE screen.2.“SCALE STABLE”appears whenever a scale is stable.Select scale to calibrate.DIALYSATEREPLACEEFFLUENTEXIT 2007,Gambro Lundia AB48Great team in Greater China to achieve greatest success!零点调校CALIBRATEDIAGNOSESERVICE-SCALES NOTE：1、EXIT key returns unit to main SERVICE-CALIBRATE screen.2、“SCALE STABLE”appears whenever a scale is stable.1、Please weight on selected scale.Use weight of:-100 to+100 grams.2、Use arrows to enter weight used.Weight used:0 grams.3、Wait for scale to stabilize.DIALYSATEREPLACENEXTEFFLUENTEXITSCALE STABLE 2007,Gambro Lundia AB49Great team in Greater China to achieve greatest success!挂一个砝码（2600克）调校CALIBRATEDIAGNOSESERVICE-SCALES NOTE：1、EXIT key returns unit to main SERVICE-CALIBRATE screen.2、“SCALE STABLE”appears whenever a scale is stable.1、Please weight on selected scale.Use weight of:2500 to 2700 grams.2、Use arrows to enter weight used.Weight used:2600 grams.3、Wait for scale to stabilize.DIALYSATEREPLACENEXTEFFLUENTEXITSCALE STABLE 2007,Gambro Lundia AB50Great team in Greater China to achieve greatest success!挂两个砝码（5200 克）调校CALIBRATEDIAGNOSESERVICE-SCALES NOTE：1、EXIT key returns unit to main SERVICE-CALIBRATE screen.2、“SCALE STABLE”appears whenever a scale is stable.1、Please weight on selected scale.Use weight of:5100 to 5300 grams.2、Use arrows to enter weight used.Weight used:5200 grams.3、Wait for scale to stabilize.DIALYSATEREPLACESTOREEFFLUENTEXITSCALE STABLE 2007,Gambro Lundia AB51Great team in Greater China to achieve greatest success!PRISMA使用过程中的自检及相关报警 2007,Gambro Lundia AB52Great team in Greater China to achieve greatest success!PRISMA功能自检类型开机自检预充测试治疗中的定期自检 2007,Gambro Lundia AB53Great team in Greater China to achieve greatest success!按“重新测试”键按“停止”键压力室内软膜重复位重复1-3步(如果需要)确认动脉压和静脉压在正常范围结束治疗联系维修技术人员 0 0 0 0 A1 A2 A3 A4永远为“0”操作者无需将其纳入考虑因素0 or 1按“重新测试”键1 到 9;A 到 F排气重新安装空气探测器 中的静脉管按“重新测试”键PRISMA 自检错误代码 2007,Gambro Lundia AB54Great team in Greater China to achieve greatest success!2007,Gambro Lundia AB55Great team in Greater China to achieve greatest success!1:Air detector macrobubble test failure (空气探测器大气泡测试失败）-0001 2:Air detector test failure （空气探测器测试失败）-0002 4:Air detector microbubble test failure (空气探测器小气泡测试失败)-0004 8:24 V 电压测试失败 -0008A4位常见自检失败错误代码 2007,Gambro Lundia AB56Great team in Greater China to achieve greatest success!常见错误代码、原因及解决方法举例00F0压力值偏移Unable to perform normalization按“Retest”或做膜的重置位0002空气探测器测试失败静脉管位置不正确或管路中有空气 2007,Gambro Lundia AB57Great team in Greater China to achieve greatest success!常规清洁：使用温和的去污剂清除表面污物表面消毒：1-4%的次氯酸钠（或漂白水）清洁漏血探测器和空气探测器：用医用酒精和纱布清洁后待干使用机器在不使用时要遮盖防尘。PRISMA日常维护保养 2007,Gambro Lundia AB58Great team in Greater China to achieve greatest success!謝謝大家 2007,Gambro Lundia AB59