ECMO Equipments博識(shí)企管與您一起闢建管理的開(kāi)心農(nóng)場(chǎng)

1、ecmo equipmentsmachine：item manufacturercentrifugal pumpmedtronicmaquetbiomedicus pump console-550biomedicus pump console-560include: a. centrifugal pump: internal drive external driveb. internal battery pack, standarde. emergency hand crankf. flow transducer:for console 550: tx-50p (1/4), tx-50 (3/

2、8)560 console：tx-50p (1/4), tx-50 (3/8)centrifugal pump rotaflow rf32heater blanketrol iihirtzhyper-hypothermiahico-aquatherm 660air-o2 blendersechristair-oxygen mixermonitormedtronic 興東biotrend (sao2, svo2, hct)m3tubing flow metertransonic system inc.ht100 bypass flowmeterht110 bypass flowmeterflow

3、 probe: 3/8 medtronic carmeda tubing：h9xl3/8 supertygon tubing：h8x1/4 medtronic carmeda tubing：h6xl3/16 dialysis tubing：h4xacthemochronmodel 401, model 801，response(兒醫(yī))act tubehemochronp215，510(兒醫(yī))free hb monitorhemocueplasma/low hbcentrifugekubotakn-70oxygenator holdermedtronicecmo system holder 61

4、399401072model 1302 (holder for minimax plus)pressure transducer cableabbott critical care systemsbiotranstm2transpac reusable cabletie gunavery dennisoncable tie toolecmo cartntuh customer-made大瓏upsft飛碟ups飛瑞ups緊急手搖系統(tǒng)(emergency hand crand)consumable supplies:item manufacturerecmo packmedtronic cb1v9

5、7r1for adult, cb2503r1 for pediatric including biopump, flow sensor, oxygenator, circuitntuh package：cb1q91r6cannulamedtronicorigen biomedicalmaquet medtronicmedosvenous cannula: bio-medicus10fr, cb96835-01012fr, cb96835-01214fr, cb96835-01415fr, cb96605-01517fr, cb96605-01719fr, cb96605-01921fr, cb

6、96605-02123fr, cb96345-02325fr, cb96345-025artery cannula: bio-medicus8fr, cb96825-00810fr, cb96825-01012fr, cb96825-01215fr, cb96535-01517fr, cb96535-01719fr, cb96535-01921fr, cb96535-02123fr, cb96540-023double lumen cannula：12fr, 15fr, 18frels cannula(double lumen): 2024081412fr, 15fr,transthoraci

7、c route dlp cannularvenous cannula:12fr, 6931214fr, 6931416fr, 6931618fr, 6931820fr, 6932022fr, 6932224fr, 6932426fr, 6932628fr, 69328artery cannula: 8fr, 77008 10fr, 77010 12fr, 77012 14fr, 77014 16fr, 77016venous cannula and insertion kit for venous femoral cannula 22fr, me fk v 22l artery cannula

8、 and insertion kit for arterial femoral cannula : 16fr, me fk a16l 18fr, me fk a18loxygenatormedtronicmedoshollow fiber microporous membrane oxygenaor: adult: affinity nt pediatric: mini plus prfsilicone membrane oxygenator: adult: i-4500medos oxygenator: adult: medos 7000 lt pediatric: medos 2400 l

9、t, carmeda tubemedtronic1/4 tube : cb29933/8 tube : cb29941/2 tube: cb2995bladdermedtronicassist reservoir r-38 (for 3/8 tube)assist reservoir r-14 (for 1/4 tube)monitor sensor cellmedtronicadult：tmc-38 connector 3/8 tubepediatric：tmc-25 connector 1/4 tubehemofilter gambro興東fresenius adult: hf6shph-

10、minihph-400m30av-600distal perfusion catheterarrowsingle lumen femoral catheterization set (8.5fr. 20cm, cs-15851-e)distal perfusion catheter adaptorgish biomedical inc.specialty connector華億pressure kithospiratranspac iv monitor kitconnector華億1/2 1/2，1/2 1/2 y1/2 3/8，1/2 3/8 y3/8 3/8，3/8 3/8 y3/8 1/

11、4，3/8 1/4 y1/4 1/4，1/4 1/4 y connector with luermedtronic3/8 3/8，3/8 1/4，1/4 1/4nylon cable tiescacu-200 (200mm x 4.8mm)note: edward life sciences: fem-fex duraflo treated femoral aterial (venous) cannula cannot be used in ecmo due to its low resistance to deformity.reference pump:一、 幫浦1. 滾輪式幫浦滾輪式幫浦

12、使用的管路為耐磨材質(zhì)的supertygon，其特點(diǎn)為比一般pvc材質(zhì)的管路在滾輪碾動(dòng)下可減少微栓脫削及較長(zhǎng)時(shí)間碾動(dòng)不會(huì)破裂。但各種材質(zhì)的suprtygon仍有其平均使用時(shí)間，如下表comparative peristaltic pump tubing life test resultstest 1: hours of pump life in master flex pump (600 rpm)tygons-50-hltygons-40-hltygons-56-hltygons-65-hlaverage life32265228117minimum life2414411881maximum

13、life40380300141滾輪幫浦的前後管路被夾起來(lái)時(shí)，產(chǎn)生的負(fù)壓和正壓很大，巨大的負(fù)壓會(huì)產(chǎn)生氣泡，巨大的正壓會(huì)使管路破裂，因此滾輪式幫浦要有較佳的監(jiān)視器及較嚴(yán)格的控制。滾輪式幫浦前的管路上含有一個(gè)具彈性的血囊，血囊置於一個(gè)控制供電的裝置中，血囊充血時(shí)膨脹，則該裝置會(huì)繼續(xù)供電給滾輪式幫浦讓其繼續(xù)轉(zhuǎn)動(dòng)。一旦靜脈引流不足，血囊扁掉，該裝置能立刻查覺(jué)血囊扁掉，自動(dòng)停止供電給滾輪式幫浦，而停止幫浦的轉(zhuǎn)動(dòng)，避免靜脈導(dǎo)管引流不足，滾輪幫浦仍急續(xù)轉(zhuǎn)動(dòng)而在管路內(nèi)形成巨大的負(fù)壓。當(dāng)幫浦停止轉(zhuǎn)動(dòng)後，血液續(xù)流入血囊，使血囊重新膨脹起來(lái)，該裝置才重新供電讓滾輪式幫浦繼續(xù)轉(zhuǎn)動(dòng)。 2. 離心式幫浦物體在作同心圓運(yùn)轉(zhuǎn)時(shí)

14、產(chǎn)生一個(gè)向外的力量，即離心力。其大小與轉(zhuǎn)速和質(zhì)量成正比，離心幫浦即是根據(jù)此原理設(shè)計(jì)的。在密閉圓錐容器(即離心幫浦)的圓心上端和圓周部各有一孔，當(dāng)其圓錐部高速轉(zhuǎn)動(dòng)時(shí)，圓心部為負(fù)壓，可將血吸入，而圓周部為正壓，可將血液打出。驅(qū)動(dòng)部份由電機(jī)和磐磁頭組成：電機(jī)具有體積小，重量輕，噪音小，磨損小等優(yōu)點(diǎn)。電機(jī)帶動(dòng)磐磁頭高速旋轉(zhuǎn)，轉(zhuǎn)頭磁力帶動(dòng)密封幫浦內(nèi)的磁性圓錐旋轉(zhuǎn)產(chǎn)生離心力。離心轉(zhuǎn)頭內(nèi)設(shè)計(jì)有轉(zhuǎn)子葉片，可增加液體轉(zhuǎn)動(dòng)，減少產(chǎn)熱，現(xiàn)在離心幫浦內(nèi)和血液接觸的部份用了肝素結(jié)合技術(shù)，生物相容性好，可短時(shí)間不用肝素或減少肝素劑量使用。3. 離心幫浦及滾輪式幫浦之比較(一). 滾輪幫浦較適合長(zhǎng)期使用，小兒使用滾輪幫浦可

15、作小流量的精細(xì)調(diào)節(jié)，作脫離訓(xùn)練比離心幫浦較方便(二). 壓力緩衝大：離心幫浦轉(zhuǎn)速愈高，產(chǎn)生壓力越大，輸出量越高，而管路阻力升高，流量會(huì)相對(duì)減少。離心幫浦之血流速是轉(zhuǎn)速組力依賴(lài)型。離心式幫浦前後的管路被夾起來(lái)時(shí)，在幫浦前後，各自產(chǎn)生負(fù)壓和正壓，但到一定的程度為止(level off)。因此離心式幫浦前不需要一個(gè)特殊裝置去偵側(cè)是否吸不到血，而停止幫浦運(yùn)作。如果管線扭折，流量會(huì)減少，但不會(huì)在接頭處崩脫。滾輪幫浦的流量和轉(zhuǎn)速及管線內(nèi)徑平方成線性正比，屬於容量依賴(lài)性。如果管線扭折，管路內(nèi)壓力會(huì)急速劇增至崩脫。(三). 離心式幫浦安全性高離心幫浦因中心為負(fù)壓且氣體質(zhì)量小，轉(zhuǎn)動(dòng)時(shí)若有氣體在幫浦內(nèi)會(huì)把氣體陷在

16、中心處(air trapping)，故不易將幫浦內(nèi)的氣體流入體內(nèi)，而滾輪幫浦有此缺點(diǎn)。再則離心幫浦表面光滑，結(jié)構(gòu)堅(jiān)硬，很少產(chǎn)生固體微栓，而滾輪幫浦的管線在滾輪擠壓時(shí)產(chǎn)生較大的摩擦，管線內(nèi)可能有微栓脫落。(四). 使用方便性離心式幫浦轉(zhuǎn)動(dòng)時(shí)，可形成負(fù)壓，有吸引(suction)靜脈血的作用，因此幫浦位置與病床的垂直距離，要求較不嚴(yán)格。反之，滾輪式幫浦全憑重力把靜脈血引流至血囊中，因此一般要求血囊的位置比病床低一公尺以上，以促進(jìn)靜脈血引流。pump比較圖式bio-pump離心式幫浦roller pump滾輪式幫浦levitronix磁浮式幫浦maquet離心式幫浦容量80毫升35毫升31 毫升32

17、 毫升flowgentle flowturbulent flowcentrimag magnetically levitated pumprota flow laminar flowminimal turbulencesconceptsmooth coneshear stressimpellerimpeller材質(zhì)acrylicecmo tube：95-epolycarbonatepolycarbonate可見(jiàn)空氣deprime因磁性離心式設(shè)計(jì)，儘可能減少空氣進(jìn)入完全的將空氣推向病人安置血液幫浦並藉由電磁力使幫浦內(nèi)部之葉輪浮起並轉(zhuǎn)動(dòng)無(wú)軸心，儘可能減少空氣進(jìn)入微小空氣離心式幫浦的中心點(diǎn)有助於控制

18、住空氣比葉片式久小氣泡透過(guò)幫浦通過(guò)，導(dǎo)致循環(huán)管有針孔般的裂縫8片葉片置於葉輪外之防渦流及滯流特殊設(shè)計(jì)，以符合最少的體外血液循環(huán)血流偵測(cè)器與氣體偵測(cè)器合併，可偵測(cè)到微小空氣微量分子原料不會(huì)從循環(huán)管釋放出來(lái)從循環(huán)管的內(nèi)部會(huì)釋放出10m以下的碎片幫浦本身無(wú)迴旋式密封墊與旋轉(zhuǎn)軸承安全性控制感應(yīng)式壓力循環(huán)管線若停止，壓力不會(huì)過(guò)大，且流量會(huì)隨著壓力微量改變而逐漸改變?nèi)粞h(huán)管組在只有一個(gè)循環(huán)周期的rpm高峰被糾結(jié)或停止，則壓力過(guò)大葉輪運(yùn)轉(zhuǎn)時(shí)可完全浮起並與外殼完全無(wú)任何接觸點(diǎn)無(wú)金屬軸心，密閉堅(jiān)固的推力，減少機(jī)械故障的危險(xiǎn)性凝塊可有助於控制凝塊至少1mm凝塊向前流向病人不需任何固定軸或?qū)бS，並藉由電磁力與幫浦

19、內(nèi)壁以無(wú)任何接觸方式作全磁浮式離心式轉(zhuǎn)動(dòng)幫浦內(nèi)壁塗層(bioline+saveline)，較不易造成凝塊流量測(cè)試電子流量可測(cè)量整個(gè)流量區(qū)，來(lái)自動(dòng)力補(bǔ)償不穩(wěn)定的流量無(wú)流量偵測(cè)統(tǒng)，流量用計(jì)算且易變不需任何固定軸或?qū)бS，並藉由電磁力與幫浦內(nèi)壁以無(wú)任何接觸方式作全磁浮式離心式轉(zhuǎn)動(dòng)血液測(cè)量在幫浦出口處急性溶血現(xiàn)象會(huì)損害血液，造成溶血所造成的血球破壞比離心式幫浦大損害血液，造成溶血機(jī)率較小減少血液損害referencecannula m-numberbiomedicus cannula m-numbersizelength (cm)m-numberarterial 8254.410254.012253.

20、5514253.2515373.317373.0519372.821372.6venous8254.3510253.912253.5514253.3515503.6517503.419503.1521502.923502.6525502.55pressure drop vs. flowmedos femoral cannula:medos cannula 全長(zhǎng)(mm)implantable(mm)tip不顯影長(zhǎng)度(mm)22v8075924016a3831684018a38316840origen double lumen catheter:priming volumebw (kg)lengt

21、h (cm)arterial (ml)venous (ml)12 fr2-58.52.83.015 fr4-810.53.03.518 fr7-12154.05.2ecmo oxygenator specificationsavecor0800avecor2500avecor4500medtronicaffinityminimaxplus prfdevice designmlmlmlhfhfsurface area (m2)0.82.54.52.50.8priming volume(ml)100455665270149o2 transfer(ml/min)70113400374131o2 tr

22、ansfer/m2 (ml/m2/min)887589150164co2 tranfer(ml/min)3256208309133maximan gas flow rate (l/min)2.47.513.514maximum blood flow (l/min)1.24.56.57.02.3compliance(ml/100mmhg)103259lowlowblood phase pressuredrop at rated flow (mmhg) 30030030080115specifications and gas exchange capabilities artificial lun

23、gshfhollow fiber lung mlmembrane lung “ rated flow” which is defined as the blood flow rate at which blood enters 70% oxygen saturated and leaves the device 95% saturate. reference-hemofilter成人cavh & cvvh filter hf- 6sav-600hf-3000(ts)hf-5000(ts)廠牌gambrofresenius medical carefreseniuskabifreseniuska

24、bi膜材質(zhì)polyamidefreseniuspolysulfonepolysulfonefreseniuspolysulfonefreseniuspolysulfonesurface area (m2)0.6 m21.4 m20.35 m21.0 m2wall thickness (mm)50 mm35mm35mm35mminside diameter (mm)215 mm220mm200mm200mmcut-off point (dalton) 30000300003000030000priming volume (ml)57 ml100ml27 ml63 ml pb (mmhg) at qb200 ml/min45mmhg172.5 mmhg45mmhg小兒c