Nws yog qhov nyuaj heev los xav txog kev saib xyuas niaj hnub no yam tsis muaj txheej txheem catheterization ntawm ncauj tsev menyuam. Rau kev qhia txog lub catheter, feem ntau siv cov hlab ntsha subclavian. Cov txheej txheem no tuaj yeem ua tau ob qho tib si hauv qab thiab sab saum toj ntawm caj dab. Qhov chaw nkag ntawm lub catheter yog txiav txim los ntawm tus kws tshaj lij.
Txoj kev no ntawm txoj hlab ntsha catheterization muaj ntau qhov zoo: kev taw qhia ntawm lub catheter yog qhov yooj yim thiab xis rau tus neeg mob. Cov txheej txheem no siv lub hauv paus venous catheter, uas yog lub raj ntev, hloov tau yooj yim.
Clinical Anatomy
Cov hlab ntsha subclavian sau cov ntshav los ntawm sab sauv qaum. Nyob rau theem ntawm sab ntug ntawm thawj tav, nws txuas ntxiv nrog cov leeg axillary. Nyob rau hauv qhov chaw no, nws mus ib ncig ntawm thawj tav los ntawm saum toj no, thiab ces khiav raws ntug anterior ntawm lub scalene leeg qab lub clavicle. Nws nyob hauv qhov chaw preglacial. Qhov chaw no yog qhov sib txawv ntawm daim duab peb sab pem hauv ntej, uas yog tsim los ntawm qhov zawj ntawm cov leeg. Nws yog surrounded los ntawm scalene leeg, sternothyroid, sternohyoid nqaij thiab clavicular-mastoid nqaij nqaij. subclavian leegnyob rau hauv qab ntawm qhov sib txawv.
Hla dhau ob lub ntsiab lus, thaum qhov qis dua yog nyob ntawm qhov deb ntawm 2.5 centimeters sab hauv los ntawm cov txheej txheem coracoid ntawm scapula, thiab sab saud mus txog peb centimeters hauv qab ntawm sternal ntug ntawm qhov kawg ntawm lub clavicle. Hauv cov menyuam yaus hnub nyoog qis dua tsib xyoos thiab cov menyuam yug tshiab, nws kis mus rau hauv nruab nrab ntawm lub clavicle. Qhov projection hloov nrog hnub nyoog mus rau nruab nrab peb ntawm lub clavicle.
Cov leeg yog nyob me ntsis obliquely txheeb ze rau kab nruab nrab ntawm lub cev. Thaum txav caj npab lossis caj dab, qhov chaw ntawm cov hlab ntsha subclavian tsis hloov. Qhov no yog vim lub fact tias nws cov phab ntsa yog heev sib txuas nrog cov thawj tav, subclavian nqaij, clavicular-thoracic fascia thiab clavicular periosteum.
Indications rau CPV
Cov hlab ntsha subclavian (daim duab hauv qab no) muaj txoj kab uas hla loj, ua rau nws yooj yim tshaj catheterization.
Cov txheej txheem rau catheterization ntawm cov leeg no yog qhia nyob rau hauv rooj plaub ntawm:
- Yam kev phais mob uas yuav ua rau ntshav poob.
- Kev Kho Mob hnyav.
- Pacemaker insertion.
- Yuav tsum ntsuas qhov nruab nrab venous siab.
- khoom noj khoom haus parenteral.
- Yuav tsum tau soj ntsuam cov kab mob plawv.
- Qhib lub plawv phais.
- Qhov xav tau rau kev kawm X-ray sib piv.
Catheterization technique
EAP yuav tsum tuavtshwj xeeb los ntawm tus kws tshaj lij thiab tsuas yog nyob rau hauv ib chav tshwj xeeb uas muaj cov txheej txheem zoo li no. Chav yuav tsum tsis muaj menyuam. Rau cov txheej txheem, chav saib xyuas mob hnyav, chav ua haujlwm lossis chav hnav khaub ncaws zoo yog tsim nyog. Hauv cov txheej txheem ntawm kev npaj tus neeg mob rau CPV, nws yuav tsum tau muab tso rau ntawm lub rooj ua haujlwm, thaum lub taub hau kawg ntawm lub rooj yuav tsum tau qis dua 15 degrees. Qhov no yuav tsum tau ua kom tsis suav nrog kev txhim kho ntawm huab cua embolism.
Txoj kev puncture
Puncture ntawm cov hlab ntsha subclavian tuaj yeem ua tau ob txoj hauv kev: supraclavicular nkag thiab subclavian. Hauv qhov no, qhov puncture tuaj yeem ua los ntawm txhua sab. Cov hlab ntsha no yog tus cwj pwm los ntawm cov ntshav txaus, uas, dhau los, txo qhov kev pheej hmoo ntawm thrombosis. Muaj ntau tshaj ib qho chaw nkag thaum lub sij hawm catheterization. Cov kws tshaj lij muab qhov nyiam tshaj plaws rau qhov hu ua Abaniac point. Nws yog nyob rau ntawm ciam teb ntawm lub puab thiab nruab nrab peb ntawm lub clavicle. Qhov kev vam meej ntawm catheterization ntawm qhov no nce mus txog 99%.
Contraindications rau CPV
CPV, zoo li lwm yam kev kho mob, muaj ob peb contraindications. Yog tias cov txheej txheem ua tsis tiav lossis tsis tuaj yeem ua tau rau ib qho laj thawj, tom qab ntawd cov leeg jugular lossis sab hauv thiab sab nraud femoral leeg yog siv rau catheterization.
Puncture ntawm subclavian leeg yog contraindicated nyob rau hauv lub xub ntiag ntawm:
- Kev tsis txaus siab ntawm cov ntshav coagulation thiab hypocoagulation.
- Superior vena cava syndrome.
- Paget-Schroeter syndrome.
- Cov txheej txheem mob hauv zos ntawm qhov chaw npaj catheterization.
- Bilateral pneumothorax.
- Emphysema lossis ua tsis taus pa hnyav.
- kev raug mob clavicle.
Nws yuav tsum to taub tias tag nrho cov contraindications teev saum toj no yog cov txheeb ze. Nyob rau hauv cov ntaub ntawv ntawm ib qho tseem ceeb xav tau rau CPV, ceev nkag mus rau cov hlab ntsha, cov txheej txheem yuav ua tau yam tsis tau mus rau hauv tus account contraindications.
Muaj teeb meem tom qab txheej txheem
Feem ntau, catheterization ntawm cov hlab ntsha subclavian tsis muaj teeb meem loj. Txhua qhov kev hloov pauv thaum lub sij hawm catheterization tuaj yeem txheeb xyuas tau los ntawm cov ntshav liab pulsating. Cov kws tshaj lij ntseeg tias qhov laj thawj tseem ceeb yog vim li cas qhov teeb meem tshwm sim yog tias lub catheter lossis cov lus qhia tau muab tso rau hauv cov leeg tsis raug.
Qhov yuam kev no tuaj yeem ua rau muaj kev cuam tshuam tsis zoo xws li:
- YHydrothorax thiab fiber ntau infusion.
- Venous phab ntsa perforation.
- Subclavian vein thrombosis.
- Kev tsiv teb tsaws ntawm catheter hla cov leeg.
- Irregular heart rhythm.
Nyob rau hauv rooj plaub no, yuav tsum tau kho qhov catheter txoj hauj lwm. Tom qab hloov chaw nres nkoj, nws yuav tsum tau hu rau cov kws pab tswv yim uas muaj kev paub dhau los. Yog tias tsim nyog, lub catheter raug tshem tawm tag nrho. Txhawm rau kom tsis txhob cuam tshuam tus neeg mob tus mob, nws yog ib qho tsim nyog yuav tsum tau teb tam sim ntawd rau cov tsos mob ntawm cov teeb meem, tshwj xeeb tshaj yog.thrombosis.
Kev Tiv Thaiv Kab Mob
Txhawm rau tiv thaiv kev txhim kho ntawm huab cua embolism, kev ua raws li nruj nruj ntawm lub kaw lus yuav tsum tau ua. Tom qab ua tiav cov txheej txheem, tag nrho cov neeg mob uas tau ua tiav nws tau muab x-rays. Nws tiv thaiv kev tsim ntawm pneumothorax. Cov teeb meem zoo li no tsis suav nrog yog tias lub catheter nyob hauv caj dab ntev ntev. Tsis tas li ntawd, cov hlab ntsha thrombosis, kev loj hlob ntawm huab cua embolism, ntau yam kab mob sib kis, xws li sepsis thiab suppuration, catheter thrombosis yuav tshwm sim.
Txhawm rau tiv thaiv qhov no los ntawm qhov tshwm sim, txhua qhov kev tswj hwm yuav tsum tau ua los ntawm tus kws tshaj lij tshwj xeeb.
Peb tau tshuaj xyuas lub cev ntawm cov hlab ntsha subclavian, nrog rau cov txheej txheem rau nws qhov puncture.
