Lub hauv paus venous catheter (CVC) tsis tas yuav tsum muaj nyob rau hauv cov neeg mob tsaug zog nrog kev ruaj khov thiab hauv cov neeg mob tsis tau txais cov tshuaj osmolarity siab. Ua ntej muab cov catheter no, nws yog ib qho tsim nyog los ntsuas tag nrho cov teeb meem thiab kev pheej hmoo. Hauv kab lus no, peb yuav saib seb qhov catheterization hauv nruab nrab ntawm venous tau ua li cas.
Xaiv qhov chaw teeb tsa
Thaum xaiv qhov chaw ntawm lub catheter (txhaj tshuaj), ua ntej ntawm tag nrho cov, cov kev paub ntawm tus neeg ua haujlwm noj qab haus huv raug coj mus rau hauv tus account. Qee zaum hom kev cuam tshuam ntawm kev phais, qhov xwm txheej ntawm kev puas tsuaj thiab cov yam ntxwv ntawm lub cev raug coj mus rau hauv tus account. Tshwj xeeb, rau cov txiv neej cov neeg mob, ib lub catheter yog muab tso rau hauv cov hlab ntsha subclavian (vim lawv muaj hwj txwv). Yog tias tus neeg mob muaj lub siab intracranial siab, tsis txhob tso ib lub catheter rau hauv cov hlab ntsha jugular, vim qhov no yuav cuam tshuam cov ntshav tawm.
Lwm qhov chaw puncture yog axillary, medial thiab lateral saphenous leeg ntawm caj npab, uas kujQhov chaw ntawm lub hauv paus catheter yog ua tau. PICC catheters yog nyob rau hauv ib qeb tshwj xeeb. Lawv raug ntsia rau hauv cov hlab ntsha ntawm lub xub pwg nyom raws li kev tswj hwm ntawm ultrasound thiab yuav tsis hloov rau ob peb lub hlis, sawv cev, qhov tseeb, ib qho kev hloov pauv ntawm qhov chaw nres nkoj. Cov teeb meem ntawm ib hom tshwj xeeb yog thrombosis thiab thrombophlebitis.
Kev qhia
Central vein catheterization yog ua raws li cov lus qhia hauv qab no:
- Yuav tsum tau tswj hwm cov tshuaj hyperosmolar (ntau dua 600 mosm / l) rau tus neeg mob.
- Hemodynamic xyuas - ntsuas qhov nruab nrab venous siab (CVP), PICCO hemodynamic xyuas. Kev ntsuas CVP ib leeg tsis yog qhov qhia txog kev tso catheter, vim kev ntsuas tsis muab qhov tseeb.
- ntsuas qib carbon dioxide saturation hauv cov ntshav (hauv ib tus neeg mob).
- Kev siv catecholamines thiab lwm yam kab mob ntawm cov leeg.
- Nyob ntev, ntau tshaj 10 hnub, kev kho mob infusion.
- Venous dialysis lossis venous hemofiltration.
- Tshuaj kho cov kua dej rau cov kab mob peripheral tsis zoo.
YContraindications
Contraindications rau kev tso catheter yog:
- kis kab mob hauv cheeb tsam puncture.
- thrombosis ntawm cov hlab ntsha uas lub catheter npaj yuav muab tso.
- Impaired coagulation (tus mob tom qab lub cev tsis ua hauj lwm, anticoagulation). Nyob rau hauv rooj plaub no, nws muaj peev xwm nruab ib lub catheter nyob rau hauv peripheral leeg ntawm caj npab los yog ncej puab.
Xaiv qhov chaw thiab ceev faj
Ua ntej catheterization ntawm cov hlab ntsha hauv nruab nrab, nws yuav tsum tau soj ntsuam qee qhovcov cai:
- Ceev faj: siv hnab looj tes tsis muaj menyuam, daim npog qhov ncauj, lub kaus mom, lub tsho tsis muaj menyuam thiab cov ntaub so, yuav tsum tau them tshwj xeeb rau kev tua kab mob ntawm daim tawv nqaij.
- Tus neeg mob lub cev: Lub taub hau ntawm txoj hauj lwm yog qhov kev xaiv zoo tshaj plaws, vim qhov no ua kom yooj yim rau kev tso cov catheter rau hauv cov hlab ntsha jugular thiab subclavian. Nws kuj txo qhov kev pheej hmoo ntawm kev tsim cov hlab ntsws embolism. Txawm li cas los xij, nws yuav tsum nco ntsoov tias txoj haujlwm ntawm lub cev tuaj yeem ua rau muaj kev nce siab hauv intracranial. Saib hauv qab no rau Seldinger Central Vein Catheter Kit.
Kev txwv
Xaiv qhov chaw puncture yog ib kauj ruam tseem ceeb hauv cov txheej txheem thiab yuav raug txwv raws li hauv qab no:
- Lwm txoj hauv kev rau txoj kev taw qhia los ntawm cov yam ntxwv anatomical yog qhov puncture ntawm cov leeg jugular thiab subclavian leeg hauv qab 1/3 tswj. Txoj kev no pom pom cov yam ntxwv ntawm lub cev thiab txo qhov kev pheej hmoo ntawm cov teeb meem xws li txoj haujlwm catheter tsis raug lossis qhov tsis raug (nrog hematoma).
- tshuaj loog hauv zos. Yog hais tias tus neeg mob tsis nco qab lawm, ces lub teeb tshuaj loog yog muab rau nws ua ntej tus txheej txheem, nyob rau hauv tej rooj plaub, lub teeb sedation nrog txhaj tshuaj midazolam.
- Venous puncture. Yog tias peb tab tom tham txog sab nraud, sab hauv lossis sab hauv jugular leeg, tom qab ntawd qhov kev sib tsoo yog ua nrog lub koob txhaj tshuaj ib nrab puv nrog saline. CVC nyob rau hauv cov ntaub ntawv no yog tsim los ntawm txoj kev Seldinger. Yog tias yuav tsum tau muab tso rau hauv cov hlab ntsha subclavian, j-wire yog coj mus rau hauv qab. Lub catheter yog nyob ntawm 3-4centimeter nyob rau hauv lub clavicle mus rau sab xis ntawm parasternal kab. Kev soj ntsuam tas li ntawm electrocardiogram tsis yog qhov tsim nyog, vim tias qhov tob tob ntawm lub catheter tuaj yeem cuam tshuam lub plawv dhia. Cov khoom siv catheterization rau menyuam yaus yuav pab tau qhov no.
- Aspiration test. Tom qab txhim kho lub catheter, lub syringe raug rho tawm kom nkag siab seb cov hlab ntsha los yog cov ntshav venous los ntawm qhov chaw puncture. Yog tias muaj kev tsis ntseeg, cov ntshav raug coj los tshuaj xyuas. Yog hais tias kev ntshaw tshwm sim dawb, ces lub catheter ntsia tau siv rau kev kho infusion. Nws yog ib qho tsim nyog los xyuas qhov tseeb ntawm lub tshuab catheter uas siv lub x-ray thiab tsuas yog kho nws.
- Saib xyuas tus neeg mob tus mob. Tam sim ntawd tom qab kev teeb tsa lub catheter, tus neeg mob yuav tsum tau saib xyuas kom lub sijhawm txheeb xyuas cov teeb meem uas tshwm sim, uas tuaj yeem ua rau pneumothorax.
- TsVK. Txhua lub catheter muab tso rau yuav tsum tau cim rau ntawm lub sijhawm tshwj xeeb qhia hnub, qhov chaw thiab hom catheter. Nyob rau hauv rooj plaub thaum muaj xwm ceev catheter insertion tsis muaj aseptic mob, nws yuav tsum tau muab tshem tawm thiab xa mus rau kev soj ntsuam kom sai li sai tau. Cov khoom siv Seldinger Central Vein Catheter yog qhov nrov tshaj plaws.
Nyob zoo ib tsoom niam txiv kwv tij neej tsa sawv daws.
Kev txiav thiab tswj lub kaw lus yuav tsum zam. Kinks thiab unsanitary mob ntawm lub catheter yog tsis tsim nyog. Lub kaw lus yog tsau nyob rau hauv xws li ib txoj kev uas tsis muaj kev hloov nyob rau hauv lub puncture cheeb tsam. Txoj kev loj hlob ntawm cov teeb meem thiab kev pheej hmoo ntawm lawv qhov tshwm sim yuav tsumkuaj txhua hnub. Qhov kev xaiv zoo tshaj plaws yog siv cov ntaub qhwv pob tshab rau hauv qhov chaw tso catheter. Lub catheter yuav raug tshem tawm sai yog tias muaj kab mob hauv lub cev lossis hauv zos thaum lub sij hawm catheterization hauv plawv.
Hygiene Standards
Txhawm rau zam kom tsis txhob tshem tawm sai ntawm lub catheter, kev ua raws li cov qauv kev tu cev thiab asepsis yog tsim nyog thaum lub sijhawm teeb tsa. Yog tias CVC tau teeb tsa ntawm qhov xwm txheej, nws raug tshem tawm tom qab tus neeg mob raug coj mus rau tsev kho mob. Nws yog ib qho tsim nyog kom tshem tawm cov kev tsis tsim nyog nrog cov catheter thiab ua raws li cov cai ntawm asepsis thaum noj ntshav thiab txhaj tshuaj. Disconnection ntawm lub catheter los ntawm infusion teeb yuav tsum tau tua kab mob ntawm CVC handpiece nrog ib tug tshwj xeeb tov. Nws yog ib qho tseem ceeb uas yuav tsum tau siv cov khaub ncaws uas tsis muaj menyuam yaus thiab cov khoom siv rau kev nres peb txoj kev, txo cov tees thiab kev sib txuas, thiab tswj xyuas cov ntshav protein, leukocyte, thiab qib fibrinogen kom tsis txhob muaj kab mob.
Ua raws li tag nrho cov cai no, koj tsis tuaj yeem hloov lub catheter ntau zaus. Tom qab tshem tawm ntawm CVC, lub koob txhaj tshuaj raug xa mus rau kev kuaj tshwj xeeb, txawm tias tsis muaj cov tsos mob ntawm tus kab mob.
Kev hloov pauv
Qhov ntev ntawm kev nyob ntawm rab koob rau hauv nruab nrab venous catheterization tsis raug tswj, nws nyob ntawm tus neeg mob qhov kis tau tus kab mob thiab lub cev teb rau qhov kev qhia ntawm CVC. Yog hais tias lub catheter raug ntsia rau hauv cov hlab ntsha peripheral, ces yuav tsum tau hloov txhua 2-3 hnub. Yog tias muab tso rau hauv cov hlab ntsha hauv nruab nrab, lub catheter raug tshem tawm ntawm thawj cov tsos mob ntawm sepsis lossis kub taub hau. Lub syringe, tshem tawm nyob rau hauv sterile tej yam kev mob, yog xa mus rauKev tshawb nrhiav microbiological. Yog tias qhov yuav tsum tau hloov CVC tshwm sim hauv thawj 48 teev, thiab tsis muaj qhov khaus lossis cov tsos mob ntawm tus kab mob ntawm qhov taw tes, lub catheter tshiab tau muab tso rau siv txoj kev Seldinger. Kev soj ntsuam tag nrho cov kev cai asepsis, lub catheter yog rub rov qab ob peb centimeters kom nws, ua ke nrog cov koob txhaj tshuaj, tseem nyob hauv lub nkoj, thiab tsuas yog tom qab ntawd cov koob txhaj tshuaj raug tshem tawm. Tom qab cov hnab looj tes raug hloov, ib txoj hlua coj tau muab tso rau hauv lub lumen thiab lub catheter raug tshem tawm. Tom ntej no, muab ib lub catheter tshiab tso thiab tsau.
Muaj Teeb Meem
Tom qab cov txheej txheem, cov teeb meem hauv qab no tuaj yeem ua tau:
- Pneumothorax.
- YHematoma, hemomediastinum, hemothorax.
- Arterial puncture nrog kev pheej hmoo ntawm kev puas tsuaj rau kev ncaj ncees ntawm cov hlab ntsha. Hematomas thiab los ntshav, cuav aneurysms, strokes, arteriovenous fistulas thiab Horner's syndrome.
- YPulmonary embolism.
- Ntxhais cov hlab ntsha nrog chylomediastinum thiab chylothorax.
- Txoj haujlwm tsis raug ntawm catheter hauv cov leeg. Infusothorax, catheter nyob rau hauv lub pleural kab noj hniav los yog tob heev nyob rau hauv lub ventricle los yog atrium ntawm sab xis, los yog misdirection ntawm lub CCV.
- Kev raug mob rau lub caj pas lossis lub ncauj tsev menyuam plexus, phrenic lossis vagus hlab ntsha, stellate ganglion.
- Sepsis thiab catheter kab mob.
- Vim thrombosis.
- Lub plawv tsis sib xws thaum nce mus rau Seldinger central venous catheter.
Txhim kho ntawm Central Exhibition Center
Nws muaj peb txoj hauv kev los ntxig lub hauv paus cathetercheeb tsam:
- Subclavian leeg.
- Jugular internal vein.
- Femoral leeg.
Tus kws tshaj lij tsim nyog yuav tsum tuaj yeem tso lub catheter nyob rau hauv tsawg kawg yog ob ntawm cov leeg leeg. Thaum catheterizing cov hlab ntsha hauv nruab nrab, kev taw qhia ultrasonic tseem ceeb tshwj xeeb. Qhov no yuav pab kho cov hlab ntsha thiab txheeb xyuas cov txheej txheem cuam tshuam nrog nws. Yog li ntawd, nws yog ib qho tseem ceeb uas yuav tsum tau siv lub tshuab ultrasound thaum ua tau.
Kev tsis muaj menyuam ntawm cov khoom siv catheterization hauv nruab nrab yog qhov tseem ceeb tshaj plaws kom txo qis kev pheej hmoo kis mob. Cov tawv nqaij yuav tsum tau kho nrog cov tshuaj tua kab mob tshwj xeeb, qhov chaw txhaj tshuaj yuav tsum tau them nrog cov ntaub so tsis huv. Cov ris tsho tsis muaj menyuam thiab hnab looj tes yog qhov yuav tsum tau nruj me ntsis.
Tus neeg mob lub taub hau nqes mus, uas tso cai rau koj los sau cov hlab ntsha hauv nruab nrab, ua kom lawv ntim. Txoj hauj lwm no pab txhawb cov txheej txheem catheterization, txo qhov kev pheej hmoo ntawm pulmonary embolism thaum tus txheej txheem nws tus kheej.
Cov leeg leeg sab hauv feem ntau yog siv los tso lub hauv nruab nrab venous catheter. Nrog rau hom kev nkag no, qhov kev pheej hmoo ntawm pneumothorax txo qis (piv rau subclavian catheterization). Tsis tas li ntawd, nyob rau hauv cov ntaub ntawv ntawm los ntshav, nws raug tso tseg los ntawm clamping cov hlab ntsha los ntawm compression hemostasis. Txawm li cas los xij, hom catheter no tsis xis nyob rau tus neeg mob thiab tuaj yeem tshem tawm cov xov hlau ntawm lub pacemaker ib ntus.
Protocol actions
Cov txheej txheem rau hauv nruab nrab venous catheterization suav nrog cov kauj ruam hauv qab no:
- Qhov zoo tshaj plaws yog siv Seldinger koob rau catheterization (kev taw qhia raws tus neeg xyuas pib). Cov catheters zoo li peripheral yog qhov nyuaj rau qhov chaw.
- Ua ntej txhaj tshuaj, nws yuav tsum tau tshuaj loog ntawm daim tawv nqaij thiab fiber ntau nrog lidocaine (1-2% tov).
- Tus koob muab tso rau ntawm lub koob txhaj tshuaj nrog sodium chloride tov.
- Tus neeg xyuas pib nyob rau hauv qhov chaw tsis muaj menyuam tuaj yeem nkag tau dawb.
- Ib qho kev txiav tawm hauv daim tawv nqaij nrog lub ntsej muag me me. Qhov no yog ua kom yooj yim rau kev nkag ntawm cannula.
- Tom ntej no, koj yuav tsum txav lub koob mus rau pem hauv ntej, rub lub piston kom tswj qhov tsis zoo.
- Yog tias tsis tuaj yeem nkag mus rau hauv cov hlab ntsha, koj yuav tsum maj mam rub lub koob, txuas ntxiv kom tsis txhob muaj qhov tsis zoo ntawm lub koob txhaj tshuaj. Muaj cov kab mob ntawm cov hlab ntsha los ntawm. Hauv qhov no, rub rab koob pab.
- Yog tias qhov kev sim ntxig rau lub catheter ua tsis tiav, rab koob yuav ntws tawm kom tshem tawm cov khoom thaiv cov lumen. Tom ntej no, qhov chaw ntawm cov hlab ntsha yog rov ntsuam xyuas dua thiab ib qho kev tawm tswv yim tshiab rau kev qhia lub catheter yog txiav txim siab.
- Thaum rab koob nkag mus rau hauv cov hlab ntsha thiab cov ntshav nkag mus rau hauv lub koob txhaj tshuaj, koj yuav tsum txav rab koob rov qab los yog xa mus me ntsis kom cov ntshav ntws mus tau zoo.
- Txhawb koob nrog ib txhais tes, tshem lub koob txhaj.
- Tom qab ntawd cov lus qhia hloov pauv hloov pauv tau muab tso rau. Nws hla mus rau hauv lub pavilion ntawm rab koob nrog qhov tsawg kawg nkaus ua haujlwm. Koj tuaj yeem ua qhov txheej txheem no yooj yim me ntsis los ntawm kev hloov lub kaum sab xis.
- Yog tias qhov kev tawm tsam thaum txav tus neeg xyuas pib muaj zog txaus,koob txoj hauj lwm yuav tsum tau kuaj los ntawm aspirating ntshav.
- Thaum qhov loj dua ib nrab ntawm cov kab lus qhia nkag mus rau hauv cov hlab ntsha, cov koob yuav tsum tau muab tshem tawm thiab lub catheter nrog dilator tso rau ntawm tus taw qhia.
- Cov ntaub qhwv yuav tsum tsis txhob nce mus txog qhov ntev me me ntawm cov kab ntawv qhia tawm dhau ntawm qhov kawg ntawm lub dilator thiab ruaj khov.
- Yog tias muaj kev tiv thaiv rau CVC qhov ntxig, qhov kev txiav tuaj yeem nthuav dav. Yog tias muaj kev tiv thaiv nyob rau hauv cov khaubncaws sab nraud povtseg, koj tuaj yeem ua ntej ntxig ib txoj kab uas hla me me kom qhib qhov nkag.
- Tom qab lub catheter tau muab tso rau tag nrho, lub dilator raug tshem tawm thiab CVC tau ruaj ntseg nrog cov ntaub qhwv pob tshab thiab ligature.
- Thaum kawg, kev kuaj X-ray yog ua los tswj txoj haujlwm ntawm lub catheter. Yog tias tsis muaj teeb meem, lub catheter tuaj yeem siv tam sim ntawd yam tsis muaj kev saib xyuas ntxiv.
Nkag mus rau subclavian leeg
Kev teeb tsa lub catheter rau hauv cov hlab ntsha subclavian yog siv thaum tsis muaj kev nkag mus rau tus neeg mob lub caj dab. Qhov no ua tau nrog lub plawv nres. Lub catheter ntsia rau hauv qhov chaw no yog nyob rau pem hauv ntej ntawm lub hauv siab, nws yog ib qho yooj yim mus ua hauj lwm nrog nws, nws tsis ua rau inconvenience rau tus neeg mob. Qhov tsis zoo ntawm hom kev nkag no yog qhov kev pheej hmoo siab ntawm kev tsim pneumothorax thiab tsis muaj peev xwm clamp lub nkoj yog tias nws puas lawm. Yog tias nws tsis tuaj yeem ntxig lub catheter rau ntawm ib sab, koj yuav tsum tsis txhob sim ntxig nws rau sab nraud, vim qhov no ua rau muaj kev pheej hmoo ntawm kev tsim pneumothorax.
Kev txhim kho catheter muaj cov hauv qab nokev ua:
- Muaj ib qho taw qhia nyob rau sab saum toj ntawm ntug ntug ntawm lub clavicle nruab nrab ntawm ib feem peb ntawm qhov nruab nrab thiab ob feem peb ntawm sab.
- Qhov chaw txhaj tshuaj yog nyob 2 centimeters hauv qab no.
- Tom ntej no, tshuaj loog yog tswj hwm, thiab ob qho tib si qhov chaw thiab cov pob txha caj dab nyob ib ncig ntawm qhov chaw pib yog tshuaj loog.
- koob catheterization yog ntxig rau tib yam li tshuaj loog.
- Thaum kawg ntawm rab koob yog nyob rau hauv lub dab teg, koj yuav tsum tig nws mus rau qis qis ntawm lub jugular notch ntawm lub sternum.
Kev nkag mus los ntawm cov hlab ntsha femoral yog tshwj xeeb tshaj yog siv thaum muaj xwm txheej ceev, vim nws pab nkag mus rau hauv cov hlab ntsha loj rau kev ua haujlwm ntxiv. Tsis tas li ntawd, nrog rau hom kev nkag no, nws yog ib qho yooj yim kom tsis txhob los ntshav los ntawm clamping cov leeg. Qhov kev nkag mus no tso cai rau koj tso lub pacemaker ib ntus. Qhov teeb meem tseem ceeb ntawm hom catheterization no yog qhov kev pheej hmoo siab ntawm kev kis kab mob thiab qhov yuav tsum tau ua rau tus neeg mob tsis tuaj yeem.
Catheter ntxig li cas?
Lub catheter tau muab tso rau hauv qab no:
- Tus neeg mob nyob rau hauv txoj kab rov tav. Ob txhais ceg tig thiab txav mus rau sab.
- Tej puab tais tau shaved, daim tawv nqaij yog kho nrog tshuaj tua kab mob thiab npog nrog sterile wipes.
- Cov hlab ntsha femoral yog palpable ntawm lub crease ntawm lub hauv paus ntawm ceg.
- Tshuaj kho qhov chaw uas tso catheter.
- koob yog ntxig rau ntawm lub kaum sab xis ntawm 30-45 degrees.
- Cov hlab ntsha feem ntau nyob ntawm qhov tob li 4 cm.
Central venous catheterization yog ib txoj kev kho mob nyuaj thiab txaus ntshai.manipulation. Nws yuav tsum tau ua los ntawm tus kws tshaj lij thiab tsim nyog nkaus xwb, vim tias qhov yuam kev hauv qhov no tuaj yeem ua rau tus neeg mob lub neej thiab kev noj qab haus huv.
Dab tsi hauv Dual Channel Central Vein Catheterization Kit?
Includes sterile (disposable) insertion kits - port chamber, port catheter, thin-walled needle, 10 cm syringe3, ob lub xauv xauv, guidewire nrog mos J-tip hauv unwinder, ob rab koob Huber yam tsis muaj catheter, leeg lifter, ib rab koob Huber nrog kho tis thiab txuas catheter, bougie dilator, tunneler, split sheath.
Central vein kit
Cov khoom siv yog tsim los rau catheterization ntawm superior vena cava siv txoj kev Seldinger. Tej zaum yuav xav tau kev tswj hwm tshuaj mus sij hawm ntev, kev noj zaub mov rau niam txiv, kev saib xyuas ntshav siab.
Known set for catheterization of central veins "Certofix".
Raws ib feem ntawm cov teeb koj tuaj yeem pom:
- Polyurethane radiopaque catheter nrog txuas ntxiv thiab clamp.
- Seldinger koob (introducer).
- Ncaj nylon conductor.
- Dilator (expander).
- Ntxiv mount rau fixation rau tus neeg mob daim tawv nqaij.
- Plug nrog txhaj tshuaj membrane.
- Mobile clamp.
Certofix teeb rau hauv nruab nrab venous catheterization yog feem ntau siv.
