Peripheral venous catheterization: qhov zoo thiab qhov tsis zoo ntawm cov txheej txheem

2024 Tus sau: Curtis Blomfield | [email protected]. Kawg hloov kho: 2023-12-16 21:10

Muaj qee qhov xwm txheej thaum tus neeg mob muaj mob hnyav yuav tsum tau txhaj tshuaj tas li thiab txhaj tshuaj txhaj tshuaj. Nyob rau hauv rooj plaub thaum muaj xwm txheej ceev rau cov hlab ntsha tsis zoo, resuscitation tuaj yeem ncua sijhawm, yog li cov kws kho mob siv cov txheej txheem xws li peripheral vein catheterization. Qhov no manipulation yog dab tsi, rau dab tsi lub hom phiaj yog nqa tawm thiab puas muaj teeb meem? Cov lus teb rau cov lus nug no muaj nyob hauv kab lus.

txheej txheem catheterization

Qhov no yog ib txoj hauv kev uas yuav tsum tso ib lub catheter peripheral kom nkag mus rau cov hlab ntsha. Lub peripheral venous catheter (PVC) yog ib qho cuab yeej tsim los muab tso rau hauv cov hlab ntsha thiab muab kev nkag mus rau cov hlab ntsha kom nrawm tshaj plaws.

Cov txheej txheem no tau dhau los ua ib txwm ua rau cov kws kho mob, ntau tshaj 500 catheters tau teeb tsa rau cov neeg mob hauv lub xyoo. Qhov tshwm sim ntawm cov txheej txheem zoo ua rau nce qhov nyiaj ntawm catheterization ntawm peripheral veins piv rau cov hlab ntsha hauv nruab nrab. Raws li kev tshawb fawb, kev kho cov hlab ntsha yog yooj yim dua yog tiassiv cov hlab ntsha peripheral.

Catheters yog nruab nrab thiab peripheral. Yog tias thawj hom raug ntsia los ntawm kws kho mob nkaus xwb, ces lub catheter nrog rab koob rau catheterization ntawm peripheral veins tuaj yeem ntsia tau los ntawm tus kws saib xyuas neeg mob.

Qhov zoo thiab qhov tsis zoo ntawm cov txheej txheem

Cov txheej txheem muaj nws qhov zoo thiab qhov tsis zoo. Yog hais tias peb tham txog cov pros, ces lawv yog:

• Muab kev nkag mus sai rau tus neeg mob cov leeg, uas tso cai rau koj los muab kev pabcuam tam sim yog tias tsim nyog lossis tswj hwm cov tshuaj yam tsis muaj teeb meem.
• Tom qab muab tso rau hauv catheter, tsis tas yuav ntswj cov hlab ntsha txhua zaus rau cov tshuaj drip.
• Cov txheej txheem tsis cuam tshuam rau tus neeg mob txoj kev mus los ntawm ib qho twg: tom qab tso catheter, tus neeg mob tuaj yeem txav nws txhais tes yam tsis muaj kev txwv.
• Cov neeg ua haujlwm kho mob txuag lawv lub sijhawm, uas yuav tsum tau siv rau kev tswj hwm cov tshuaj hauv cov hlab ntsha. Thiab tus neeg mob yuav tsis muaj mob txhua zaus thaum txhaj tshuaj.

Tab sis tsis txhob hnov qab txog qhov tsis txaus uas twb muaj lawm:

• Lub catheter peripheral venous tsis tuaj yeem muab tso rau tsis muaj sijhawm. 3 hnub tshaj plaws, tom qab ntawd nws yuav tsum tau muab tshem tawm.
• Txawm hais tias tsawg heev, muaj kev pheej hmoo ntawm cov teeb meem tom qab tso catheter. Txhua yam yog nyob ntawm qhov kev paub ntawm tus neeg ua haujlwm noj qab haus huv hauv kev tsim cov kab ke no.

Peripheral venous catheterization system - cov lus qhia rau kev teeb tsa

Nws tshwm sim thaum muaj xwm txheej ceev yuav tsum muab kev pab rau cov neeg raug tsim txom, thiab nkag mus rau cov ntshavcov channel yog tsis yooj yim sua vim poob siab, tsis tshua muaj ntshav siab los yog daig ua ke cov leeg. Hauv qhov no, kev txhaj tshuaj ncaj qha rau hauv cov ntshav yuav tsum tau txhaj. Qhov ntawd yog thaum lub puncture thiab catheterization ntawm peripheral leeg yog tsim nyog.

Qee zaum koj yuav tsum nkag mus rau cov hlab ntsha los ntawm cov hlab ntsha femoral. Qhov no feem ntau tsim nyog yog tias yuav tsum tau muaj kev kho mob plawv. Cov kws kho mob tuaj yeem ua haujlwm sib npaug thiab tsis cuam tshuam rau ib leeg. Peripheral vein catheterization tseem yuav tsum tau nyob rau hauv cov xwm txheej hauv qab no:

• Kev kho dej kub ceev hauv lub tsheb thauj neeg mob. Tom qab mus pw hauv tsev kho mob, cov kws kho mob tsis tas yuav nkim sijhawm, thiab koj tuaj yeem pib kho mob tam sim ntawd.
• Cov neeg mob yuav tsum tau txhaj tshuaj txhaj tshuaj ntau zaus hauv cov ntim loj kuj xav tau lub catheter.
• Cov neeg mob phais yuav tsum tau txhaj tshuaj txhaj tshuaj raws li lawv yuav tsum tau phais sai.
• Kev tswj cov tshuaj loog hauv lub cev thaum phais.
• Nruab lub catheter rau cov poj niam hauv kev ua haujlwm yog tias muaj kev pheej hmoo ntawm teeb meem thaum lub sijhawm ua haujlwm nrog kev nkag mus rau cov leeg.
• Yog xav tau kuaj ntshav venous ntau zaus rau kev kuaj.
• xov ntshav ntau ntau.
• Peripheral venous catheterization tseem ua tau yog tias tus neeg mob xav tau zaub mov noj.
• Yuav tsum muaj kev txhawb nqa lossis kho cov kua dej thiab electrolyte tshuav.
• Peripheral venous catheterizationTej zaum yuav yog ib txoj kev ua ntej ua ntej tso lub hauv paus catheter.

Raws li koj tuaj yeem pom, muaj ntau cov npe qhia rau cov txheej txheem, tab sis contraindications yuav tsum tau coj mus rau hauv tus account.

Thaum twg venous catheterization tsis qhia?

Tseem xyaum tsis muaj contraindications uas yuav categorically txwv txoj kev. Tab sis muaj qee qhov nuances uas tsis pub catheterization ntawm cov hlab ntsha tshwj xeeb lossis hauv cheeb tsam no.

1. Nyiam Central venous access yog:

• kev qhia cov tshuaj irritates lub vascular phab ntsa (feem ntau qhov tshwm sim no tau pom thaum infusing daws nrog siab osmolarity);
• yuav tsum tau ntim ntshav ntau;
• cov hlab ntsha tsis pom kev tsis pom lossis pom tau txawm tias tom qab siv lub tshuab ua kom pom.

2. Nws yog ib qho tsim nyog los xaiv lwm qhov chaw rau kev qhia txog lub catheter yog tias muaj cov txheej txheem inflammatory ntawm daim tawv nqaij los yog thrombophlebitis hauv ib cheeb tsam.

Nws tuaj yeem hais tau tias catheterization venous nrog lub catheter peripheral yog ua tau rau yuav luag txhua tus neeg mob. Kev xaiv ntawm qhov chaw yog ua raws li tus kheej qhia.

Yuav ua li cas txhawm rau ntxig lub catheter?

Cov khoom siv sab hauv cov hlab ntsha suav nrog cov cuab yeej hauv qab no:

• Tab, tab sis ib txwm tsis muaj menyuam.
• Trash can.
• Syringe nrog tshuaj heparinized.
• paj rwb thiab sterile wipes.
• Patch lossis nplaum ntaub qhwv.
• Kev haus cawv.
• Catheter. Yuav tsum xaivQhov loj me raws li tus neeg mob hnub nyoog thiab qhov chaw tso.



• Txuas tube.
• Tourniquet thiab sterile hnab looj tes kho mob.
• Bandage.
• txiav.
• Y"Hydrogen peroxide".

Muaj txhua yam koj xav tau los nruab ib lub catheter kuj yuav tsum tau npaj qhov chaw rau kev ua haujlwm zoo. Yuav tsum muaj teeb pom kev zoo. Koj yuav tsum tshem tawm txhua yam superfluous ntawm lub rooj. Tus nais maum yuav tsum nyob hauv lub tsho tshaj sab thiab lub kaus mom. Tus neeg mob yuav tsum tau qhia ua ntej txog tus txheej txheem thiab muaj tswv yim txog nws.

Peripheral leeg catheterization - algorithm

Cov txheej txheem rau ntxig ib lub catheter yuav tsum muaj cov kauj ruam hauv qab no:

1. Cov neeg ua haujlwm kho mob npaj rau catheterization: txhais tes ntxuav kom huv si, kho nrog tshuaj tua kab mob thiab ziab.
2. Npaj tus neeg mob rau tus txheej txheem. Yog xav tau, tshem cov plaub hau hauv cheeb tsam kom tuav tau zoo dua.
3. Sib sau cov khoom siv catheterization peripheral leeg, xyuas nws txoj kev ncaj ncees thiab txee lub neej. Tus kws saib xyuas neeg mob yuav tsum xyuas kom meej tias tus neeg mob raug nyob ntawm nws xub ntiag.
4. Muab lub teeb pom kev zoo, npaj lub tais pov tseg thiab pab tus neeg mob kom xis nyob.
5. Xaiv lub catheter raws li qhov loj ntawm cov hlab ntsha, hnub nyoog ntawm tus neeg mob, tus yam ntxwv ntawm cannula, thiab zaus ntawm IV infusions. Qhib pob.
6. Qhov chaw ntawm daim tawv nqaij uas yuav ua rau yuav tsum tau degreased thiab khotshuaj tua kab mob.
7. Saum toj ntawm qhov chaw tso catheter, siv lub tshuab nqus tsev thiab hais kom tus neeg mob ua haujlwm nrog lub nrig.



8. Nqa lub catheter nrog koj sab tes xis, tshem lub hau tiv thaiv, kho cov leeg nrog koj tus ntiv tes xoo thiab ntiv tes xoo thiab ntxig rab koob ntawm lub kaum sab xis ntawm 5-15 °.
9. rub rov qab lub piston. Yog tias ntshav pib ntws mus rau hauv lub koob txhaj tshuaj, txhais tau hais tias rab koob tau nkag mus rau hauv cov leeg.
10. Dhau catheter 0.5 cm ntxiv rau hauv cov leeg, tuav cov tis.
11. Kho tus koob stylet thiab ua ntej lub catheter kom tshem tawm ntawm rab koob qhia.
12. Remove tourniquet.
13. Txhob cov leeg, thaum kawg tshem cov koob qhia thiab xa mus rau lub thawv pov tseg.
14. Saib qhov chaw nkag rau qhov liab, o.
15. Klawm cov leeg thiab txiav lub koob txhaj tshuaj.
16. Ntxuav qhov chaw ntawm catheter ntxig nrog cov tshuaj tua kab mob thiab siv cov ntaub qhwv tsis muaj menyuam lossis ntaub qhwv.
17. Nkag mus rau hnub thiab lub sijhawm ntawm catheterization, qhov system loj hauv phau ntawv tshwj xeeb.

Yog hais tias cov txheej txheem ntawm peripheral leeg catheterization ua raws, ces, raws li txoj cai, tsis tshwm sim. Tab sis tsis txhob txiav lawv ib yam.

Kev mob catheterization

Feem ntau, cov teeb meem ntawm peripheral venous catheterization yog provoked los ntawm inexperience ntawm cov neeg ua hauj lwm kho mob uas ua cov txheej txheem no. Lub luag haujlwm tseem ceeb yog ua los ntawm kev ua raws li txhua theem ntawm kev qhia txog catheter. Yog tias qhov algorithm tsis ua raws, ces cov teeb meem tsis tuaj yeem zam tau.

Qhov tshwm sim tsis zoo tuaj yeem muab faib ua ob pawg:

1. Generalkev nyuaj siab.
2. Local.

Cia peb xav txog txhua yam kom ntxaws ntxiv. Cov kev mob tshwm sim hauv zos tsis xav tau muaj xws li:

• Hematoma. Nws tuaj yeem tsim los ntawm cov dej ntws los ntawm cov hlab ntsha thiab nws cov tsub zuj zuj hauv thaj tsam ntawm lub catheter ntsia. Qhov no feem ntau tshwm sim yog tias qhov ua tsis tiav ntawm txoj hlab ntshav tau ua thaum lub sijhawm tso lossis tshem tawm cov catheter.
• Venous thrombosis tsim tawm tsam keeb kwm ntawm kev tsim cov ntshav txhaws hauv cov hlab ntsha. Feem ntau, qhov teeb meem no tshwm sim los ntawm qhov tsis sib xws ntawm qhov loj ntawm lub catheter thiab cov hlab ntsha, nrog rau kev saib xyuas tsis raug tom qab txheej txheem.



• Kev nkag mus tau pom thaum cov tshuaj txhaj tsis nkag mus rau hauv cov hlab ntsha, tab sis hauv qab daim tawv nqaij. Qhov teeb meem loj heev, vim tias kev noj cov tshuaj hypertonic, alkaline daws lossis cytostatics tuaj yeem ua rau cov ntaub so ntswg tuag. Kev tshawb pom ntxov ntawm qhov teeb meem no yuav pab kom tsis txhob muaj qhov tshwm sim loj dua.
• Phlebitis. Nws tsim los ntawm kev siv tshuab, tshuaj lom neeg los yog kab mob, uas tshwm sim thaum kev tu cev thiab kev tsis muaj menyuam ntawm cov txheej txheem tsis raug soj ntsuam. Thrombophlebitis tuaj yeem tshwm sim, cov tsos mob yog liab thiab mob nyob rau hauv qhov chaw ntawm lub catheter ntsia. Tom qab ntawd, qhov kub thiab txias tuaj yeem pom muaj kua paug thaum lub catheter tshem tawm.

Cov teeb meem muaj xws li:

1. Thromboembolism. Nws raug kuaj pom thaum cov ntshav txhaws ntawm lub catheter lossis hauv cov hlab ntsha tawg thiab xa mus rau lub plawv nrog cov ntshav ntws.
2. Air embolismTej zaum yuav txhim kho thaum lub sij hawm kho cov hlab ntsha, tab sis raws li txoj cai, yog siv cov kab mob catheterization ntawm peripheral leeg, qhov kev pheej hmoo ntawm kev loj hlob yuav txo qis vim qhov muaj qhov zoo ntawm venous siab.
3. tsawg heev, tab sis catheter rupture yog ua tau.

Cov neeg ua haujlwm kho mob yuav tsum tau npaj los daws cov teeb meem tom qab tso catheter, thiab yuav tsum tau ceev faj kom tiv thaiv lawv.

Tiv thaiv kev nyuaj

Tau kawg, qhov tshwm sim ntawm tus txheej txheem tsis tuaj yeem kwv yees 100%, vim tias lub cev ntawm txhua tus neeg mob yog tus kheej. Tab sis cov kws kho mob yuav tsum ua txhua yam ua tau kom txo tau qhov kev pheej hmoo ntawm kev tsis zoo yog tias ua tiav cov catheterization peripheral venous. Yuav ua li cas kom tsis txhob muaj teeb meem? Rau lo lus nug no, tus kws tshaj lij tshwj xeeb yuav muab cov lus qhia tsim nyog rau cov kws kho mob hluas:

1. Tsis txhob xaiv cov nkoj me me rau cov txheej txheem.
2. Koj tuaj yeem tiv thaiv kev tsim ntawm hematoma yog tias koj nias koj ntiv tes rau ntawm qhov chaw uas lub catheter tau ntxig thiab tuav rau 3-4 feeb.
3. Thrombosis yog tiv thaiv los ntawm kev ntsuas catheter kom raug. Nws tseem yog ib qho tseem ceeb uas yuav tau xav txog cov khoom siv los ntawm cov cannulas tsim, piv txwv li, polyurethane, polytetrafluoroethylene tsawg thrombogenic. Nws raug nquahu kom siv thaj chaw ntawm daim tawv nqaij hla lub catheter thov nrog cov tshuaj pleev heparin (Lyoton tsim nyog).
4. Txhawm rau kom tsis txhob nkag mus, nws yuav tsum tau siv lub tourniquet kom stabilize lub catheter (tshwj xeeb tshaj yog tias nws muab tso rau hauv lub quav ntawm caj npab lossis ceg).
5. Tiv thaiv phlebitis thaum lub sijhawm teeb tsacatheter, nws yog ib qho tsim nyog yuav tsum ua tib zoo saib cov cai ntawm antisepsis, siv cov cuab yeej zoo thaum twg los tau. Kev taw qhia ntawm cov tshuaj yuav tsum tau nqa tawm maj mam, ib txwm ua raws li cov lus qhia rau kev yug me nyuam. Rau kev tiv thaiv, nws raug pom zoo kom hloov cov hlab ntsha rau kev tso catheter yog tias yuav tsum tau ua txoj haujlwm thib ob.
6. Nws yog qhov tsis tsim nyog rau nruab PVCs ntawm sab qis, qhov no ua rau muaj kev pheej hmoo ntawm cov ntshav txhaws. Tom qab qhov kev txhaj tshuaj raug tso tseg vim yog tsim cov hlab ntsha ntawm lub catheter, nws yuav tsum tau muab tshem tawm thiab muab tso rau ib qho tshiab.
7. Air embolism tiv thaiv los ntawm kev tshem tawm tag nrho cov cua los ntawm cov kab infusion ua ntej txuas mus rau catheter. Txhua qhov chaw yuav tsum tau muab khi ua ke.

Cov lus qhia tseem ceeb no yuav pab kom tsis txhob muaj ntau yam teeb meem thaum ua catheterization ntawm cubital thiab lwm cov hlab ntsha peripheral.

Catheter tu txheej txheem

Yog tias txoj kev txhim kho PVK ua tiav, qhov no tsis tau txhais hais tias koj tuaj yeem hnov qab txog lub catheter. Kev saib xyuas kom raug yog qhov tseem ceeb kom pom cov tsos mob ntxov tshaj plaws ntawm kev tsim teeb meem.

Txoj kev saib xyuas yog raws li hauv qab no:

1. Txhua hnub, tus kws saib xyuas neeg mob yuav tsum kuaj xyuas qhov chaw uas lub PVC tau teeb tsa. Yog tias pom muaj kab mob sib kis, lawv raug tshem tawm tam sim ntawd.
2. Thaum tswj lub catheter thiab infusion teeb, asepsis yuav tsum tau soj ntsuam.
3. Lub catheter yuav tsum tau hloov txhua 2-3 hnub. Yog tias cov khoom siv ntshav siv rau kev hloov ntshav, cestxhua hnub.
4. Isotonic sodium chloride yuav tsum tau siv los ntxuav cov catheters.
5. Thaum txuas lub catheter, tsis txhob kov cov khoom siv.
6. Txhua yam kev hloov pauv yuav tsum tau ua nrog cov hnab looj tes tsis muaj menyuam.
7. Hloov cov kaus mom kawg tsis tu ncua thiab tsis txhob rov siv dua.
8. Tom qab kev tswj hwm tshuaj, lub catheter yuav tsum tau yaug nrog saline.
9. Hloov kho cov ntaub qhwv raws li xav tau.
10. Tsis txhob siv txiab thaum tuav lub catheter.
11. Txhawm rau tiv thaiv thrombophlebitis tom qab kev sib tsoo saum qhov chaw tso catheter, kho thaj tsam ntawm daim tawv nqaij nrog cov tshuaj pleev thiab cov gels.

Ua raws li tag nrho cov lus pom zoo saib xyuas yuav tso cai rau koj tshawb pom cov teeb meem raws sijhawm lossis zam kom tsis txhob muaj qhov tshwm sim tsis zoo.

Ntawm catheterization hauv me nyuam

Catheterization ntawm peripheral leeg hauv cov menyuam yaus muaj nws tus yam ntxwv, suav nrog hnub nyoog ntawm cov neeg mob. Tus menyuam yuav tsum tau npaj. Qhov ntsuas kub hauv chav kho mob yuav tsum tau xis nyob (yog tias xav tau, lub rhaub yuav tsum tau nruab kom tsis txhob muaj kev ntxhov siab rau qhov txias). Nws tsis pom zoo kom ua cov txheej txheem tam sim tom qab noj mov.

Peripheral vein catheterization hauv cov menyuam yug tshiab yog ua raws li cov txheej txheem hauv qab no:

1. Ib hlab ntsha raug xaiv los tso lub catheter. Hauv cov menyuam mos, nws yog qhov zoo dua los siv cov hlab ntsha ntawm sab nraub qaum, ntawm caj npab, ntawm lub taub hau, ko taw, lub luj tshib lossis pob taws.



2. Qhov chaw xaiv yuav tsum tau sov so.
3. Tau ib lub tourniquet thiab nruj kom txog thaum lub pulsation nres ntawm qhov chaw.
4. Kho daim tawv nqaij nrog tshuaj tua kab mob.
5. Txuas lub koob txhaj rau lub catheter thiab adapter, xyuas qhov patency siv saline.
6. Disconnect syringe.
7. Nqa lub catheter rau ntawm rab koob rau catheterization ntawm peripheral leeg nrog qhov ntsuas thiab tus ntiv tes xoo thiab tuav ntawm "tis".
8. Nias lub nkoj nrog koj tus ntiv tes thiab tho daim tawv nqaij nrog rab koob hauv qab ntawm qhov chaw.
9. Tus koob tau muab tso rau hauv cov hlab ntsha kom txog thaum cov ntshav tshwm nyob rau hauv lub cannula thaum cov lus qhia raug tshem tawm.
10. Tshem tawm tus neeg tshawb nrhiav. Tsis txhob cia rab koob txav mus ntxiv - qhov no yuav ua rau cov phab ntsa ntawm lub nkoj puas.
11. Ntxig lub catheter kom deb li deb tau thiab tshem tawm cov kev sib tw.
12. Txuas adapter thiab syringe thiab txhaj me me ntawm saline kom ntseeg tau tias kev tso catheter kom raug.
13. Txhim lub catheter kom tus menyuam tsis tuaj yeem ua rau lub cev puas tsuaj.

Cov txheej txheem rau kev txhim kho PVCs hauv cov menyuam yaus tuaj yeem ua rau muaj teeb meem ntau. Yog hais tias nyob rau hauv cov neeg laus cov neeg mob qhov no yuav luag ib tug dog dig txheej txheem, ces nyob rau hauv cov me nyuam nws muaj peev xwm tig mus rau hauv ib tug me me phais kev cuam tshuam. Feem ntau, rau tus kws kho mob hluas, catheterization hauv cov menyuam yaus dhau los ua txoj haujlwm tsis yooj yim.

Cov txheej txheem catheterization yog qee zaum tib txoj hauv kev los kho tus neeg mob kom zoo. Yog tias tus kws kho mob mus txog qhov txheej txheem thiab nws cov kev npaj nrog kev paub txog qhov teeb meem, ces tsis muaj teeb meem. Cov neeg ua haujlwm kho mob tsis tas yuav tsum muaj txhua lub sijhawm ua ntej kev taw qhiaintravenous tshuaj los muab cov neeg mob tsis xis nyob thiab puncture cov hlab ntsha. Tsis tas li ntawd, nws feem ntau yog qhov kev teeb tsa ntawm PVK uas tso cai rau koj los muab cov kev pabcuam tsim nyog sai txhawm rau txhawm rau cawm tus neeg mob txoj sia.