Central venous catheter (CVC): chii icho, chii icho chiri uye chengetedza

Zvemukati

• Chii ichochi
• Zvinoitwa sei
• Mhando dzepakati venous kuwana
• Kutarisira kwese kwepakati catheter
• Zvinogona kuitika

Central venous catheterization, inozivikanwawo seCVC, inzira yekurapa inoitwa kuti igadzirise kurapwa kwevamwe varwere, kunyanya mumamiriro ezvinhu senge kudiwa kwekuputirwa kwemvura yakawanda muropa, kushandiswa kwenzvimbo ine huturu kwenguva refu, kwe zvirinani hemodynamic yekutarisa, pamwe nekunyudzwa kweropa kana parenteral chikafu, semuenzaniso, inoda mukana wakachengeteka wemitsipa yeropa.

Iyo yepakati venous catheter yakareba uye yakafara kupfuura yakajairika epamhepo catheters anoshandiswa mutsinga dzenzvimbo dzakaita seruoko, uye yakagadzirirwa kuunzwa mutsinga hombe dzemuviri, senge subclavia, iri muchipfuva, jugular, iri mumutsipa, kana yevakadzi, iri munzvimbo inguinal.

Kazhinji, maitiro aya anowanzo kuratidzwa munzvimbo dzevanotarisira zvakanyanya (ICU) kana mumamiriro ekukurumidzira, uye anofanirwa kuitwa nachiremba, achitevera hunyanzvi hunoda zvekuvhiya nemidziyo isina kuchena. Mushure mekuiswa, zvinodikanwa kuve nechengetedzo yekutarisira nekucherechedza nekudzivirira matambudziko akadai sehutachiona kana kubuda ropa.

Chii ichochi

Zviratidzo zvikuru zvekupinda munzvimbo ine huturu zvinosanganisira:

• Tungamira kugadziriswa kweiyo venous kuwana kwenguva yakareba, kudzivirira akawanda mapundu;
• Simbisai yakawanda yemvura kana mishonga, iyo isingatsigirwi neyakajairika perious venous accesses;
• Tungamira mishonga inogona kukonzeresa kana kuwedzerwa kuchiitika kubva kune imwe nzvimbo yekuwana hutachiona, senge vasopressors kana hypertonic mhinduro dze sodium uye calcium bicarbonate;
• Rega hemodynamic yekutarisa, senge kuyera kwepakati venous kumanikidza uye kuunganidza masampula eropa;
• Kuita hemodialysis, mumamiriro ekukurumidzira kana kana arteriovenous fistula isati yazvisimbisa. Nzwisisa kuti hemodialysis inoitwa sei uye painoratidzwa;
• Ita ropa kana zvikamu zveropa kuwedzerwa;
• Shandura kurapwa kwemakemikari;
• Bvumira parenteral chikafu kana uchidya kuburikidza nemudumbu turakiti hazviiti.

Iko kushanda kweiyo yepakati venous kuwana kunofanira kutora matanho ekudzivirira njodzi yezvinetso. Nekudaro, maitiro aya haaratidzwe muzviitiko zvehutachiona kana hurema hwesaiti kubayiwa, shanduko mukuvhara ropa kana paine njodzi dzakakomba dzekubuda ropa, kunze kwekunge mune akakosha mamiriro anoratidzwa nachiremba.

Zvinoitwa sei

Zvekuita kwepakati venous catheterization, zvinofanirwa kumisikidza munhu, uyo anowanzo kuvete pakabhedha. Ipapo, chiremba anozoona iko chaiko kwekubaya, asepsis yedunhu uye ganda rakakomberedza rinoitwa, kubvisa hutachiona hwehutachiona.

Pamusoro pezvo, chiremba nechikwata vanofanirwa kunge vakageza maoko zvine hungwaru uye vakagadzirwa nemidziyo inoderedza njodzi yekutapukirwa, senge magurovhosi asingabatsiri, chifukidzo, ngowani, nguvo yekuvhiya uye madhirezi asina kuchena.

Iyo nzira inonyanya kushandiswa kuita yepakati venous catheterization inonzi iyo Seldinger maitiro. Kuti uzviite, kuwedzera pazvidziviriro, bhegi nemidziyo yeserum, yokutindivadza, isina gauze, scalpel uye yepakati catheter kit, ine tsono, guidewire, dilator uye intravenous catheter, inofanira kushandiswa sezvinhu. tsono neshinda yekubatanidza catheter kuganda.

Parizvino, vamwe vanachiremba vanosarudzawo kushandisa ultrasound kutungamira kuisa catheter uye kudzikisa njodzi yezvinetso.

Izvo zvakakoshawo kuti urangarire kuti, sezvo iri nzira inoparadza, zvakafanira kuzivisa uye kuwana mvumo yemurwere yekuita kwayo, kunze kwekunge zvangoitika kana njodzi iripedyo yerufu, kana kutaurirana kusingaiti.

Mhando dzepakati venous kuwana

Central venous catheterization inogona kuitwa munzira nhatu, zvinoenderana netsinga yakasarudzwa kubayiwa:

• Subclavian vein;
• Yemukati jugular tsinga;
• Tsinga yevakadzi.

Sarudzo yemhando yehutachiona hwekuwana inoitwa nachiremba maererano nezvinoitika, zvido uye hunhu hwemurwere, zvese izvi zvinoshanda uye zvine zvazvakanakira nekuipira. Semuenzaniso, kune varwere vakave nekukuvadzwa kwemutsipa kana mune iyo cardiopulmonary rumus inodiwa, kubaya kwevechikadzi mutsinga kunoratidzwa zvakanyanya, nepo kupinda kuburikidza nejugular kana subclavia mutsinga kashoma kuve nehutachiona.

Tarisa uone mamwe marudzi e catheterization anogona kudikanwa.

Kutarisira kwese kwepakati catheter

Kazhinji, iyo yepakati venous catheter inoshandiswa chete munzvimbo yechipatara, sezvo ichida kutarisirwa zvakanaka, kudzivirira kupinda kwehutachiona mukopro, izvo zvinogona kukonzera hutachiona hwakakomba nekuisa hupenyu panjodzi.

Nekudaro, iyo CVC inowanzo chengetwa nemukoti, uyo anofanirwa kuve neakajairwa hanya akadai se:

• Kuita iyo kugeza ye catheter ine munyu, kudzivirira kuti isavharwe nemakunduru, semuenzaniso;
• Chinja kupfeka kwekunze, kunyanya kana iwe uine chero rudzi rwekuvanzika;

Munguva yekuchengetwa kwepakati venous catheter, zvakakosha kuti ugare wageza maoko ako uye shandisa nzira isina kuchena, ndiko kuti, unofanirwa kushandisa CVC uchishandisa munda usina kuchena, pamwe nemagirovhosi asina kuchena, kunyangwe kana iri yekungopa chete. imwe mhando yemishonga.

Zvinogona kuitika

Central venous kuwana kunogona kukonzera mamwe matambudziko sekubuda ropa, kupwanya, hutachiona, kuputika kwemapapu, arrhythmia kana venous thrombosis.