Central venous catheter (CVC): ndi chiyani, ndi chiyani ndikusamalira

Zamkati

• Ndi chiyani
• Zatheka bwanji
• Mitundu yopezeka pakati pa ma venous
• Chisamaliro chachikulu cha catheter chapakati
• Zovuta zotheka

Catheterization yapakati, yomwe imadziwikanso kuti CVC, ndi njira yochizira yomwe imathandizira kuchiritsa odwala ena, makamaka munthawi ngati kufunikira kulowetsedwa kwamadzimadzi ambiri m'magazi, kugwiritsa ntchito kupezeka kwa venous kwakanthawi, kwa kuwunika bwino kwa hemodynamic, komanso kulowetsedwa magazi kapena zakudya zopatsa thanzi, mwachitsanzo, zomwe zimafunikira mwayi woteteza mitsempha.

Catheter yapakatikati yayitali ndi yayitali komanso yotakata kuposa ziwalo zotumphukira zomwe zimagwiritsidwa ntchito m'mitsempha ya malo monga mkono, ndipo adapangidwa kuti azilowetsedwa m'mitsempha yayikulu ya thupi, monga subclavia, yomwe ili pachimake, chodzikongoletsera, yomwe ili pakhosi, kapena chachikazi, yomwe ili m'chigawo cha inguinal.

Nthawi zambiri, njirayi imawonetsedwa m'malo osamalira odwala (ICU) kapena pakagwa mwadzidzidzi, ndipo imayenera kuchitidwa ndi adotolo, kutsatira njira yomwe imafunikira maopaleshoni ndi zida zosabereka. Mukayikidwa, ndikofunikira kukhala ndi chisamaliro cha unamwino kuti muwone ndikupewa zovuta monga matenda kapena magazi.

Ndi chiyani

Zizindikiro zazikulu zakupezeka kwapakati pamatenda ndi awa:

• Thandizani kukonza kwa malo opatsirana kwa nthawi yayitali, kupewa kupindika kangapo;
• Adzapatsa zakumwa zambiri kapena mankhwala, omwe sagwiritsidwa ntchito ndi zotumphukira zofala;
• Kuthandizira mankhwala omwe angayambitse kukhumudwa pamene kuwonjezeka kwapadera kumachitika kuchokera kumalo otumphukira, monga vasopressors kapena hypertonic solution ya sodium ndi calcium bicarbonate;
• Lolani kuwunika kwa hemodynamic, monga kuyeza kuthamanga kwapakati komanso kusanthula magazi;
• Kuchita hemodialysis, munthawi yovuta kapena fistula yovuta kwambiri sinakhazikitsidwe. Mvetsetsani momwe hemodialysis imagwirira ntchito komanso nthawi yomwe iwonetsedwa;
• Chitani magazi kapena zigawo za magazi;
• Kuthandizira chithandizo cha chemotherapy;
• Lolani zakudya za makolo pamene mukudyetsa m'mimba mwa m'mimba sizingatheke.

Magwiridwe a malo opatsirana mwa venous ayenera kutenga njira zochepetsera mavuto azovuta. Chifukwa chake, njirayi siyikusonyezedwa ngati munthu ali ndi matenda kapena zofooka za tsambalo kuti zibowole, kusintha kwa magazi kapena ngati pali ngozi zowopsa zakutuluka magazi, kupatula pazochitika zapadera zomwe dokotala akuwonetsa.

Zatheka bwanji

Pogwiritsa ntchito catheterization yapakati ya venous, ndikofunikira kuyika munthu, yemwe nthawi zambiri amagona pabedi. Kenako, adotolo azindikira komwe kuli ma puncture, asepsis amderali ndi khungu loyandikira, kuthana ndi matenda.

Kuphatikiza apo, adotolo ndi gululi ayenera kuti adasamba m'manja mosamala ndikukhala ndi zida zomwe zimachepetsa chiopsezo chotenga matenda, monga magolovesi osabala, chigoba, chipewa, diresi yopangira maopaleshoni komanso ma drapes osabala.

Njira yomwe imagwiritsidwa ntchito popanga katemera wa venous amatchedwa njira ya Seldinger. Kuti muchite izi, kuphatikiza pa zida zodzitetezera, thumba ndi zida za seramu, mankhwala oletsa ululu, gauze wosabala, scalpel ndi kateti yapakatikati, yomwe imakhala ndi singano, guidewire, dilator ndi catheter yolumikizira, iyenera kugwiritsidwa ntchito ngati zida. singano ndi ulusi wolumikizira catheter pakhungu.

Pakadali pano, madotolo ena amasankhanso kugwiritsa ntchito ultrasound kutsogolera kuyika kwa catheter ndikuchepetsa chiopsezo cha zovuta.

Ndikofunikanso kukumbukira kuti, popeza ndi njira yowononga, ndikofunikira kudziwitsa ndi kupeza chilolezo cha wodwalayo kuti achite, kupatula pakagwa zadzidzidzi kapena ngozi yakufa, pomwe kulumikizana sikutheka.

Mitundu yopezeka pakati pa ma venous

Catheterization yapakati imatha kuchitidwa m'njira zitatu, kutengera mitsempha yomwe yasankhidwa kuti iphulidwe:

• Mitsempha ya Subclavia;
• Mitsempha yamkati yamkati;
• Mitsempha yachikazi.

Kusankha kwamtundu wa venous access kumapangidwa ndi dokotala malinga ndi zomwe adakumana nazo, zomwe amakonda komanso mawonekedwe a wodwalayo, zonse zomwe ndizothandiza ndipo zili ndi zabwino komanso zoyipa. Mwachitsanzo, kwa odwala omwe ali ndi vuto la thoracic kapena momwe amafunikira kutsitsimutsa mtima, kuphulika kwa mitsempha ya chikazi kumawonetsedwa kwambiri, pomwe kulumikizidwa kudzera m'mitsempha yama jugular kapena subclavia sikungakhale koyipitsidwa.

Onani mitundu ina ya catheterization yomwe ingafunike.

Chisamaliro chachikulu cha catheter chapakati

Nthawi zambiri, catheter yapakatikati ya venous imagwiritsidwa ntchito pachipatala chokha, chifukwa imafunika kusamalidwa moyenera, kuletsa kulowa kwa tizilombo mu copro, komwe kumatha kuyambitsa matenda akulu ndikuyika moyo pachiwopsezo.

Chifukwa chake, CVC nthawi zambiri imasamaliridwa ndi namwino, yemwe amayenera kukhala ndi chisamaliro cha generic monga:

• Kuchita chamadzi wa catheter wokhala ndi mchere, kuteteza kuti isadzaze ndi kuundana, mwachitsanzo;
• Sinthani mavalidwe akunja, makamaka ngati muli ndi chinsinsi chilichonse;

Mukamayang'anira katemera wa venous, ndikofunikira kuti nthawi zonse muzisamba m'manja ndikugwiritsa ntchito njira yolera, ndiye kuti, muyenera kugwiritsa ntchito CVC pogwiritsa ntchito malo osabereka, komanso magolovesi osabereka, ngakhale atangowerengedwa mankhwala amtundu wina.

Zovuta zotheka

Kufalikira kwapakati pamatenda kumatha kuyambitsa zovuta zina monga kutuluka magazi, mabala, matenda, mafuta m'mapapo, arrhythmia kapena venous thrombosis.