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穿刺血管通道的选择省人民摘要课件

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穿刺 血管 通道 选择 人民 摘要 课件
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MC PP 349 BAS Confidential and Proprietary For Internal Educational Purposes Only As an intern who has just entered kindergarten the following plans have been drawn up for the new semester An Overview of Vascular Access Devices And Early Assessment 血管通道器材概述 As an intern who has just entered kindergarten the following plans have been drawn up for the new semester 目录 中国输液的现状和改革的必要性 输液工具的分类 As an intern who has just entered kindergarten the following plans have been drawn up for the new semester 被被 动动 静静 脉脉 治治 疗疗 完成任务性质的 习惯性的器材使用 不 对病人做全面 准确的评估 病人从使用外周通道器材 即传统的套管 针 甚至钢针 开始静脉治疗 As an intern who has just entered kindergarten the following plans have been drawn up for the new semester 被被 动动 静静 脉脉 治治 疗疗 的的 结结 果果 需要重复穿刺 由于药物特性引发严重并发症 可能最终丧失外周静脉穿刺机会 给药有可能被延误 治疗可能中断 需要再用中心静脉输液器材完成继 续的治疗 中心静脉穿刺变得更费时 费力 甚至不能完成 As an intern who has just entered kindergarten the following plans have been drawn up for the new semester 被被 动动 静静 脉脉 治治 疗疗 的的 结结 果果 As an intern who has just entered kindergarten the following plans have been drawn up for the new semester 静脉治疗新思路静脉治疗新思路 As an intern who has just entered kindergarten the following plans have been drawn up for the new semester 主主 动动 静静 脉脉 治治 疗疗 As an intern who has just entered kindergarten the following plans have been drawn up for the new semester 药物的特性药物的特性 许多药物由于它的渗透压和许多药物由于它的渗透压和pHpH值对血管内膜具有值对血管内膜具有 刺激性 在没有血液充分稀释的情况下 这些刺刺激性 在没有血液充分稀释的情况下 这些刺 激性药物损伤内膜激性药物损伤内膜 血管毒性药物则对内膜损伤巨大 并可能造成渗血管毒性药物则对内膜损伤巨大 并可能造成渗 出坏死出坏死 pH值 低于4 5或高于9 0引起静脉内膜损伤 需要血液稀释 渗透压 文献表明 600mOSM L 必定引起静脉炎 As an intern who has just entered kindergarten the following plans have been drawn up for the new semester INS 建议为了将静脉治疗并发症降到 最低对于PH值低于5或高于9 渗透压高于 500MOSM L 持续性输注发泡性药物 如长 春新碱 阿霉素 需经中心静脉输注 As an intern who has just entered kindergarten the following plans have been drawn up for the new semester 静脉血管直径及血流量 头静脉 6mm40 ml min 贵要静脉 8mm95 ml min 腋静脉 16mm 333 ml min 锁骨下静脉 19mm 800 ml min 无名静脉 19mm 800 ml min 上腔静脉 20 30mm 2000 2500 ml min As an intern who has just entered kindergarten the following plans have been drawn up for the new semester 为什么使用中心静脉通道器材 多数VADs终止于上腔静脉 因而在输入药物时 高渗溶液或刺激性药物可被高流速和大流量 的血液迅速稀释和播散 在小血管输入这些药物 则会引起内皮损伤 进而造成静脉炎 血栓形成 As an intern who has just entered kindergarten the following plans have been drawn up for the new semester 套 管 针中 线 导 管 急 性 期CVC PICC PICC 隧 道 型CVC PICC 隧 道 型CVC 输 液 港 6 个 月 4 周 6 个 月3 天 4 周48 72 小时 根据治疗相关因素选用器材根据治疗相关因素选用器材 使用时间使用时间 As an intern who has just entered kindergarten the following plans have been drawn up for the new semester 目录 中国输液的现状和改革的必要性 输液工具的分类 As an intern who has just entered kindergarten the following plans have been drawn up for the new semester As an intern who has just entered kindergarten the following plans have been drawn up for the new semester 器材选择原则 正确的输液工具意味着成功的开始 治疗全程中最为有效的输注通路 保证所有治疗方案的需求 满足所有通路的要求 最少的侵入性治疗 保护外周静脉 满足风险 利益的评估 As an intern who has just entered kindergarten the following plans have been drawn up for the new semester VAD 血管通道 类型 PIV 外周静脉导管 短期 天 中线导管 大于PIV 周 外周插管的中心导管 PICC 最长1年 中心插管的中心静脉导管 CVC 或者 CICC 长期 年 隧道式 套袖式 短期 数日至数周 无隧道 短期 CVC 无套袖 As an intern who has just entered kindergarten the following plans have been drawn up for the new semester 中等长度导管 尚无固定的留置时 最常见的留置时间为2 4周 PICC 尚未确定留置时间 INS推荐为1年 CDC 2002美国疾控中心2002 PICC是首选的中心静脉导管 适用于短 中及长期的治疗 AHRQ 2002 美国卫生研究及质量机构2002 PICC相比其他中心静脉导管而言 能明显降低相关并发症 VAD 血管通道 类型 As an intern who has just entered kindergarten the following plans have been drawn up for the new semester 外周短期静脉导管外周短期静脉导管 套管针套管针 穿刺针外套导管短期治疗 每96小时更换穿刺位置 特氟隆 聚脲胺脂材质 多种内径和长度 单腔和双腔 As an intern who has just entered kindergarten the following plans have been drawn up for the new semester 外周短期静脉导管外周短期静脉导管 套管针套管针 费用 价格低廉 方便 操作步骤已被广泛接受 通常为护士操作 优点 As an intern who has just entered kindergarten the following plans have been drawn up for the new semester 外周短期静脉导管外周短期静脉导管 套管针套管针 不能超过 96 小时 堵塞率 脱出率高 静脉炎发生率高 药物可能过分刺激外周血管 病人最终可能没有可以穿刺 的血管 缺点 As an intern who has just entered kindergarten the following plans have been drawn up for the new semester 外周短期静脉导管外周短期静脉导管 套管针套管针 Maki 1989关于静脉炎的研究 1054例短期外周导管 24 48 hr 内静脉炎发生率明显较高 30 的并发症发生于置管后 24 48 hr 内 48 72 hr 后 39 50 套管针不得不被拔 除 第5天 70 失去通路 其中41 8 发生 静脉炎 27 发生药物外渗 堵塞或漏液 外周静脉输液的最主要并发症是药物损伤性静脉炎外周静脉输液的最主要并发症是药物损伤性静脉炎 As an intern who has just entered kindergarten the following plans have been drawn up for the new semester 外周短期静脉导管外周短期静脉导管 套管针套管针 结论 静脉治疗护理标准 INS 推荐 应于 72 小时内为病人更换常规的外周静脉 导管 不能超过 96 小时 As an intern who has just entered kindergarten the following plans have been drawn up for the new semester 外周短期静脉导管外周短期静脉导管 套管针套管针 意味着 外周静脉导管并非在所有情况下节省费用 费用的增加 护理的次数 时间及器材 较差的临床结果和病人舒适度 由于外周静脉的损害造成静脉治疗的困难 As an intern who has just entered kindergarten the following plans have been drawn up for the new semester 外周静脉导管 效果差 As an intern who has just entered kindergarten the following plans have been drawn up for the new semester 外周静脉导管的并发症 出血 静脉损伤 神经损伤 渗液 静脉炎 血栓形成 感染 As an intern who has just entered kindergarten the following plans have been drawn up for the new semester 中线导管 插管 前臂 上臂 肘窝 无需进行胸片检查确认头 端 As an intern who has just entered kindergarten the following plans have been drawn up for the new semester 概要 置于上臂或肘窝 头端位于外周静脉 一般 为腋静脉而不可使其进入 中心血管 不是中心静脉导管 中线导管 As an intern who has just entered kindergarten the following plans have been drawn up for the new semester 中线导管 优势 留置时间长于外周静脉导管 无需进行胸片检查 并发症 导管堵塞 静脉炎 深静脉血栓形成 可能延迟的并发症诊断 常被误用作中心静脉导管 血液稀释作用轻微 不适用于极端pH值 和高渗的静脉输液 As an intern who has just entered kindergarten the following plans have been drawn up for the new semester CVCs中心静脉导管 概要 由医生经皮插管 可能未来由RN 执行 可放置在颈内静脉 锁骨下或股 静脉 适用于短期使用 7 10 天 在所有VAD中的CRBSI 率最高 多用于ICU CCU中病情危重患者 可急性放置 As an intern who has just entered kindergarten the following plans have been drawn up for the new semester 并发症 植入相关 气胸 误穿动脉 神经损伤 植入后相关 感染 意外脱出 出血 血栓 中心静脉损伤 CVCs中心静脉导管 As an intern who has just entered kindergarten the following plans have been drawn up for the new semester 隧道型CVCs中心静脉导管 在手术室或导管室留置 中期到长期使用 末端到达上腔静脉 末端开口式或三向瓣膜式导管 硅胶或聚脲胺脂材质 单腔 双腔 三腔 儿童至成人规格 Cuff 套袖 导管外壁上的抗感染材料的 套袖 导管外壁上促进周围组织长入 包裹导管的涤纶织物制成的 套袖 加 强导管固定 As an intern who has just entered kindergarten the following plans have been drawn up for the new semester PICC导管 PICC 由外周置入的中心静脉导 管 属于中心静脉导管 能够用于输送任何药物 包括那 些需经中心静脉输送的药物 不相容的药物 极端pH值的药物 高渗性的药物 发泡剂及刺激性的药物 可靠的采血方法 可由护士在床旁放置 As an intern who has just entered kindergarten the following plans have been drawn up for the new semester PICC的优点 相对外周留置针 减少治疗中断 保护静脉系统 提供可依赖的通路 相比中心静脉导管 减少CVC置管并发症 降低费用 减少病人外伤的发生 减少导管相关性感染 增加病人满意度 As an intern who has just entered kindergarten the following plans have been drawn up for the new semester PICC导管 局限性局限性 须有可穿刺的静脉须有可穿刺的静脉 创 举 As an intern who has just entered kindergarten the following plans have been drawn up for the new semester PICC导管 视锐5 超声导引系统 微插管鞘 思乐扣 PICC导管固定装置 As an intern who has just entered kindergarten the following plans have been drawn up for the new semester 探 头 探头支架 中心标记 影像冻结键 功能键 一体式手柄 电源状态 导管尺寸示意图 血管深度 影 像 对 比 度 存储显示 打印显示 As an intern who has just entered kindergarten the following plans have been drawn up for the new semester 导针器原理 确定静脉深度 根据静脉深度以及穿刺针尺寸选 择合适的导针 器 2cm As an intern who has just entered kindergarten the following plans have been drawn up for the new semester 超声定位穿刺 As an intern who has just entered kindergarten the following plans have been drawn up for the new semester PICC适应症 不考虑治疗时间 治疗需要CVC 静脉治疗大于6天 小于1年 多种药物联合静脉治疗 应用刺激性或发疱性药物 药物PH小于5大于9 渗透压大于600 As an intern who has just entered kindergarten the following plans have been drawn up for the new semester PICC适应症 血样采集和输血 预期的连续加强X光照相研究 血液动力学监测 住院患者和门诊患者 As an intern who has just entered kindergarten the following plans have been drawn up for the new semester 不适于PICC应用疾病 肾疾病前期 透析病人肌酐大于3 肢端影响 感染 皮肤缺损 静脉回流 肌无力 乳房切除术伴淋巴结清除 远端深静脉血栓 动静脉瘘 As an intern who has just entered kindergarten the following plans have been drawn up for the new semester 其他因素 深静脉血栓历史 曾经先植入过CVC 臂部活动降低 凝血功能 挛缩 拄拐 As an intern who has just entered kindergarten the following plans have been drawn up for the new semester PICC导管类型 末段封闭 有瓣膜 适于带管回家 只需生理盐水冲管无需 肝素 不能监测中心静脉压 As an intern who has just entered kindergarten the following plans have been drawn up for the new semester PICC导管类型 前段开口无瓣膜 可修剪 可通过导丝递送 可测量中心静脉压 可以进行高压注射 需要肝素或末端正 压连接注射帽 如果注射帽偶然脱 落则系统开放状态 不能用于带管回家 As an intern who has just entered kindergarten the following plans have been drawn up for the new semester 最新上市 PowerPICC 导管特点 专利的分叉结构设计 最大5ml 秒的输注速度 随时检查回血和延长管 是否注满 紫色连接处 耐高压注射 标识 As an intern who has just entered kindergarten the following plans have been drawn up for the new semester PowerPICC导管对于患者的益处 更少的针刺次数 实施CT检查时患者不需要额外放置其他的血 管通道器材 更快的输注 5ml 秒意味着更快的对比剂输注速度 获得CT扫描需要的理想输注速度 As an intern who has just entered kindergarten the following plans have been drawn up for the new semester PICC导管材质 硅胶的优点 柔软 柔韧 生物相容性好 对化学药物和潮湿有很好抵抗 力 表面光滑降低表面面积 缺点 需要导丝递送导管和再定位 抗压力差不能承受大于40PSI As an intern who has just entered kindergarten the following plans have been drawn up for the new semester PICC导管材质 聚氨酯 好的生物相容性 抗张力强度 抗磨损性 进入机体内变得柔软 耐受化学药物 薄壁 缺点 不能耐受丙酮 As an intern who has just entered kindergarten the following plans have been drawn up for the new semester 植入式中心静脉导管PORTs 目标科室 外科 放射介入科 植入式输液输液港 耐高压注射型 非耐高压注射型 M R I device Dual Lumen Hard Base Low Profile Ultra SlimPort device Peritoneal Titanium SlimPort device Dual Lumen Rosenblatt Catheter Titanium Dome Low Profile SlimPort X Port device duo Dual Lumen inline Dual Lumen isp device 多种选择 Groshong导管或ChronoFlex聚氨酯材质导管或者普通的硅胶导管 As an intern who has just entered kindergarten the following plans have been drawn up for the new semester 植入式中心静脉导管PORTs 概要 完全植入体内的静脉输液器材 在手术室或介入放射工作室放置 最常置于肿瘤患者体内 优势 在所有VAD中的感染风险最低 方便患者 洗浴等 使用时间长 并发症 导管夹闭综合症 阻塞 深静脉血栓形成 As an intern who has just entered kindergarten the following plans have been drawn up for the new semester 即将上市的高压注射PORT Bard Broviac Groshong Hickman isp M R I Per Q Cath PowerGroshong PowerHohn PowerLine PowerPICC PowerPICC SOLO PowerPort RadPICC SlimPort and X Port are trademarks and or registered trademarks of C R Bard Inc All other trademarks are the property of their respective owners C R Bard Inc All rights reserved 扫描速度 特异性扫描需要较快速度 肺栓塞检查 4毫升 秒 PSI 以及毫升 秒都是重要影响因素 一致性 标准最大速度 没有额外步骤 容易辨认 使用维护 CT 提供全线产品 IR和护理套装 多种管腔型号 多种冲洗选择 As an intern who has just entered kindergarten the following plans have been drawn up for the new semester 成功的关键 倡导选择恰当的通道器材
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本文标题:穿刺血管通道的选择省人民摘要课件
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