Central Line, PICC, alo Hickman Catheter si Gba Alo Si Wohe: Mɔxexe Ðe Venous Air Embolism si Wua Ame Nu¶

Titinaʋuka si me ʋu sina tona, si wotso, si wometsɔ nutsyɔnu o, alo si woɖe do goe (si me Peripherally Inserted Central Catheter [PICC], Hickman alo Broviac line si me mɔ̃ le, jugular alo subclavian catheter si le eme, hemodialysis Permcath, alo Port-a-Cath si wotsɔ Huber ƒe aŋe si woɖe le eme de ame me hã le) nye dzitodzito me ʋuka si me ʋu sina tona le evelia me nudzɔdzɔ kpata. Esi wònye be titinaʋuka ɖesiaɖe ƒe nugbɔ nɔa dzia ƒe ɖusime ʋuka si le dzitodzito me si ƒe nyaƒoɖeamenu sue aɖe me tẽ ta la, ʋuka si le ʋuʋu ɖi alo dodoƒe yeye ate ŋu axɔ xɔa me ya tẽ ayi ʋukawo me ɣesiaɣi si dɔnɔa gbɔ ya. Ne catheter aɖe gbã, eƒe nutsyɔnu bu, alo he do le ŋutigbalẽa me la, yɔ wò nutoa me tɔ xexlẽdzesi siwo wozãna kpata enumake. Ne èdi ʋukawo kple akɔta ƒe nɔnɔme kpata siwo do ƒome kplii la, kpɔ ɖa dialysis ƒe mɔɖeɖe kple AV fistula ƒe ʋu si dona le ame ŋu, . aklã me ʋu ƒe sisi kple ʋuka goglo ƒe ʋuka me ʋu ƒe sisi, kple tension pneumothorax kple nomi akɔta ƒe abi ƒe kpekpeɖeŋunadɔ gbãtɔ.

To vovo na ʋuka si le gota (IV) si le asi alo abɔta, si ʋuna yia gota ne woʋui le esi abɔta ƒe ʋukawo ƒe nyaƒoɖeamenu nyui le esi ta la, titina ʋuka siwo le akɔta me kpɔa nyaƒoɖeamenu si mede yame o (vɔ̃ɖi) ɣesiaɣi si akɔtaƒua ƒo le gbɔgbɔ me. Gbɔgbɔ deto ɖeka, kɔdzidede, alo gbɔgbɔtsixe tsi tre ɖe titina esime wometsɔ nutsyɔnu alo mã o ate ŋu ahe ya si le yame mililita 50 va ɖo 300 (tsi ounces 1.7 va ɖo 10) ayi ɖusime ʋuka me, si ana foam "ya ƒe ʋuʋu" si woate ŋu aƒo si xea mɔ na ʋu ƒe sisi yi lãkusiwo me eye wòana dzi natɔ le sɛkɛnd ʋɛ aɖewo ko me.

Wɔ esia fifia¶

1. Lã ka la alo ƒoe enumake le gbagbãƒea kple dɔnɔa ƒe ŋutigbalẽ dome. Ne PICC, Hickman, Broviac, alo hemodialysis catheter ƒe gotagome mɔ̃a gbã, lãe, alo eƒe kadodo ƒe nugbɔ bu la, tsɔ wò asibidɛwo ƒo ka falɛfalɛa sesĩe te ɖe dɔnɔa ƒe ŋutilã ŋu wu afisi wòtso. Gbugbɔ plastic-kplu si wotu ɖe eme la ɖe akpa si me gblẽ o si te ɖe ŋutigbalẽa ŋu dzi, alo nàbla ʋuƒoa sesĩe ɖe afã me ("kink it") eye nàtsɔ tape si me tsi mele o alo rababa ablae sesĩe.
2. Ne woɖe catheter la do goe le ŋutilãa me keŋkeŋ la, te ami si me ya megena ɖo o (si xea mɔ na) ɖe doa dzi sesĩe. Mègazã gauze ƒuƒu dzro ɖeɖeko mègazã o, elabena ya ƒoa kpẽ tẽ to kotoku ƒuƒu ƒuƒu me yia anyigba te ka si ƒoa ŋutigbalẽa nu ƒu kple jugular alo subclavian vein la me. Tsɔ ami si me dɔlékui mele o (Vaseline) alo dɔlékuiwutike ƒe ami tsyɔ gauze-gbadzɛ si me dɔlékui mele o dzi dɔmenyotɔe, tsɔ aŋe alo agbalẽ xatsa ɖe edzi, eye nàzi edzi sesĩe ɖe teƒe si nàdo le eme aɖabaƒoƒo 5 va ɖo 10 esime nèle tap ƒom ɖe eƒe go eneawo katã ŋu be ya nagage ɖe eme o.
3. Mlɔ dɔnɔa ɖe Durant ƒe nɔnɔme me enumake (wòanɔ gbadzaa le woƒe MIAME gome eye eƒe ta kple akɔta nabɔbɔ ɖe anyime). Mègana dɔnɔ si ƒe titina fli ʋu, si gbã, alo esi wohe yeyee la nanɔ tsitrenu alo atsi tre gbeɖe o. Mia wo ɖe woƒe miame (left lateral decubitus) eye woakɔ abatia ƒe afɔ ɖe dzi alo atsɔ woƒe afɔwo kple akɔta aɖo akɔtaɖonuwo dzi (Trendelenburg tilt) eyata ɖusime ʋuka kple ɖusime ʋuka nɔa anyi kɔkɔ wu aklã ƒe ʋuka si dona le eme, eye wòléa ya ƒe kuɖɔ ɖesiaɖe si woɖu le ɖusime dzi ƒe tame la ɖa tso aklãa gbɔ.
4. Fia dɔnɔa be wòagbɔ ya alo aƒo ɣli blewu esime nèle ka alo nusi wotsɔ blae la nu. Gblɔ na amea be: "Gbugbɔ alo ƒo ɣli esime mele do sia tsyɔm; mègagbɔ ya goglo o." Yagbɔgbɔ alo ɣlidodo naa akɔta ƒe nyaƒoɖeamenu dzina ɖe edzi wu xɔme ƒe nyaƒoɖeamenu eye wòdzudzɔa ya mimi yi eme.
5. Ƒo ka na wò nutoa me xexlẽdzesi kpata enumake. Ƒo ka na 911 le United States kple Canada, 112 le Europa Dukɔwo ƒe Habɔbɔ bliboa me, 999 le United Kingdom, 000 le Australia, alo nàlé ŋku ɖe míaƒe xexlẽdzesiwo ŋu xexlẽdzesi siwo wozãna kpata. Gblɔ na amesi ɖoe ɖa be: "Central venous catheter emergency: titina fli si gbã alo he do goe kple afɔku be venous air embolism."
6. Dzra ka si woɖe do goe la ɖo nyuie ale be kɔdzi ɖɔktawo nate ŋu alé ŋku ɖe eƒe nugbɔ ŋu. De ka la ɖe aŋekotoku dzadzɛ aɖe me ale be atikewɔla siwo kpɔa nudzɔdzɔ kpatawo gbɔ nate ŋu alé ŋku ɖe nugbɔ si le didiƒe ŋu eye woaɖo kpe edzi nenye be ka bliboa do go keŋkeŋ alo ne wotsɔ aŋe kakɛ aɖe si wotso la ƒo ɖe dzia me.

Nyametsotsoti: titina venous catheter ƒe vovototodedeameme kpata¶

flowchart TD
    A["Central Line, PICC, Hickman, Permcath, alo Melidzeƒea ƒe Nya Kpata"] --> B{"Nukae dzɔ ɖe catheter la dzi?"}
    B -->|"Tubing gbagbã, lã, alo nutsyɔnu ge"| C["Pin tubing enumake le gbagbã kple ŋutigbalẽ dome"]
    C --> D["Do clamp si wotu ɖe eme proximal be nàgbã alo abla tubing ɖe afã me eye nàtsɔ tape ablae sesĩe"]
    D --> E["Mlɔ dɔnɔa ɖe MIAME eye nàkɔ akɔta/afɔwo ɖe dzi (Durant ƒe nɔnɔme) ."]
    B -->|"Catheter he do le ŋutigbalẽa me keŋkeŋ"| F["Na dzigbɔɖi nagbɔ ya alo aƒo nu esime nèmlɔ anyi"]
    F --> G["Tsɔ petroleum jelly gauze + plastic wrap de eme eye nàzi do si me nàdo le la dzi sesĩe"]
    G --> H["Tape axa 4 la katã be ya mate ŋu age ɖe eme o eye nàlé ŋku ɖe catheter ƒe nugbɔ si woɖe ɖa ŋu be ede blibo hã"]
    H --> E
    B -->|"Catheter la ƒu du do go le eƒe akpa aɖe alo tsi tre ɖe tsilele ŋu"| I["MÈGATU tubing ɖe megbe ayi eme o eye MÈGAZE tsilele kple syringe sue aɖe dzi o"]
    I --> J["De gotagome fli si susɔ la dedie kple atike si me dɔlékui mele o kple clamp lumen"]
    E --> K{"Gbɔgbɔtsixetsixe, akɔtave, gbɔgbɔtsixetsixe, cyanosis, alo ame ƒe anyidzedze kpata?"}
    K -->|"Ẽ: Wosusu be Venous Air Embolism"| L["Midzra ɖo ɖe Left-Lateral Trendelenburg, na oxygen 100% ne ele, yɔ EMS enumake"]
    K -->|"Dzesi aɖeke medze haɖe o"| M["Na wòanɔ gbadzaa/miame eye nàtsɔe kpata hena kɔdzi ka dzadzraɖo alo akɔta ƒe X-ray"]

Alesi venous air embolism wua ame: ɖusime ventricular "ya lock" ƒe dzɔdzɔmeŋusẽŋununya.¶

Ne míese ʋuka siwo le titina ƒe nyaƒoɖeamenu ƒe ŋusẽkpɔɖeamedzi gɔme la, eɖe nusita wowɔa atike na titinaʋuka ƒe ka si wometsɔ nutsyɔnu o alo si megbã o la kpata abe alesi wowɔa atike na akɔta ƒe abi si le no nom ene la me.

Nusita titinaʋukawo noa ya yia eme evɔ abɔta ƒe ʋukawo ya ʋuna yia gota¶

Ne dɔnɔdzikpɔla tsɔ IV-ka kpui aɖe de wò asi alo abɔta megbe la, ʋu ƒe sisi le ʋuka ma si le gota la me nyea mercury milimeta +8 va ɖo +15 (mmHg) wu yame ƒe xɔme ƒe nyaƒoɖeamenu. Ne nutsyɔnu la ge tso alɔnu IV si le gota la, ʋu sina yia gota eye ya mate ŋu age ɖe eme o.

Titina venous catheter wu enu ɖe ​​superior vena cava (SVC) alo cavoatrial junction me le ɖusime ʋuka ƒe mɔnu tututu. Le akɔta ƒe akɔta la, titinaʋuka ƒe nyaƒoɖeamenu (CVP) nɔa dzodzom le 0 va ɖo +5 mmHg gbɔ le ɖiɖiɖemeɣi, eye wòɖiɖina va ɖoa -3 va ɖo -8 mmHg le yame ƒe nyaƒoɖeamenu te ɣesiaɣi si ʋukaa ƒo le gbɔgbɔ si sɔ me. Ne tsi vɔ le dɔnɔa ŋu, ebɔbɔ nɔ tsitrenu, alo gbɔgbɔ deto le vevesese alo dzimaɖitsitsi ta la, akɔta ƒe nyaƒoɖeamenu gbegblẽa ɖiɖina ɖe anyi wu -15 va ɖo -20 mmHg.

Le Poiseuille ƒe se si ku ɖe tsi ƒe sisi ŋu nu la, titina ka si ƒe didime nye gauge 14 alo gauge 16 ƒe ʋuka si le ʋuʋu ɖi si wotsɔ de 5 mmHg ƒe nyaƒoɖeamenu ƒe dzidzeme me le didime si nye sentimeta 20 (inch 8) me la ɖea mɔ na xɔme ya mililita 100 (tsi ounces 3.4) le sɛkɛnd ɖeka me be wòaƒu du ayi vena cava si le etame la me tẽ. Le gbɔgbɔ eve va ɖo etɔ̃ me la, ya si wua ame (mililita 200 va ɖo 300 le ame tsitsiwo gome, alo mililita 3 va ɖo 5 le eƒe kpekpeme kilogram ɖeka me; eye mede nenema kura o ne patent foramen ovale le dɔnɔa ŋu) gena ɖe dzia me.

The compressible foam "ya ʋɔtru" kple acute cor pulmonale¶

Ʋu nye tsi si womate ŋu aƒo o. Ne ya gã aɖe si le yame ge ɖe ɖusime ʋuka kple ɖusime ʋuka me la, mɔ̃ɖaŋunudzɔdzɔ etɔ̃ dzɔna le ɣeyiɣi ɖeka me:

1. Right ventricular outflow tract (RVOT) air lock: Esi aklã ƒe ʋuka dona tso ɖusime ventricle ƒe ŋgɔgbekpa si le etame wu (ne ame bɔbɔ nɔ anyi alo mlɔ anyi gbadzaa ɖe eƒe akɔta) ta la, ya si le ʋuʋum la ƒua du yia aklã ƒe conus kple aklã ƒe ʋuka vevitɔ ƒe ʋuka me tẽ. Ne ɖusimeʋukaa tsi la, ɖeko wòmia gas si le abe sponge ene ƒe kuɖɔa heɖenɛ ɖa le esi teƒe be wòado ʋu ɖe ŋgɔ, si wɔnɛ be miameʋuka ƒe agba si do ŋgɔ kple dzi ƒe dodo dzi ɖena kpɔtɔna va ɖoa zero.
2. Ʋu ƒoƒo to mɔ̃ dzi wòzua fibrin-ya ƒe futukpɔ: Tricuspid valve ƒe aŋgbawo ʋuʋua ʋuka me ʋu kple xɔme ya si me nitrogen sɔ gbɔ ɖo wòzua kuɖɔ suesuesue siwo wotsɔ ʋumenugbagbevi dzĩwo kple fibrin ƒo xlãe ƒe ʋuʋudedi ɣi aɖe, si wɔnɛ be gbeɖiɖi si le ʋuʋum ɖe akɔta si woyɔna be "mill-wheel murmur" (bruit de moulin).
3. Aklã ƒe ʋukawo ƒe ʋuʋu kple ʋusɔgbɔdɔ si tsi tre ɖe wo nɔewo ŋu: Kuku suesuesue siwo sina yia aklã me ʋukawo me hea aklã me ʋusɔgbɔdɔ sesẽ vɛ. Le ame tsitsi 25 le alafa me siwo ŋu ŋutilã ƒe wɔwɔme ƒe patent foramen ovale (PFO) (si nye akɔta sue aɖe si ʋuna le ɖusime kple miame ƒe dzitodzito dome) gome la, ɖusime dzi ƒe nyaƒoɖeamenu ƒe dzidziɖedzia ƒoa abɔta wòʋuna, eye wòɖea ya ƒe kuɖɔwo yia miame dzi, dzitodzito me ʋukawo, kple ahɔhɔ̃ me tẽ (paradoxical arterial air embolism), si hea ʋusɔgbɔdɔ alo dzidɔ vɛ enumake.

Dzesi siwo wonya nyuie le ʋuka me ya si me ʋu sina tona kabakaba ŋu¶

Ne ya ge ɖe titina fli alo ʋuka si le ʋuʋu ɖi me le dɔnɔ si le ŋudzɔ me la, dzesiawo dzena enumake:

• Kasia, si bua tame gbɔgbɔ deto alo kɔdzidede ya si dona enumake la ƒoa aklã ƒe ʋuka siwo me ʋu sina tona (si noa ya geɖe wu gɔ̃ hã yia eme ne ka la gakpɔtɔ le ʋuʋu ɖi) .
• Akɔta ƒe vevesese si le megbe gbãm kple tsɔtsrɔ̃ si gbɔna ƒe seselelãme
• Gbɔgbɔtsixe sesẽ kpata (tachypnea) eye nuyiwo kple mo ƒe amadede trɔna blɔ (cyanosis) .
• Taɖuame, ŋku ƒe ʋuʋu, tɔtɔ, lãmetutudɔ si le abe focal stroke ene, alo ame ƒe susu ƒe dɔwɔwɔ kpata (syncope) .
• Ʋu ƒe sisi kabakaba (obstructive shock), kɔ ƒe ʋuka siwo keke, kple Pulseless Electrical Activity (PEA) dzi ƒe dɔmawɔmawɔ nyuie

De dzesi titinaʋuka me ʋuka ƒomevi vevi atɔ̃awo¶

Titinaʋuka vovovowo tsɔa mɔ̃ɖaŋununya ƒe afɔku vovovowo le aƒeme. Ne ènya fli si le dɔnɔ aɖe si la, ana nàte ŋu awɔ kpekpeɖeŋunadɔ gbãtɔ ƒe mɔnu nyuitɔ eye nàgblɔ nyatakaka siwo de pɛpɛpɛ na amedɔdɔwo.

Afɔɖeɖe ɖesiaɖe ƒe ɖoɖo kpatawo to kpododonu ƒe nɔnɔme nu¶

Nɔnɔme 1: Gotagome catheter tubing si me gbagbã, ma, alo lã¶

Silicone-ka falɛfalɛwo (Hickman, Broviac, kple dialysis-kawo) kple polyurethane PICC-kawo ate ŋu ana ɖeɖiteameŋu ƒe gbagbãƒewo nadze le Luer-lock hub la gbɔ le esi wobɔbɔ enuenu, aha sesẽ ƒe gbegblẽ, alo lãgbalẽŋudɔwɔnu ƒe lãɖeɖe le vo me le awuɖɔliɖɔli me ta. Àte ŋu akpɔ tsi si me kɔ alo ʋuka dovivitiwo ƒe ʋu si le dodom, alo ase nomi ƒe ɣlidodo ne èle gbɔgbɔm.

1. Tsɔe enumake: Lé catheter tubing la sesĩe le wò asibidɛ gã kple asibidɛ sue dome le gbagbãƒea kple ŋutigbalẽa ƒe dodoƒe dome.
2. Ðo dɔnɔa ɖe Durant ƒe nɔnɔme me: Na dɔnɔa namlɔ anyi ɖe woƒe miame eye wòakɔ eƒe afɔwo ɖe dzi enumake.
3. Tsɔ atraumatic clamp alo fold-and-tape seal de eme:
4. Ne plastic slide clamp si wotu ɖe eme ate ŋu aƒu du ate ɖe ŋutigbalẽa ŋu wu aɖatsi la, tsɔe ƒu gbe to break la ŋu eye nàtue.
5. Ne gbagbãƒea te ɖe ŋutigbalẽa ŋu wu gavi si wotu ɖe eme la, klo ʋuƒo si me gblẽ o si le gbagbãƒea kple ŋutigbalẽa dome la sesĩe ɖe afã me (digri 180) abe abɔ me hose ƒe ƒoƒo ene, eye nàbla atikewɔgbalẽvi si me tsi mate ŋu age ɖo o alo rababa ɖe abɔta si woxatsa la ŋu sesĩe.
6. Ne èle ʋumenugbagbeviɣidɔlékui si ƒe aɖuwo le gbadzaa zãm la, tsɔ gaze si me dɔlékui mele o xatsa ɖe ʋuƒo si le gbagbãƒea kple ŋutigbalẽa dome eye nàbla gazea ɖe edzi. Mègabla ga aɖu ƒuƒluwo ɖe silikɔ dzi tẽ gbeɖe o.
7. Ʋu yi kɔdzi hena ka si me dɔlékui mele o dzadzraɖo ƒe dɔwɔnu: Zi geɖe la, ʋukawo ƒe mɔɖeɖe ŋuti nunyala bibiwo ate ŋu axɔ Hickman alo PICC ka si wotu ɖe mɔ̃ me to dɔlékuiwutike si wotsɔ dzraa ka si me dɔlékui mele o zazã me, atso gotagome akpa si gblẽ la ɖa eye woatsɔ siminti aɖo ʋuƒo yeye aɖe ŋu amekoko manɔmee.

Nɔnɔme 2: Kadodo ƒe nutrenu si me aŋe mele o si bu alo le gbadzaa (Clave / MicroClave hub) .¶

Egbegbe titinakawo ƒe ʋuƒo si me aŋe mele o (MicroClave, MaxPlus, alo Bionector) si wotsɔ gavi bla ɖe ha ƒe asike ɖesiaɖe ŋu. Ne nutsyɔnu sia ʋu esime slide clamp la le ʋuʋu la, ke lumen la ʋuna na xɔa me ya.

1. Tsɔ slide clamp si wotu ɖe eme la enumake (alo tsɔ wò asibidɛwo ƒo tubing la ɖe afã me).
2. Tsɔ dɔnɔa da ɖe Durant ƒe miame ƒe ta ƒe nɔnɔme me ne wonɔ anyi ɖe dzi esime kposɔa do.
3. Klɔ kaawo sesĩe hena sɛkɛnd 15 kple 70% isopropyl alcohol alo chlorhexidine swab yeye eye nàna wòaƒu le ya me keŋkeŋ. Mègaƒo ya ɖe hub la dzi gbeɖe o.
4. Klɔ ka yeye si me dɔlékui mele o si me aŋe mele o ne ele, alo nàna ka la nabla sesĩe eye nàblae, tsɔ gaze si me dɔlékui mele o xatsa kaƒomɔ̃a, eye nàyi dɔwɔƒe si kpɔa nudzɔdzɔ kpatawo gbɔ.

Nɔnɔme 3: Catheter he keŋkeŋ tso akɔta, kɔ, alo alɔnu¶

Ne woɖe titina fli aɖe do goe le ŋutilãa me la, afɔku eve siwo ate ŋu ade ame ƒe agbe afɔku me la dzɔna: ʋu si dona le ʋukawo me le gota kple ya ƒe ʋuʋu to fibrin mɔ̃ si le anyigba te me.

1. Nusitae titina ka si woɖe do goe la dzona le ya si le ʋuʋu ɖi me: Ne titina ka aɖe tsi kɔ alo akɔta wu gaƒoƒo 48 va ɖo 72 la, ŋutilãa wɔa collagen kple fibrin ƒe abɔta si le gbadzaa ƒo xlã mɔ̃a tso ŋutigbalẽa me yia ememe jugular alo subclavian vein me. Ne woɖe mɔ sesẽ sia do goe la, memu enumake o; ewɔa dɔ abe gbe si me do le si tsɔa xɔmeya doa ka kple vena cava ene.
2. Mlɔ dɔnɔa ɖe anyigba enumake eye nàfia wo be woaɖe ɣli alo agbɔ ya: Ne èbɔbɔ nɔ tsitrenu esime nèle gaze ƒuƒu tem ɖe do aɖe si me woɖea do le le titina la dzi la na ya ƒe ʋuka si me ʋu sina tona si wua ame.
3. De ami si me ya megena ɖo o (si xea mɔ na nu) si wotsɔna ƒoa amie:
4. Tsɔ ami si me dɔlékui mele o (Vaseline) alo ami si wua dɔlékuiwo tsyɔ gaze si me dɔlékui mele o dzi dɔmenyotɔe (alo zã Vaseline petrolatum gauze si wodzrana).
5. Mia gaze si wotsɔ ami ƒo ɖe edzi la sesĩe ɖe ŋutigbalẽa ƒe dodoƒe kple edzi vie ne dɔnɔa le gbɔgbɔm.
6. Lé asibidɛ ƒe nyaƒoɖeamenu me ɖe asi sesĩe aɖabaƒoƒo 5 va ɖo 10 ya teti (aɖabaƒoƒo 15 va ɖo 20 na ʋumenugbagbeviɣidɔlékui si ƒe do keke alo dɔnɔ si me ʋu sina tona).
7. Tsɔ polyurethane film dressing si me ya megena ɖo o si me kɔ (Tegaderm alo Opsite) alo tape plastic bla ɖe anyi ɖe axa eneawo katã (four-sided occlusive seal). Na ami si me ya megena ɖo o la nanɔ teƒea hena gaƒoƒo 24 va ɖo 72 esime fibrin-mɔ̃a ƒe abiwo le tutum.
8. Dzro catheter ƒe nugbɔ si woɖe ɖa me kpɔ: Titina fli si me gblẽ o alo PICC ƒe nugbɔ le gbadzaa, si wowɔ le dɔwɔƒe, eye wode dzesi vovototo si le wo dome, si nye yevu alo blɔ. Ne eƒe nuwuwu dze abe ɖe wòle ʋuʋu ɖi alo wòle kpuie wu alesi wotsɔe de eme ƒe didime si woŋlɔ ɖi la, ke kakɛ aɖe lã le ʋukaa me eye wòhiã be woatsɔ fluoroscopic mɔ̃ aɖe axɔ kpata.

Nɔnɔme 4: Wohe catheter le mɔa ƒe akpa aɖe do goe (ʋuʋu / eƒe akpa aɖe ƒe ʋuʋu) .¶

Ne atike si wotsɔ blaa nu ɖe ​​eŋu la vuvu eye ka si wotsɔ blaa nu sentimeta bubuwo le alɔ alo akɔta godo la:

1. MÈGATU ka si woɖe ɖe go la ƒe mɔ̃ si woɖe ɖe go la atrɔ ayi ŋutigbalẽa me GBEÐE o. Ŋutilã me dɔlékuiwo le gotagome mɔ̃a me; ne wotsɔe ƒu gbe ɖe eme la, ehea ʋumenugbagbeviɣidɔ (CLABSI) vɛ eye wòdea afɔku me be ʋukawo nado.
2. Dzudzɔ atikeawo katã dodo enumake. Ne titina fli aɖe he ɖe megbe sentimeta 5 va ɖo 10 (inch 2 va ɖo 4) la, eƒe nugbɔ dona le vena cava si le etame si keke la me yia subclavian alo axillary vein gbadza aɖe me, afisi hyperosmolar Total Parenteral Nutrition (TPN), potassium, alo atikewɔmɔnu hea ʋuka me dɔléle sesẽ, ʋuka me ʋu ƒe sisi, alo lãkusi vɛ le necrosis ƒe dɔléle.
3. Tsɔ gotagome ʋuƒo si sɔ gbɔ wu la ƒo ɖe gauze si me dɔlékui mele o dzi, tsɔ ka si me kɔ nyuie la bla teƒea nyuie, eye nàyi kɔdzi hena akɔta ƒe X-ray wɔwɔ atsɔ akpɔe ɖa be afi si nugbɔ le hã.

Nɔnɔme 5: Port-a-Cath ƒe aŋe si wodo ɖe lãme na ame ƒe ʋuʋu kple atikewɔmɔnu ƒe ʋukawo ɖeɖe ɖa¶

Dodoƒe aɖe si wodo ɖe ŋutigbalẽ te ( .Port-a-Cath alo PowerPort) ƒe titanium-dzraɖoƒe aɖe le akɔta ƒe ŋutigbalẽ te si me Huber needle si wobɔbɔ le dzidzenu 90 me gena ɖe eme. Ne woɖe asi le eŋu la, ŋutigbalẽa kple silicone septum xea tsidzraɖoƒea keŋkeŋ eye ya ƒe ʋuka me ʋu ƒe sisi ƒe afɔku aɖeke mele eme o. Le aƒeme atikewo dodo to pɔmpi si zɔna dzi me la, nudzɔdzɔ kpata eve dzɔna:

1. Huber aŋe hea ɖa keŋkeŋ tso akɔta ƒe ŋutigbalẽ me: Silicone septum la xea eɖokui nu ne aŋea do le melidzeƒea teti. Do nusi wotsɔ blaa aŋea ƒe ʋuƒoa, do nitrile asigɛwo hafi nàka asi atikewɔmɔnu si kɔ ɖe anyi ŋu, nàtsɔ aŋe atsyɔ ŋutigbalẽa ƒe ƒoƒoe dzi, eye nàyɔ kansadɔdalawo.
2. Huber needle backs partway out of the septum into subcutaneous fat (Extravasation): Ne aŋea ƒe nugbɔ ƒu du do go le rubber septum la me milimeta 3 (inch 0.12) esime wòkpɔtɔ le ŋutigbalẽa te la, aɖitike ƒoa ami ɖe akɔta ƒe gli ƒe ami me tẽ.
3. Aflaga dzĩwo: Dzobibi, ʋuʋudedi, vevesese si le veve sem, dzodzro, alo vuvu le melidzeƒea ƒe kotoku dzi le ʋudodo me, alo ʋu ƒe tɔtrɔgbɔ manɔmee.
4. Afɔɖeɖe enumake: Dzudzɔ pɔmpia eye nàbla ka la enumake. Mègahe MELE Huber ƒe aŋea ado goe haɖe o; kɔdzi dɔnɔdzikpɔlawo zãa aŋea tsɔ kɔa atikewɔtsi si xaxa me eye wodoa atike tɔxɛ aɖewo (dexrazoxane na anthracyclines, hyaluronidase na vinca alkaloids, alo sodium thiosulfate na cisplatin). Yi dɔwɔƒe si kpɔa nudzɔdzɔ kpatawo gbɔ tẽ.

Alesi Durant ƒe afɔɖeɖea wɔa dɔe kple alesi woawɔe afɔɖeɖe ɖesiaɖe¶

Le ƒe 1947 me la, dzidɔŋutinunyala Thomas M. Durant ɖe nusita ŋutilã ƒe nɔnɔme fiaa agbetsitsi alo ku le sɛkɛnd ʋɛ aɖewo me le ʋuka me ya si me ʋu sina tona megbe la fia.

Mɔ̃ si wotsɔna ƒua du le dzi ɖusime la me¶

Ne dɔnɔ aɖe mlɔ anyi ɖe woƒe akɔta (supine) alo ne wobɔbɔ nɔ tsitrenu la, ɖusime ventricular outflow tract (RVOT) kple pulmonary artery valve nɔa anyi ɖe ɖusime dzitodzito ƒe ŋgɔgbekpa si kɔkɔ wu. Esi ya le bɔbɔe wu ʋu si nye tsi ta la, ya ƒe kuɖɔ ɖesiaɖe si gena ɖe ʋuka si le etame la dzina ɖe dzi abe kuɖɔ si le atikpala ƒe seƒe ene yia aklã ƒe ʋuka ƒe ʋuƒoa me tututu, eye wòxea mɔ nɛ keŋkeŋ.

Ne èmli dɔnɔa ɖe woƒe miame (left lateral decubitus) eye woakɔ woƒe ta kple akɔta ɖe anyi dzidzenu 15 va ɖo 30 (Trendelenburg position), ɖusime ʋuka kple ɖusime ʋuka ƒe ta kple axadzi gli va zua teƒe kɔkɔtɔ kekeake le dzia me, gake aklã ƒe ʋuka si dona le eme ya trɔna yia anyime. Ya si le ʋuʋum la ƒua du yia dzi ɖaa tso aklã ƒe ʋuƒoa gbɔ eye wòƒoa ƒu ɖe ɖusime dzi ƒe domedome si le etame la me, si wɔnɛ be ʋu si me tsi le sina toa kuɖɔa te yia aklãa me.

Alesi woaɖo dɔnɔa ɖe aƒeme¶

1. Klɔ akɔtaɖonuwo katã do goe tso dɔnɔa ƒe ta kple abɔta te ale be woƒe tame nanɔ gbadzaa le mattress alo anyigba.
2. Mia dɔnɔa ɖe woƒe miame (miame abɔta kple miame akɔta nagbɔ ɖe eme, ɖusibɔta dze ŋgɔ dzisasrã).
3. Gbugbɔ akɔtaɖonu eve alo etɔ̃ alo avɔ si woxatsa ɖe dɔnɔa ƒe akɔta, ata, kple afɔ te ale be woƒe akɔta kple afɔwo nanɔ anyi sentimeta 15 va ɖo 30 (inch 6 va ɖo 12) kɔkɔ wu woƒe dzi kple ta.
4. Na dɔnɔa nanɔ nɔnɔme sia me pɛpɛpɛ vaseɖe esime kpekpeɖeŋunalawo natsɔ wo ade dɔnɔdzikpɔʋu ƒe aba dzi le mɔ ɖeka nu.

Lumen siwo me ʋu le, syringe ƒe dzɔdzɔmeŋusẽŋununya, kple catheter pinch-off syndrome¶

Aƒedzikpɔlawo tsɔa sodium chloride 0.9% (saline si sɔ) si me dɔlékui mele o klɔa PICC kawo kple titina kawo enuenu. Syringe ƒe nyaƒoɖeamenu ƒe mɔ̃ɖaŋunuwo gɔmesese xea mɔ na nyaƒoɖeamenu gã ƒe catheter ƒe gbagbã le akɔta me le vo me.

Nusita MELE be nàzã atikekui si le sue wu 10 mL le titina ka dzi GBEÐE o¶

Le tsi ƒe mɔ̃ɖaŋununya me la, tsi ƒe nyaƒoɖeamenu si dona le atikekui ƒe ʋuƒo me sɔ kple asibidɛ ƒe ŋusẽ si wotsɔna ƒoa ʋuƒoa si woma ɖe ʋuƒoa ƒe akpa si wotso ɖe ʋuƒoa ŋu (Pressure = Force / Area).

• 10-mililita (10-mL) standard barrel syringe ƒe mo keke eye wònana abe 15 va ɖo 25 pounde le inch square (psi) ɖeka me ene le asikɔklɔ sesĩe me, le catheter ƒe gbagbã ƒe seɖoƒe me nyuie.
• mililita 3 (3-mL) alo mililita 1 (1-mL tuberculin) syringe ƒe didime le plunger sue aɖe me. Ne wotsɔ asibidɛ ƒe ŋusẽ ma ke tutu ɖe 3-mL alo 1-mL syringe dzi la, tsi ƒe nyaƒoɖeamenu 90 va ɖo 180 psi kple edzivɔ dona, si ate ŋu agbã catheter ƒe gli tsɛ si le ʋukaa me eye wòalã plastic kakɛ aɖe ɖe dzia me.

Zã syringe siwo ƒe didime nye 10-mL barrel diameter ɣesiaɣi nàtsɔ akɔ tsi alo ahee tso titina fli ɖesiaɖe, PICC, alo melidzeƒea me, eye mègazi tsilele dzi gbeɖe be wòagatsi tre ɖe eŋu o. Kpɔe ɖa be gotagome ʋuƒoawo ʋu, bia tso dɔnɔa si be wòakɔ eƒe alɔnu alo atrɔ ta, eye ne tsitretsitsi gakpɔtɔ li la, bla ka la eye nàyɔ dɔnɔdzikpɔla si kpɔa ʋukawo gbɔ be wòaƒã alteplase (Cathflo Activase) ɖe eme.

Catheter "pinch-off syndrome" le subclavian fliwo kple melidzeƒewo¶

Ne port catheter alo tunneled line ge ɖe subclavian vein me le titina akpa (afisi kɔmeƒua tso akɔta gbãtɔ) la, ƒuawo ƒoa plastic catheter la ɣesiaɣi si dɔnɔa da eƒe abɔta. Positional flushing (ne wogbugbɔ abɔta ƒo ɖe megbe ko), swishing gbeɖiɖiwo, alo infraclavicular vevesese le tsilele me xlɔ̃a nu le catheter transection si gbɔna (Grade 3 pinch-off) kple fragment embolization yi dzia me ŋu. Dzudzɔ melidzeƒea zazã enumake eye nàwɔ akɔta ƒe X-ray.

Aflaga dzĩ vevi bubu siwo le titina: dɔlékuiwutikewo, ʋumenugbagbeviɣidɔ, kple vena cava ƒe dɔléle si le etame¶

Ne titina ka aɖe me gblẽ le ŋutilã me o gɔ̃ hã la, ememe kuxi etɔ̃ hiã be woada wo kpɔ kpata:

1. Central Line-Associated Bloodstream Infection (CLABSI): Vuvɔ ʋuʋu kpata (sesẽ) kple dzoxɔxɔ ƒe dzidziɖedzi le miniti 15 va ɖo 60 le fli la kɔklɔ vɔ megbe, ʋuʋudedi alo fli dzĩ si le akɔta ƒe mɔ si le ŋutigbalẽ te, alo dzoxɔxɔ ɖesiaɖe si wu Celsius 38.0 (Fahrenheit dzidzenu 100.4) (kpɔ neutropenic fever kple atikewɔmɔnu ƒe dɔlékuiwo kple sepsis kple septic shock ƒe ʋuʋu).
2. Catheter-Related Upper-Extremity Deep Vein Thrombosis (DVT): Abɔ, abɔta, alo kɔ ƒe vuvu le akpa ɖeka, vevesese ƒe kpekpeme, akɔta ƒe ʋuka siwo dzena nyuie, kple asi ƒe amadede si do viviti. Mègatsɔ asi ƒo alɔ si vuvu la o; di ultrasound ƒe dodokpɔ kpata.
3. Catheter-Induced Superior Vena Cava (SVC) Syndrome: Ʋuka me ʋu ƒe sisi bliboe ƒo xlã catheter ƒe nugbɔ le superior vena cava me nana mo kple kɔ vuvu, dzĩ-dzẽ, ŋkumeʋuʋu, gbe si le ɖiɖim, kple gbɔgbɔtsixe tsia ame ƒo. Kpɔe ɖa superior vena cava syndrome kple kansadɔléle ƒe nɔnɔme kpatawo.

Nutome ƒe xexlẽdzesi siwo ku ɖe nudzɔdzɔ kpatawo ŋu kple dɔwɔƒea ƒe ɖoɖowo¶

Ne èle yɔyɔm be woaɖo dɔnɔdzikpɔʋu kpata ɖe ʋuka si le titina si me ʋuʋudedi, si le ʋuʋu ɖi, alo esi woɖe do goe ta la, bia be woana Agbe ƒe Kpekpeɖeŋunana Deŋgɔ (ALS) kpekpeɖeŋunalawo eye nàna wo nanya enumake ne gbɔgbɔtsixe tsi dɔnɔa, akɔta le veve sem, alo eƒe susu trɔ.

• United States kple Canada: Ƒo ka na 911. Infusion Nurses Society (INS) Infusion Therapy Standards of Practice kple Centers for Disease Control and Prevention (CDC) de se be woawɔ proximal clamping enumake, miame ƒe Trendelenburg (Durant) ɖoɖo ɖe teƒe si wosusu be venous air embolism, kple petroleum-jelly gauze dressings siwo me ya megena ɖo o si woalé be na gaƒoƒo 24 va ɖo 72 le central line ɖeɖe vɔ megbe.
• United Kingdom: Ƒo ka na 999 hena dɔnɔdzikpɔʋu kpata (alo 111 na nutome dɔnɔdzikpɔla siwo menye kpata o ƒe vovototodedeameme ne wobla ka dedie eye ya aɖeke mele eme o). NHS England kple NICE tsɔ ʋuka me ya ƒe ʋuʋu tso titina ʋuka me yiyi ƒe mɔ̃wo me da ɖe hatsotso me be enye Nudzɔdzɔ Gbeɖe si hiã be woatsɔ nutrenu si xea mɔ na nu enumake, Durant ƒe teƒeɖoɖo, kple oxygen si sina 100% ŋutɔ.
• Europa Dukɔwo ƒe Habɔbɔ: Ƒo ka na 112. ESPEN kple Europa Gbugbɔgadzɔ ƒe Aɖaŋuɖoha (ERC) ƒe mɔfiamewo fia mɔe be woatsɔ ka abla enumake, woatsɔ ta aɖo anyi ɖe miame, oxygen si sina kabakaba be nitrogen nakɔ kabakaba, kple etsɔtsɔ kpata.
• Australia kple New Zealand: Ƒo ka na 000 le Australia alo 111 le New Zealand. Australiatɔwo ƒe Dedienɔnɔ Kple Lãmesẽnyawo Gbɔkpɔha ƒe Mɔfiamewo kple ANZCOR ƒe mɔfiamewo fiaa mɔ enumake be woatsɔ abla ɖe nusi gblẽ le eŋu gbɔ eye ya megena ɖe eme occlusive dressing ɖe titinamɔ̃ ɖesiaɖe si woɖe ɖa dzi.
• India kple Asia-Pacific: Ƒo ka na 112 le India, 995 le Singapore, 119 le Japan kple South Korea, alo 999 le Malaysia kple Hong Kong. Le dukɔ bubuwo gome la, kpɔ míaƒe nyatakakadzraɖoƒe si nye dukɔwo dome xexlẽdzesi siwo ku ɖe nudzɔdzɔ kpatawo ŋu.

Nya siwo wobiaa amewo enuenu¶

Nukatae màte ŋu atsɔ gaze ƒuƒu si wozãna edziedzi alo Band-Aid ade doa dzi ko ne kɔ alo akɔta ƒe titina fli aɖe he do goe o?¶

Ne titinaʋuka si me ʋu sina tona la bɔbɔ nɔ akɔta, akɔta te, alo afɔkpodzi ƒe ʋuka si le eme wu gaƒoƒo 48 la, ŋutilãa wɔa ka si me do le tso ŋutigbalẽa me yia titina ʋuka gã la me tẽ. Esi wònye be akɔta ƒe ʋuka siwo le titina naa ame ƒe nu menoa nu gbegblẽ ɣesiaɣi si amea gbɔ ya ta la, xɔa me ya ƒoa tome to gaze ƒuƒu ƒe kotoku si me ʋuʋudedi le me toa mɔ ma me yia dzia me. Ele be nàtsɔ ami si me dɔlékui mele o (Vaseline) alo ami si wua dɔlékuiwo atsyɔ gaze la dzi eye nàtsɔ plastic film alo tape si me ya megena ɖo o atre eƒe go eneawo katã ale be ya aɖeke mate ŋu age ɖe eme o.

Ðe ya sue aɖe si lolo abe champagne ƒe kuɖɔ ene le nye IV-mɔ̃a me hea ya si me ʋu sina tona si wua ame vɛa?¶

Le ame tsitsi akpa gãtɔ siwo me do aɖeke mele woƒe dzi ƒe xɔwo dome o gome la, wotsɔa lãkusi suesuesue siwo le woƒe dzitodzito me tsia kuɖɔ suesuesue siwo ƒe didime nye mililita ɖeka ƒe akpa sue aɖe siwo léna ɖe IV-donamɔ̃ si wozãna ɖaa ƒe axadzi ŋu afɔku aɖeke manɔmee eye woɖea ya doa goe. Gake ne patent foramen ovale (PFO) alo dzitodzito si wodzi tso ɖusime yi miame ƒe ʋuʋu le dɔnɔ aɖe ŋu la, kuɖɔ suesuesuewo gɔ̃ hã ate ŋu atso ayi ahɔhɔ̃a me, eye titinaka ƒe ʋuƒo si womexe o alo si megbã o la hea ya mililita alafa geɖe le sɛkɛnd ʋɛ aɖewo ko me, si wua amesiame kabakaba. Kpe titinaka ɖesiaɖe si me gbagbã alo le ʋuʋu ɖi enumake.

Vovototo kae le Grosong catheter kple Hickman alo PICC ka si wozãna ɖaa dome ne kpoa ge?¶

Wotrɔ asi le Groshonng titina ka aɖe ŋu kple eƒe nugbɔ si wotu, si le goglo eye wòte ŋu sea nyaƒoɖeamenu ƒe ʋuƒo si me woɖea mɔ etɔ̃ le si te ɖe eƒe nuwuwu si le didiƒe ŋu le vena cava la me; ʋuƒoa nɔa tutu le nyaƒoɖeamenu si mewɔa akpa aɖeke o me, eʋuna yia gota le nyaƒoɖeamenu nyui ƒe tsilele me, eye wòʋuna yia eme ne wole nyaƒoɖeamenu gbegblẽ ƒe atikekui ƒe ʋuʋu me. Togbɔ be ememe ʋuƒo sia ɖea afɔku si le ya si gena ɖe eme le eɖokui si ne gotagome nutsyɔnu la ge dzi kpɔtɔna hã la, woate ŋu agbɔ ya goglo aɖe si me ya si le eme la mimi ʋua kokoko alo ado kpo nu le ɣeyiɣi aɖe megbe. Ele kokoko be nàƒo Groshong ka ɖesiaɖe si me gbagbã alo esi womexe o la ahalée enumake.

Aleke oxygen 100% gbɔgbɔ kpena ɖe ame ŋu be ya ƒe kuɖɔ aɖe si le ʋukawo me la ƒua gbe?¶

Nitrogen si ade 78 le alafa me kple oxygen 21 le alafa me ye le yame ƒe xɔ me ya me. Esi nitrogen melɔ̃na le ʋu me nyuie o ta la, nitrogen ƒe kuɖɔ si le dzi alo aklã ƒe ʋuka me la dzi ɖena kpɔtɔna blewu ŋutɔ le eɖokui si. Ne kpekpeɖeŋunalawo alo atikewɔla siwo kpɔa nudzɔdzɔ kpatawo gbɔ na oxygen dzadzɛ 100 le alafa me to ametakpɔnu si megagbɔa ya o dzi la, nitrogen ƒe agbɔsɔsɔ si le dɔnɔa ƒe lãkusiwo kple ʋu si ƒo xlãe me dzi ɖena kpɔtɔna yia zero, si wɔnɛ be kaka ƒe ʋuʋudedi si hea nitrogen doa goe kabakaba tso ya si le ʋukawo me me ale be wòtsina eye wòlɔna kabakaba zi gbɔ zi ene.

Ðe woate ŋu aɖɔ PICC ka alo Hickman ƒe ka si me gbagbã ɖo amekoko manɔmeea?¶

Ẽ, nenye be gotagome ka si me woɖea ka le si megblẽ o si didi sentimeta 4 va ɖo 5 (inch 1.5 va ɖo 2) ya teti gakpɔtɔ le ŋutigbalẽa ƒe dodoƒe godo eye nèbla ka la enumake be wòagaƒo ɖi alo aƒoe o. Kɔdzi ƒe ʋukawo me yiyi ŋuti nunyala bibiwo kple keklẽŋusẽŋutinunyala siwo dea nu nyaa me tsɔa atikewɔlawo ƒe nuwo ɖɔɖɔɖonu siwo me dɔlékui mele o, siwo ƒe lolome sɔ kple wo nɔewo, siwo wɔnɛ be woate ŋu atso gotagome asike si gbã la le nɔnɔme siwo me dɔlékui mele o me eye woblaa gotagome pigtail kple Luer-lock hub yeye aɖe ɖe ka si li xoxo la ŋu le miniti 15 me.

Dzɔtsoƒewo kple dziɖuɖumegãwo ƒe mɔfiame¶

• Dɔnɔdzikpɔlawo ƒe Habɔbɔ (INS, United States): Infusion Therapy Standards of Practice, 9^th Edition (2024) (Central venous access device ƒe kuxiwo gbɔ kpɔkpɔ, syringe ƒe lolome ƒe nyaƒoɖeamenu ƒe seɖoƒe, catheter dzadzraɖo, kple ya ƒe ʋuka me ʋu ƒe sisi nutsitsi).
• Dɔlélewo Dzi Kpɔkpɔ Kple Mɔxexe Ðe Enu Dɔwɔƒewo (CDC, United States): Mɔfiamewo na Mɔxexe Ðe Dɔlékui Siwo Do Ƒome Kple Ʋukawo Me Dɔlékuiwo kple Dɔléle Siwo Do Ƒome Kple Ʋukawo Me Dɔlékuiwo (CLABSI) ƒe Mɔxexe Ŋuti Numekuku*.
• Dukɔa ƒe Lãmesẽnyawo Gbɔkpɔha (NHS England) & Dukɔa ƒe Lãmesẽnyawo Kple Belélename Ŋuti Nusrɔ̃ƒe (NICE, United Kingdom): Never Events Policy and Framework: Intravascular Air Embolism kple Central Venous Catheters Dede Dedie Kple Wo Ðeɖeɖa.
• European Resuscitation Council (ERC) & American Heart Association (AHA): Mɔfiamewo na Dzitodzito me Gbugbɔgadzɔ Kple Dzitodzitowo ƒe Beléle Kpata: Dzi ƒe Dɔléle le Nɔnɔme Tɔxɛwo Me (Vascular Air Embolism, Durant Positioning, kple Hyperbaric Oxygen Therapy).
• McCarthy CJ kple ame bubuwo. (Journal of Clinical Medicine / New England Journal of Medicine): Ya ƒe Ʋuʋudedi: Aɖaŋuɖoɖo Nyuiwo hena Mɔxexe Ðe Enu Kple Edada (Sub-atmospheric central venous pressure gradients, right ventricular outflow tract air lock, kple akpa ene ƒe occlusive petroleum dressing protocols).

Mɔfiame siwo do ƒome kplii¶

• Dialysis ƒe mɔɖeɖe kple AV fistula si dea ame ƒe agbe afɔku me ʋu si dona kple dialysis hyperkalemia si to
• Neutropenic fever, atikewɔmɔnu ƒe dɔléle, kple kansa ŋuti atikewɔwɔ kpata
• Aklã me ʋu ƒe sisi kple ʋuka goglo me ʋu ƒe sisi (DVT) .
• Tension pneumothorax kple mimi akɔta abi kpekpeɖeŋu gbãtɔ
• Ame tsitsiwo ƒe CPR kple AED zazã