I-Central Line Ephukile noma Ekhishiwe, i-PICC, noma I-Hickman Catheter: Ukuvimbela I-Fatal Venous Air Embolism¶

I-catheter ye-venous eqhekekile, esikiwe, engavaliwe, noma ekhishiwe (okuhlanganisa ne-Peripherally Inserted Central Catheter [PICC], umugqa we-Hickman noma we-Broviac omhubhe, i-jugular yangaphakathi noma i-subclavian catheter, i-hemodialysis Permcath, noma i-Port-a-Cath efakiwe enesidingo esiphuthumayo se-Huber-vascular dislodged). Ngenxa yokuthi ichopho lwayo yonke i-catheter ye-venous emaphakathi luhlala ngqo ngaphakathi kwe-low-pressure superior superior ngenhla nje kwe-atrium engakwesokudla yenhliziyo, i-lumen evulekile noma ipheshana lokuphuma elisha lingamunca umoya wegumbi ngqo egazini noma nini lapho isiguli sihogela. Uma i-catheter iqhekeka, ilahlekelwa ikepisi, noma iphuma esikhumbeni, shayela indawo yangakini izinombolo eziphuthumayo ngokushesha. Ngezimo eziphuthumayo ezihlobene nemithambo nesifuba, thintana ukufinyelela kwe-dialysis kanye nokopha kwe-AV fistula, i-pulmonary embolism kanye ne-deep vein thrombosis, futhi i-tension pneumothorax kanye nokumunca inxeba lesifuba usizo lokuqala.

Ngokungafani nomugqa we-peripheral intravenous (IV) osesandleni noma engalweni, ophumela ngaphandle uma uvulwa ngenxa yokuthi imithambo yengalo inomfutho omuhle, imithambo emaphakathi ngaphakathi kwesifuba ithola ingcindezi engaphansi komkhathi (negative) njalo lapho i-diaphragm ifinyela ngesikhathi sokuphefumula. Ukuhefuzela okukodwa okujulile, ukukhwehlela, noma ukuphefumula okuqondile kuyilapho ihabhu ye-catheter emaphakathi ingavaliwe noma ihlukaniswe ingadonsa amamililitha angu-50 kuya kwangu-300 (ama-ounces angu-1.7 kuya kwangu-10) omoya womoya womoya ku-ventricle engakwesokudla, okudala igwebu elicindezelayo "lokhiye womoya" ovimba ukugeleza kwegazi emaphashini futhi kubangele ukuboshwa kwenhliziyo yesibili.

Yenza lokhu manje¶

1. Bopha noma ncinza i-catheter ngokushesha phakathi kwekhefu nesikhumba sesiguli. Uma ishubhu langaphandle le-PICC, i-Hickman, Broviac, noma i-hemodialysis catheter liqhekekile, lisikiwe, noma alikho isixhumi saso sesixhumi, cindezela ishubhu elithambile liqinise ngeminwe yakho eduze nomzimba wesiguli kunekhefu. Shelelezisa i-clamp yepulasitiki eyakhelwe ngaphakathi evalwe phezu kwengxenye engaguquki eduze kwesikhumba, noma usonga ishubhu ngokucijile phakathi ("kink it") bese uyibopha ngokuqinile ngeteyipu engangeni manzi noma ngebhande lerabha.
2. Uma i-catheter ikhishwe ngokuphelele emzimbeni, cindezela amafutha okugcoba angangeni emoyeni (occlusive) aqine phezu kwembobo. Ungasebenzisi ungasebenzisi i-gauze engenalutho eyomile iyodwa, ngoba umoya ushaya ikhwelo uqonde kukotini owomile weluka emhubheni one-fibrous ongaphansi komhlaba oxhuma isikhumba kumthambo we-jugular noma we-subclavian. Gcoba iphedi ye-gauze oyinyumba ngokukhululekile nge-petroleum jelly (Vaseline) noma amafutha okugcoba ama-antibiotic, beka ipulasitiki yokugoqa noma i-foil phezu kwayo, bese ucindezela ngokuqinile endaweni yokuphuma imizuzu emi-5 ukuya kweyi-10 ngenkathi uthinta yonke imiphetho emine ingangeni emoyeni.
3. Lalisa isiguli ngokushesha endaweni ka-Durant (sicaba ngohlangothi lwaso LWESINXELE ikhanda nesifuba sitshekele PHANSI). Ungalokothi uvumele isiguli esinomugqa omaphakathi ovulekile, oqhekekile, noma osanda kudonswa sihlale siqondile noma sime. Awagingqe uwafake kwesokunxele (left lateral decubitus) futhi baphakamise unyawo lombhede noma baphakamise imilenze nezinqulu zabo emicamelweni (Trendelenburg tilt) ukuze i-atrium elungile kanye ne-ventricle engakwesokudla kuhlale phezulu kunomthambo we-pulmonary outflow tract, kuvalela noma yiliphi ibhamuza lomoya elimunyisiwe phezulu kwenhliziyo yesokudla kude namaphaphu.
4. Yala isiguli ukuthi sikhiphe umoya noma sihoshe kamnandi lapho uvala umugqa noma ugqokise. Tshela umuntu ukuthi: "Hofuza umoya noma uhomume ngenkathi ngivala le mbobo; ungahefuzeli kakhulu." Ukuhogela umoya noma ukuhhumuzela kuphakamisa umfutho we-intrathoracic ngaphezu kokucindezela kwegumbi futhi kumise ukudonsa komoya ngaphakathi.
5. Shayela inombolo yakho yasendaweni yezimo eziphuthumayo ngokushesha. Dayela u-911 e-United States nase-Canada, 112 ku-European Union yonkana, 999 e-United Kingdom, 000 e-Australia, noma uhlole uhlu lwethu izinombolo eziphuthumayo. Tshela umthumeli: "Izimo eziphuthumayo ze-venous catheter: umugqa omaphakathi oqhekekile noma okhishiwe onengozi ye-venous air embolism."
6. Londoloza i-catheter ekhishiwe iphelele ukuze odokotela basesibhedlela bakwazi ukuhlola ichopho layo. Faka i-catheter esikhwameni sepulasitiki esihlanzekile ukuze abezimo eziphuthumayo bahlole ithiphu elikude futhi baqinisekise ukuthi ulayini uphume uphelele noma uma ucezu lwepulasitiki olugundiwe lufakwe enhliziyweni.

Isihlahla sesinqumo: ukulinganisa okuphuthumayo kwe-venous catheter¶

flowchart TD
    A["I-Central Line, i-PICC, i-Hickman, i-Permcath, noma i-Port Emergency"] --> B{"Kwenzekani ku-catheter?"}
    B -->|"Amashubhu aphukile, asikiwe, noma ikepisi liwile"| C["Ncinza amashubhu ngokushesha phakathi kwekhefu nesikhumba"]
    C --> D["Vala i-clamp eyakhelwe ngaphakathi ukuze uhlephule noma usonge amashubhu phakathi bese uteyipha ngokuqinile"]
    D --> E["Lala ngesineke ohlangothini LWESINXELE izinqe/imilenze iphakanyisiwe (Indawo eDurant)"]
    B -->|"I-catheter ikhishwe ngokuphelele esikhumbeni"| F["Khipha umoya ngesineke noma uhoxise ngenkathi ulele phansi"]
    F --> G["Faka i-petroleum jelly gauze + ukugoqa kwepulasitiki bese ucindezela ngokuqinile phezu kwembobo yokuphuma"]
    G --> H["Thepha zonke izinhlangothi ezi-4 ezingangeni emoyeni futhi uhlole ithiphu le-catheter elikhishiwe ukuze liphelele"]
    H --> E
    B -->|"I-catheter iphume kancane noma imelana nokushaywa"| I["UNGAPHUSHI amashubhu ubuyisele ngaphakathi futhi UNGAPHOQI ukushaywa ngesirinji encane"]
    I --> J["Vikela umugqa wangaphandle osele ngokugqoka okuyinyumba kanye ne-clamp lumen"]
    E --> K{"Ukuphefumula kanzima, ubuhlungu besifuba, ukuhefuzela, i-cyanosis, noma ukuwa kungazelelwe?"}
    K -->|"Yebo: I-Venous Air Embolism esolwayo"| L["Hlala ku-Left-Lateral Trendelenburg, unikeze umoya-mpilo ongu-100% uma utholakala, shayela i-EMS ngokushesha"]
    K -->|"Azikho izimpawu okwamanje"| M["Gcina uyisicaba/uhlangothi lwesobunxele futhi uthuthe ngokushesha ukuze ulungise ulayini wasesibhedlela noma i-X-ray yesifuba"]

I-venous air embolism ibulala kanjani: i-physics ye-ventricular efanele "i-air lock"¶

Ukuqonda ukuguquguquka komfutho wesistimu ye-venous emaphakathi kuchaza ukuthi kungani i-catheter ye-venous ephakathi engavaliwe noma eqhekekile iphathwa ngokuphuthumayo njengenxeba lesifuba elimunca.

Kungani imithambo emaphakathi incela umoya ngaphakathi kuyilapho imithambo yengalo yophela ngaphandle¶

Uma umhlengikazi ebeka i-IV cannula ngemuva kwesandla sakho noma engalweni yakho, umfutho wegazi ngaphakathi kulowo mthambo we-peripheral uba +8 kuya ku-+15 millimeters we-mercury (mmHg) ngaphezu komfutho wegumbi lomkhathi. Uma ikepisi liwa engalweni ye-peripheral IV, igazi liconsela ngaphandle nomoya awukwazi ukungena.

I-venous catheter emaphakathi inqamuka ngaphakathi kwe-superior vena cava (SVC) noma i-cavoatrial junction khona kanye emnyango we-atrium engakwesokudla. Ngaphakathi kwe-ribcage, i-central venous pressure (CVP) ihamba eduze kuka-0 kuya ku-+5 mmHg lapho iphumula, futhi yehla iye ku--3 kuya ku-8 mmHg ngaphansi komfutho womoya* noma nini lapho i-diaphragm ifinyela phakathi nokuhogela okuvamile. Uma isiguli siphelelwe amanzi emzimbeni, sihlezi siqondile, noma sithatha umoya ojulile ngenxa yobuhlungu noma ukukhathazeka, ukucindezela kwe-intrathoracic okungalungile kwehla ngaphansi -15 kuya ku-20 mmHg.

Ngokomthetho ka-Poiseuille wokugeleza koketshezi, ilume elimaphakathi le-gauge engu-14-gauge noma engu-16-gauge evezwe kugradient yengcindezi engu-5 mmHg yonkana ubude obungamasentimitha angu-20 (8-intshi) ivumela amamililitha angu-100 (ama-ounces angu-3.4) omoya wegumbi ngomzuzwana ukuthi agijimele ku-vena cavai. Ekuphefumuleni okubili ukuya kokuthathu, umthamo womoya obulalayo (amamililitha angu-200 kuya kwangu-300 kubantu abadala, noma amamililitha angu-3 kuya kwangu-5 ngekhilogremu yesisindo somzimba; futhi okuncane kakhulu uma isiguli sine-ovale ye-foramen ovale) kungena enhliziyweni.

Igwebu elicindezelayo elithi "air lock" kanye ne-acute cor pulmonale¶

Igazi liwuketshezi olungenakucindezelwa. Lapho i-bolus enkulu yomoya womkhathi ingena ku-atrium elungile kanye ne-ventricle engakwesokudla, izehlakalo ezintathu zokuzilungisa zenzeka ngesikhathi esisodwa:

1. I-right ventricular outflow tract (RVOT) air lock: Ngenxa yokuthi umthambo wamaphaphu uphuma ejikeni eliphezulu langaphambili le-ventricle engakwesokudla (lapho umuntu ehlezi noma elele phansi ngomhlane), ibhamuza lomoya elivuzayo lintanta liqonde ngqo ku-conus yamaphaphu kanye nesiqu somthambo omkhulu wamaphaphu. Uma i-ventricle engakwesokudla ifinyela, ivele icindezele futhi icindezele ibhamuza legesi eliyisiponji esikhundleni sokukhiphela igazi liye phambili, lehlise ukulayishwa kuqala kwe-ventricular kwesokunxele kanye nokuphuma kwenhliziyo kube ziro.
2. Ukushaywa kwegazi ngomshini kube igwebu le-fibrin-air: Amapheshana e-valve e-tricuspid avunguza igazi eline-venous kanye nomoya wegumbi ogcwele i-nitrogen kube igwebu eliwugqinsi lamabhamuza amancane ambozwe ngamaplatelet kanye ne-fibrin, enze umsindo onyakazayo phezu kwesifuba obizwa ngokuthi "i-mill-wheel-wheel" (bruit de moulin).
3. I-vasoconstriction yamaphaphu kanye ne-paradoxical stroke: Amabhamuza amancane abalekela emithanjeni yamaphaphu abangela umfutho wegazi ophakeme wamaphaphu. Emaphesentini angu-25 abantu abadala abane-anatomical patent foramen ovale (PFO) (i-flap encane yokuvuleka phakathi kwe-atria yesokudla nesobunxele), isipike esikumfutho wenhliziyo engakwesokudla siphusha i-flap sivuleke, sivale amabhamuza omoya ngqo enhliziyweni yesobunxele, imithambo yenhliziyo, kanye nobuchopho (*i-arterial paradoxical arterial embolism) okubangela ukumelwa yinhliziyo ngokushesha.

Izimpawu zakudala ze-acute venous air embolism¶

Lapho umoya ungena emgqeni omaphakathi noma umgudu we-venous ovulekile esigulini esiphapheme, izimpawu zivela ngokushesha:

• Kungazelelwe, okucabangayo ukuhefuzela okujulile noma ukulingana kokukhwehlela umoya osheshayo ushaya umbhede we-pulmonary capillary (omunca umoya owengeziwe ngaphakathi uma ulayini usavuliwe)
• Ukuchoboza ubuhlungu besifuba se-retrosternal kanye nomuzwa wokubhujiswa okuzayo
• Ukuphefumula kanzima okungazelelwe (tachypnea) nokushintshashintsha kombala oluhlaza okwesibhakabhaka kwezindebe nobuso (cyanosis)
• Isiyezi, ukuba mpunga okubukwayo, ukudideka, ukukhubazeka okugxilile okufana nokushaywa unhlangothi, noma ukulahlekelwa ukwazi (syncope)
• Ukwehla okukhulu komfutho wegazi (obstructive shock), imithambo yentamo egobile, kanye nePulseless Electrical Activity (PEA) ukuboshwa kwenhliziyo

Ukuhlonza izinhlobo ezinhlanu ezinkulu ze-central venous catheter¶

Imishini ehlukene ye-venous emaphakathi ithwala izingozi ezihlukile zemishini ekhaya. Ukwazi ukuthi yimuphi umugqa isiguli esinawo kukuvumela ukuthi usebenzise indlela efanele yosizo lokuqala futhi ubike imininingwane enembile kubathumeli.

Izinyathelo eziphuthumayo zesinyathelo ngesinyathelo ngesimo sokuhluleka¶

Isimo 1: Ukuqhekeka, ukuhlukaniswa, noma ukusika ishubhu ye-catheter yangaphandle¶

Ama-catheter athambile we-silicone (imigqa ye-Hickman, i-Broviac, ne-dialysis) kanye nemigqa ye-polyurethane PICC ingadala imifantu yokukhathala eduze kwehabhu ye-Luer-lock kusukela ekugobeni okuphindaphindiwe, ukucekelwa phansi kwe-alcohol-swab, noma ukusikeka kwesikere ngephutha phakathi noshintsho lwezingubo. Ungase ubone uketshezi olucacile noma igazi le-venous emnyama livuza, noma uzwe ukuncenceza okumunca lapho uhogela.

1. Ncinza ngokushesha: Bamba ishubhu le-catheter uliqinise phakathi kwesithupha sakho nomunwe wangaphambili phakathi komfantu nendawo yokuphuma esikhumbeni.
2. Misa isiguli endaweni ka-Durant: Cela isiguli silale sibheke kwesokunxele imilenze yaso iphakame ngokushesha.
3. Faka i-atraumatic clamp noma i-fold-and-tape seal:
4. Uma i-clamp ye-slide yepulasitiki eyakhelwe ngaphakathi ingashelela eduze kwesikhumba kunodabukile, shelelezisa udlule lapho kunqamuka khona bese uyivala.
5. Uma i-crack iseduze nesikhumba kune-clamp eyakhelwe ngaphakathi, goqa ishubhu eliqinile phakathi kokuqhekeka nesikhumba ngokucijile kube uhhafu (180 degrees) njengokukhiya ipayipi lengadi, bese usonga itheyiphu yezokwelapha engangeni manzi noma ibhande lerabha ngokuqinile equlwini eligoqiwe.
6. Uma usebenzisa i-hemostat enomhlathi obushelelezi, bopha izendlalelo ezimbili ze-gauze oyinyumba eduze kweshubhu phakathi kwekhefu nesikhumba bese ubamba phezu kwe-gauze. Ungalokothi ubophe amazinyo ensimbi angenalutho ngqo ku-silicone.
7. Ezokuthutha eziya esibhedlela ukuze zizothola ikhithi yokulungisa i-catheter eyinyumba: Ochwepheshe bokufinyelela emithanjeni ngokuvamile bangakwazi ukuhlenga umhubhe we-Hickman noma ulayini we-PICC besebenzisa ikhithi yokulungisa izingxenyana eziyinyumba, baphungule ingxenye yangaphandle eyonakele futhi banamathisele ihabhu entsha ngaphandle kokuhlinzwa.

Isimo sesi-2: Isixhumi esingenanaliti esilahlekile noma esixegayo (ihabhu le-Clave / MicroClave)¶

Imigqa yesimanje emaphakathi ine-screw-on valve valveless cap (MicroClave, MaxPlus, noma i-Bionector) enamathiselwe kumsila we-pigtail ngayinye. Uma lesi sivalo siqaqa ngenkathi i-clamp yesilayidi ivuliwe, i-lumen ivulekele umoya wegumbi.

1. Vala isigxivizo se-slide esakhelwe ngaphakathi ngokushesha (noma khahlela ishubhu phakathi ngeminwe yakho).
2. Beka isiguli endaweni ka-Durant ebheke phansi ebheke phansi kwesokunxele uma besihlezi ngenkathi ikepisi liphuma.
3. Khuhla imicu ngamandla imizuzwana engu-15 nge-70% isopropyl alcohol entsha noma i-chlorhexidine swab futhi uyeke yome ngokuphelele. Ungalokothi ushaye ihabhu.
4. Khipha ikepisi entsha eyinyumba engenanaliti uma ikhona, noma gcina ulayini uboshwe ngokuqinile futhi ugoqwe, bopha ihabhu nge-gauze oyinyumba, bese uya emnyangweni wezimo eziphuthumayo.

Isimo sesi-3: I-catheter ikhishwe ngokuphelele esifubeni, entanyeni, noma engalweni¶

Lapho umugqa omaphakathi ukhishwa emzimbeni, izingozi ezimbili ezisongela ukuphila zenzeka: ukopha kwe-venous ngaphandle kanye nesifiso somoya emhubheni we-fibrin ongaphansi komhlaba.

1. Kungani umugqa omaphakathi okhishiwe ushiya umhubhe womoya ovulekile: Lapho i-catheter emaphakathi ihlala entanyeni noma esifubeni amahora angaphezu kuka-48 kuya kwangu-72, umzimba wenza umkhono obushelelezi we-collagen nomkhono we-fibrin uzungeze ishubhu usuka esikhumbeni uye ngqo emithanjeni ye-jugular yangaphakathi noma ye-subclavian. Lapho ukhishwa, lomhubhe oqinile awubhidliki ngokushesha; isebenza njengotshani obungenalutho obuxhuma umoya wegumbi ku-vena cava.
2. Lalisa isiguli phansi ngokushesha futhi usifundise ukuhomuzela noma ukuphefumulela ngaphandle: Ukuhlala uqonde ngenkathi ucindezela i-gauze eyomile phezu kwembobo yokuphuma emaphakathi kubangele i-embolism ebulalayo yomoya.
3. Faka isigcobo esibamba umoya (occlusive):
4. Gcoba iphedi ye-gauze oyinyumba ngokukhululekile nge inzalo ye-petroleum jelly (Vaseline) noma amafutha okugcoba ama-antibiotic (noma sebenzisa i-gauze yokuthengisa ye-Vaseline petrolatum).
5. Cindezela i-gauze egcotshwe ngamafutha ngokuqinile phezu kwendawo yokuphuma yesikhumba futhi ngaphezu kwayo njengoba isiguli siphefumula.
6. Bamba ukucindezela komunwe okuqinile okungenani imizuzu emi-5 ukuya kweyi-10 (imizuzu eyi-15 kuye kwengama-20 ukuze uthole i-hemodialysis catheter ebanzi noma isiguli esinqande ukuqunjelwa).
7. Gcoba i-gauze ye-petroleum ngokuphelele ngendwangu yefilimu ekhanyayo ye-polyurethane eqinile (Tegaderm noma Opsite) noma ukugoqa ipulasitiki ngetheyiphu phansi nxazonke zonke izinhlangothi ezine (four-sided occlusive seal). Gcina okokugcoba okungangeni emoyeni kusendaweni24 kuya kumahora angama-72 kuyilapho i-fibrin tract tract ivala izibazi.
8. Hlola ithiphu le-catheter elikhishiwe: Ulayini omaphakathi oqinile noma i-PICC inethiphu elibushelelezi, elibunjwe njengasekuqaleni, elimakwe ngokuhlukile elimnyama noma eliluhlaza okwesibhakabhaka. Uma isiphetho sibukeka simangelengele noma sisifushane kunobude bokufaka oburekhodiwe, isiqeshana sigundiwe ngaphakathi komthambo futhi sidinga ukubuyiswa kogibe oluphuthumayo lwe-fluoroscopic.

Isimo 4: I-catheter ikhishwe kancane (ukufuduka / ukukhishwa ingxenye)¶

Uma i-dressing peels ixega futhi amasentimitha engeziwe we-catheter ilenga ngaphandle kwengalo noma esifubeni:

1. UNGALOKOTHI uphushele ishubhu le-catheter elivuliwe libuyele esikhumbeni. Ishubhu elingaphandle ligcwele amagciwane esikhumba; ukulihlohla ngaphakathi kubangela i-bloodstream sepsis (CLABSI) futhi kubeke engcupheni ukubhobozwa kwemithambo.
2. Misa konke ukufakwa ngokushesha. Lapho umugqa omaphakathi uhlehla ngamasentimitha angu-5 kuya kwangu-10 (amayintshi angu-2 kuya kwangu-4), ichopho lawo liphuma ku-vena cava ebanzi engaphezulu liye emithanjeni encane engaphansi noma e-axillary, lapho i-hyperosmolar Total Parenteral Nutrition (TPN), i-potassium, noma i-chemotherapy ibangela i-phlesis, i-tissue enzima, i-phlesis.
3. Khophela ishubhu elingeziwe ku-gauze oyinyumba, qopha ingubo ebonisa ngale ngokuphepha phezu kwesayithi, bese uya esibhedlela uyothola i-X-ray yesifuba ukuze uqinisekise indawo yethiphu.

Isimo sesi-5: Ukukhishwa kwenaliti ye-Port-a-Cath etshaliwe kanye nokwengezwa kwe-chemotherapy¶

Imbobo efakwe ngaphansi kwesikhumba (Port-a-Cath noma PowerPort) inendawo yokugcina amanzi e-titanium ngaphansi kwesikhumba sesifuba okufinyelelwa kuyo ngokugoba okungama-degree angu-90 inaliti ye-Huber. Uma kunqanyuliwe, isikhumba kanye ne-silicone septum kuvala i-reservoir ngokuphelele ngaphandle kwengozi ye-air embolism. Ngesikhathi sokufakwa kwe-chemotherapy ekhaya ngepompo ye-ambulatory, kuvela izimo eziphuthumayo ezimbili:

1. Inaliti ye-Huber ikhipha ngokuphelele esikhumbeni sesifuba: I-silicone septum izivala yona ngokushesha nje lapho inaliti isuka embobeni. Vala i-clamp kushubhu yenaliti, gqoka amagilavu ​​e-nitrile ngaphambi kokuthinta i-chemotherapy echithiwe, vala iphinifa lesikhumba ngebhandeshi, bese ubiza i-oncology.
2. Inaliti ye-Huber ihlehlisa kancane iphuma ku-septum ibe emafutheni angaphansi kwesikhumba (I-Extravasation): Uma ithiphu yenaliti iphuma ku-septum yenjoloba ngamamilimitha angu-3 (0.12 amayintshi) kuyilapho ihlezi ngaphansi kwesikhumba, izidakamizwa ezinobuthi zimpompa ngqo emafutheni odonga lwesifuba.
3. Amafulegi abomvu: Ukuvutha, ukuhlaba, ubuhlungu obubuhlungu, ububomvu, noma ukuvuvukala ephaketheni lembobo ngesikhathi sokumnika, noma ukungabuyi kwegazi.
4. Isenzo esisheshayo: Misa iphampu bese ubamba umugqa ngokushesha. Ungenzi UNGAKHI ukukhipha inaliti ye-Huber; abahlengikazi basesibhedlela basebenzisa inaliti ukuze bafune uketshezi lwe-chemotherapy oluvalelekile futhi bajove ama-antidote athile (i-dexrazoxane ye-anthracyclines, i-hyaluronidase ye-vinca alkaloids, noma i-sodium thiosulfate ye-cisplatin). Hamba uqonde emnyangweni wezimo eziphuthumayo.

Isebenza kanjani indlela kaDurant nendlela yokuyenza isinyathelo ngesinyathelo¶

Ngo-1947, udokotela wenhliziyo uThomas M. Durant wabonisa ukuthi kungani ukuma komzimba kunquma ukusinda noma ukufa phakathi nemizuzwana yokuphuma komoya we-venous.

I-buoyancy mechanics ngaphakathi kwenhliziyo efanele¶

Lapho isiguli silele phansi ngomhlane (supine) noma uhlezi uqondile, i-ventricular outflow tract (RVOT) kanye ne-valve ye-pulmonary artery kuhlala endaweni ephakeme kakhulu yangaphambili yegumbi lenhliziyo elingakwesokudla. Ngenxa yokuthi umoya ulula kunegazi eliwuketshezi, noma yiliphi ibhamuza lomoya elingena ku-vena cava ephakeme likhuphuka njengebhamuza ezingeni lombazi lingene emthanjeni wamaphaphu, liwuxhume ngokuphelele.

Uma ugingqa isiguli usifake kwesokunxele saso (left lateral decubitus) bese betshekisela ikhanda nesifuba phansi ngamadigri ayi-15 kuye kwangama-30 (Trendelenburg position), i-apex ne-lateral wall ye-atrium engakwesokudla kanye ne-ventricle engakwesokudla iba indawo ephakeme kakhulu enhliziyweni, kuyilapho i-pulmonary artery outflow izungeza iye phansi. Ibhamuza lomoya elinyakazayo lintanta liye phezulu lisuka ku-valve yamaphaphu bese liqoqa ngaphakathi kwendawo engaphezulu yenhliziyo engakwesokudla, livumele igazi eliwuketshezi ukuthi ligeleze ngaphansi kwebhamuza liye emaphashini.

Indlela yokubeka isiguli ekhaya¶

1. Shanela yonke imicamelo ngaphansi kwekhanda nasemahlombe esiguli ukuze umzimba waso ongaphezulu ulale kumatilasi noma phansi.
2. Gingqa isiguli ngokusikwele usifake sohlangothini lwesokunxele (ihlombe lesokunxele nenqulu yesokunxele ihlezi phezulu, ihlombe lesokudla libheke ophahleni).
3. Shelelisela imicamelo ewugqinsi emibili noma emithathu noma ingubo egoqiwe ngaphansi kwezinqulu, amathanga, nemilenze engezansi yesiguli ukuze ukhalo nemilenze kuhlale ngamasentimitha angu-15 kuya kwangu-30 (amayintshi ayisithupha kuya kwangu-12) ngaphezu kwenhliziyo nekhanda laso.
4. Gcina isiguli sikulesi simo kuze kube yilapho abezimo eziphuthumayo besilayisha kuhlaka lwe-ambulensi ngendlela efanayo.

Ama-lumens amahlule, i-syringe physics, kanye ne-catheter pinch-off syndrome¶

Abanakekeli basekhaya bavame ukugubha imigqa ye-PICC nama-catheter amaphakathi ne-sodium chloride eyinyumba engu-0.9% (usawoti ovamile). Ukuqonda imishini yokucindezela isirinji kuvimbela ukugqashuka kwe-catheter yomfutho ophezulu ngengozi ngaphakathi kwesifuba.

Kungani UNGALINGE usebenzise isirinji encane kuno-10 mL emugqeni omaphakathi¶

Kumakhenikha oketshezi, umfutho we-hydraulic okhiqizwa ngaphakathi kombhobho wesirinji ulingana namandla esithupha asetshenziswa ku-plunger ehlukaniswa ngendawo ephambanayo ye-plunger (Pressure = Force / Area).

• Isirinji yomphongolo engu- 10-milliliter (10-mL) ejwayelekile inobuso obubanzi be-plunger futhi ikhiqiza cishe amaphawundi angu-15 ukuya kwangu-25 iyintshi yesikwele (psi)* ngesikhathi sokushaywa ngesandla okuqinile, ngaphakathi kwemikhawulo yokuqhuma kwe-catheter.
• Isirinji 3-milliliter (3-mL) noma 1-milliliter (1-mL tuberculin) ine-diameter encane ye-plunger. Ukusunduza ngamandla afanayo esithupha kusirinji engu-3-mL noma engu-1-mL kukhiqiza 90 kuya phezu kuka-180 psi womfutho wehydraulic, ongaqhumisa udonga lwekhethetha elincanyana ngaphakathi komthambo bese kugunda ucezu lwepulasitiki enhliziyweni.

Ngaso sonke isikhathi sebenzisa amasirinji anobubanzi be-10-mL bomphongolo* ukuze ushaye noma udwebe kunoma yimuphi umugqa omaphakathi, i-PICC, noma imbobo, futhi ungalokothi uphoqe ukuguquguquka ngokumelene nokumelana. Hlola ukuthi izinsimbi zangaphandle zivuliwe yini, cela isiguli ukuthi siphakamise ingalo yaso noma siphendule ikhanda, futhi uma ukumelana kusasele, qinisa umugqa bese ubiza umhlengikazi wokufinyelela emithanjeni ukuze agxilise alteplase (Cathflo Activase).

I-Catheter "pinch-off syndrome" emigqeni ye-subclavian namachweba¶

Lapho i-port catheter noma umugqa ohubhe ingena emthanjeni we-subclavia ngokumaphakathi (lapho ithambo lekholomu liwela ubambo lokuqala), amathambo akhama i-catheter yepulasitiki noma nini lapho isiguli sehlisa ihlombe laso. Ukuguquguquka okuma endaweni (ukugeza kuphela uma ihlombe lihlehliselwe emuva), imisindo yokushwibeka, noma ubuhlungu be-infraclavicular ngesikhathi sokushaywa kuxwayisa ngokuphambana kwe-catheter okuseduze (I-Banga lesi-3 ukuncinza) kanye nokuqiniswa kwesiqephu enhliziyweni. Yeka ukusebenzisa imbobo ngokushesha futhi uthole i-X-ray yesifuba.

Amanye amafulegi abomvu womugqa omaphakathi: i-sepsis, i-thrombosis, ne-superior vena cava syndrome¶

Ngisho noma i-catheter emaphakathi iqinile ngokomzimba, izinkinga ezintathu zangaphakathi zidinga ukuhlolwa okuphuthumayo okuphuthumayo:

1. I-Central Line-Associated Bloodstream Infection (CLABSI): Ukuqhaqhazela okungazelelwe (ukuqina) kanye nokushisa komzimba emizuzwini eyi-15 ukuya kwengama-60 ngemva kokukhipha ulayini, ubomvu noma ukuklebhuka okubomvu eduze kwethaneli yesifuba engaphansi kwesikhumba, noma yimuphi umkhuhlane ongaphezu kuka-38.0 degrees Celsius (100.4 degrees Fahrenheit) (bona izifo ze-neutropenic kanye ne-chemotherapy futhi i-sepsis kanye nokushaqeka kwe-septic).
2. I-Catheter-Related Upper-Extremity Deep Deep Vein Thrombosis (DVT): Ukuvuvukala okuhlangene kwengalo, ihlombe, noma intamo, ubunzima obubuhlungu, imithambo yesifuba evelele, nokushintsha kombala kwesandla esimnyama. Ungasihlikihli ingalo evuvukele; funa ukuhlolwa okuphuthumayo kwe-ultrasound.
3. I-Catheter-Induced Superior Vena Cava (SVC) Syndrome: I-thrombosis ephelele ezungeze ichopho le-catheter ku-superior vena cava kubangela ukukhukhumala, ubuso nentamo ebomvu-nsomi evuvukele, amajwabu amehlo avuvukele, izwi elihoshozayo, kanye ne-dyspnea. Xhumana superior vena cava syndrome kanye nezimo eziphuthumayo oncologic.

Izinombolo zezimo eziphuthumayo zesifunda kanye nezinqubomgomo ze-ejensi¶

Uma ubiza ukuthunyelwa kwe-ambulensi yezimo eziphuthumayo ukuze uthole i-catheter ye-venous eqhekekile, evulekile, noma ekhishiwe, cela Ithimba Losizo Oluthuthukile Lokuphila (ALS) futhi ubazise ngokushesha uma isiguli sinokuphefumula, ubuhlungu besifuba, noma ukwazi okushintshile.

• I-United States ne-Canada: Shayela u-911*. I-Infusion Nurses Society (INS) I-Infusion Therapy Standards of Practice kanye ne-Centers for Disease Control and Prevention (CDC) igunyaza ukubamba ngokushesha okuseduze, ukubekwa kwe-left-lateral Trendelenburg (Durant) endaweni okusoleka ukuthi i-venous air embolism, kanye nendwangu ye-petroleum-jelly ye-petroleum-jelly eqinile emoyeni igcinwe kulayini ophakathi nendawo amahora angu-724.
• E-United Kingdom: Shayela u-999* ukuze uthole i-ambulensi yezimo eziphuthumayo (noma 111 ukuze uthole usizo lwabahlengikazi besifunda abangaphuthumi uma ulayini uboshelwe ngokuphephile ngaphandle kokuchayeka emoyeni). I-NHS England kanye ne-NICE zihlukanisa i-venous air embolism kusukela kumadivayisi okufinyelela e-venous amaphakathi njenge-Never Event edinga ukuvalwa kwe-occlusive ngokushesha, ukuma kwe-Durant, kanye ne-100% komoya-mpilo egeleza phezulu.
• I-European Union: Shayela 112. Imihlahlandlela ye-ESPEN kanye ne-European Resuscitation Council (ERC) iqondisa ukugoqa i-catheter ngokushesha, ukuma kwekhanda elibheke phansi kwesobunxele, i-oksijini egeleza kakhulu ukuze kusheshiswe ukukhishwa kwe-nitrogen, kanye nokuthutha okuphuthumayo.
• I-Australia ne-New Zealand: Shayela u-000* e-Australia noma 111 eNew Zealand. Imihlahlandlela ye-ANZCOR yeKhomishini Yezokuphepha Nekhwalithi Yezempilo kanye ne-ANZCOR iqondisa ukubopha ngokushesha okuseduze nesici kanye nezingubo ezingangeni komoya phezu kwanoma iliphi ipheshana elimaphakathi elichithiwe.
• I-India ne-Asia-Pacific: Shayela u-112* e-India, 995 e-Singapore, 119 e-Japan naseNingizimu Korea, noma 999 e-Malaysia nase-Hong Kong. Kwamanye amazwe, bheka inkomba yethu ye- izinombolo eziphuthumayo zamazwe ngamazwe.

Imibuzo evame ukubuzwa¶

Kungani ungakwazi ukubeka i-gauze eyomile evamile noma i-Band-Aid phezu komgodi lapho intamo noma umugqa omaphakathi wesifuba uphuma?¶

Lapho i-catheter ye-venous emaphakathi ihlala kumthambo wangaphakathi we-jugular, subclavian, noma wesifazane isikhathi esingaphezu kwamahora angu-48, umzimba wenza umhubhe we-fibrous ongenalutho osuka esikhumbeni uqonde ngqo emithanjeni enkulu emaphakathi. Ngenxa yokuthi imithambo yesifuba emaphakathi idala ukumunca okungekuhle ngaso sonke isikhathi lapho umuntu ehogela, umoya wegumbi ushaya ikhwelo phakathi kwendwangu kakotini enezimbotshana yephedi eyomile ye-gauze wehle kulowomhubhe uye enhliziyweni. Kufanele ugcobe i-gauze ngejeli ye-petroleum eyinyumba (Vaseline) noma amafutha okubulala ama-antibiotic bese uvala imiphetho emine ngefilimu yepulasitiki ebamba umoya noma itheyiphu ukuze kungene umoya oqandayo.

Ingabe ibhamuza lomoya elincane elilingana nebhamuza le-champagne kushubhu lami le-IV libangela ukufa komoya okufayo?¶

Kubantu abadala abaningi abangenayo imbobo phakathi kwamagumbi enhliziyo yabo, amabhamuza amancane akala ingxenyana yemililitha enamathela ohlangothini lweshubhu lokumnika elijwayelekile le-IV ahlungwa ngokungenabungozi ngama-capillary amancane amaphaphu futhi akhishwe. Kodwa-ke, uma isiguli sine-patent foramen ovale (PFO) eyaziwayo noma i-congenital right-to-left heart shunt, ngisho namabhamuza amancane angawela aye ebuchosheni, futhi ihabhu lomugqa omaphakathi elingavaliwe noma eliqhekekile lidonsa umoya ongamakhulu wamamililitha ngemizuzwana, obulala ngokushesha kunoma ubani. Njalo cindezela noma yimuphi umugqa omaphakathi oqhekekile noma ovulekile ngokushesha.

Uyini umehluko phakathi kwe-Groshong catheter nolayini ojwayelekile we-Hickman noma we-PICC uma ikepisi liwa?¶

I-Groshong central catheter yenziwe ngethiphu evalekile, eyindilinga kanye nevalvu yokuhlukanisa ezwa ukucindezela ezwela ukucindezela eduze nesiphetho sayo esikude ngaphakathi kwe-vena cava; i-slit ihlala ivaliwe ngengcindezi ephakathi nendawo, ivuleleka ngaphandle ngesikhathi sokucindezela okuphozithivu, futhi ivuleke phakathi ngesikhathi sokufisa isirinji ye-negative-pressure. Nakuba le valve yangaphakathi inciphisa ingozi yokungena ngokuzenzekelayo komoya uma isivalo sangaphandle siwa, ivalvu isengakwazi ukumuncwa ivuleke ngokuhefuzela okujulile noma yehluleke ngokuhamba kwesikhathi. Kusamelwe uncinde futhi ubambe noma yimuphi umugqa we-Groshong oqhekekile noma ongavaliwe ngokushesha.

Ukuphefumula 100% komoyampilo kusiza kanjani ukuncibilikisa ibhamuza lomoya ngaphakathi kwegazi?¶

Umoya wegumbi lomkhathi wakhiwe cishe ngamaphesenti angama-78 e-nitrogen namaphesenti angama-21 oksijini. Ngenxa yokuthi i-nitrogen incibilika kabi kakhulu egazini, ibhamuza le-nitrogen elingaphakathi kwenhliziyo noma umthambo we-pulmonary lishwabana ngokwalo kancane kakhulu. Lapho abezimo eziphuthumayo noma odokotela bezimo eziphuthumayo benikeza umoya-mpilo omsulwa ongamaphesenti angu-100 ngemaski engaphefuli, izinga le-nitrogen emaphashini esiguli kanye negazi elizungezile lehla liye kuqanda, okudala ukugeleza kokusabalalisa okuphakeme okudonsa i-nitrogen ngokushesha ebhamuzeni lomoya elingaphakathi kwemithambo ukuze inciphe futhi incibilike ngokushesha okuphindwe kane.

Ingabe ulayini we-PICC ophukile noma i-catheter ye-Hickman ingalungiswa ngaphandle kokuhlinzwa?¶

Yebo, inqobo nje uma kusekhona okungenani amasentimitha angu-4 kuya kwangu-5 (amayintshi angu-1.5 kuya kwangu-2) eshubhu le-catheter langaphandle elingonakalisiwe elisele ngaphandle kwendawo yokuphuma esikhunjeni futhi ubophele umugqa ngokushesha ukuze uvimbele ukungcoliswa noma ukujiyisa. Ochwepheshe bokufinyelela emithanjeni yasesibhedlela kanye nama-radiologists angenelela baphatha izinto zokulungisa umkhiqizi eziyinyumba, ezilingana nosayizi ezibavumela ukuba banqamule umsila wangaphandle odabukile ngaphansi kwezimo eziyinyumba futhi babophe i-pigtail yangaphandle entsha sha kanye nehabhu ye-Luer-lock kwi-catheter ekhona ngemizuzu engu-15.

Imithombo neziqondiso ezisemthethweni¶

• Infusion Nurses Society (INS, United States): Infusion Therapy Standards of Practice, Edition 9 (2024) (Ukulawulwa kwenkinga yedivayisi yokufinyelela emthanjeni omaphakathi, imikhawulo yokucindezela kosayizi wesirinji, ukulungiswa kwe-catheter, nokuvimbela i-air embolism).
• Izikhungo Zokulawula Nokuvimbela Izifo (CDC, United States): Iziqondiso Zokuvinjelwa Kwezifo Ezihlobene Ne-Intravascular Catheter kanye Nohlu Lokuhlola Lokuvinjelwa Kwezifo Ezihlobene Nomzila Wegazi Ezihlangene (CLABSI).
• Isevisi Yezempilo Kazwelonke (NHS England) kanye Nesikhungo Sikazwelonke Sezempilo Nokunakekelwa Okuvelele (NICE, United Kingdom): Inqubomgomo Nohlaka Lwezehlakalo Zezehlakalo: I-Intravascular Air Embolism kanye Nokufakwa Okuphephile Nokususwa Kwama-Central Venous Catheter.
• I-European Resuscitation Council (ERC) & American Heart Association (AHA): Iziqondiso Zokuvuselela I-Cardiopulmonary kanye Nokunakekelwa Okuphuthumayo Kwenhliziyo: Ukuboshwa Kwenhliziyo Ezimweni Ezikhethekile (Vascular Air Embolism, Durant Positioning, kanye ne-Hyperbaric Oxygen Therapy).
• UMcCarthy CJ et al. (I-Journal of Clinical Medicine / New England Journal of Medicine): I-Air Embolism: Amathiphu Awusizo Okuvimbela Nokwelashwa (Ama-gradient e-sub-atmospheric central venous pressure, isikhiya somoya sokuphuma kwesokudla se-ventricular outflow, kanye nezinqubo zokugqoka ze-petroleum ezinezinhlangothi ezine).

Iziqondiso ezihlobene¶

• Ukufinyelela kwe-dialysis kanye ne-AV fistula ebeka impilo engozini yokopha kanye ne-dialysis hyperkalemia ephuthelwe
• I-Neutropenic fever, ukutheleleka nge-chemotherapy, kanye nezimo eziphuthumayo zezokwelapha ze-oncologic
• I-pulmonary embolism kanye ne-deep vein thrombosis (DVT)
• I-tension pneumothorax kanye nokumunca inxeba lesifuba usizo lokuqala
• Ukusetshenziswa kwe-CPR yabantu abadala kanye ne-AED