中心静脉穿刺图解

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1、ICU深静脉插管技术详解——简单易懂，告别国内教科书分享首次分享者：ルヽ羔羊医生已被分享4232次评论(0)复制链接分享转载举报ICU深静脉插管技术详解——简单易懂，告别国内教科书来自美国旧金山加利福尼亚大学的培训资料，彻底告别国内不专业的文献以及教科书。深静脉插管主要适应症： .给予药物-很多药物（升压药、化疗药、全胃肠外营养等）因为具有刺激性，不适合经浅静脉导管给药，故需要经中心静脉导管给药。 .血液动力学检测-检测中心静脉压； .血浆过滤、血浆置换术、血液透析、持续静脉-静脉血液滤过。次要适应症： .浅静脉通路

2、困难； .容量复苏。绝对禁忌症:·Cellulitisovertheveinsite(mustpickalternativelocation)·PeripheralIVaccessisadequatefortheclinicalneedsofthepatient·Operatorinexperience(unlesssupervisedbyanexperiencedpractitioner)·Uncooperativeorcombativepatients·Infectionovercathetersite·Clot

3、intheselectedvein相对禁忌症：  部位选择：你的病人能够忍受相应的并发症吗？LocationAdvantagesDisadvantagesFemoralVeinFast,easy,highsuccessrateDoesnotinterferewithintubation0%riskofpneumothoraxHardtokeepthesitesterileNoCVPmonitoringPreventspatientmobilizationHigherratesofthrombosisthanSCVHi

4、gherratesoflineinfectionFemoralarterypuncturemorefrequentthanSCVInternalJugularEasytocontrolbleedingPneumothoraxislesscommonStraightshotintoSVCDifficulttoaccessifptbeingintubatedorwithtrachorhasalargeneckDressingshardtomaintainPoorlandmarksinobesepatientsCaroti

5、dpuncturemorefrequentthanSCVHigherratesofthrombosisthanSCVSubclavianVeinMostcomfortableforpatientBonylandmarksinobesityHigherriskforpneumothoraxCompressionofbleedingsitedifficultLongpassfromskintovein(considerinobesity)LowestriskofthrombosisLowestriskoflineinfe

6、ctionContraindicationsseriouslungdisease,coagulopathy  解剖： TheIJveintravelswiththecarotidartery;theveintypicallyliesanterolateraltothecarotidartery.Itrunsunderthemedialportionoftheupperpartofthesternocleidomastoidmuscleandtravelsundertheapexofthetriangleformedb

7、ythesternalandclavicularheadsofthesternocleidomastoidmuscleandtheclavicle. Thesubclavianveiniseasilyfoundinalmosteverypatient,andacatheterinthesubclavianveinismorecomfortableforthepatientthanoneplacedintheinternaljugularvein. Asthesubclavianveincrossesbehindthe

8、firstrib,itliesposteriortothemedialthirdoftheclavicle,andhasadiameterof1-2cm. Atthispoint,thesubclavianarteryliessuperiorandposteriortothevein. Asthesevesselscontinuelateral