icu深静脉插管技术详解美国旧金山加利福尼亚大学

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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： .浅静脉通路困难； .容量复苏。绝对禁忌症:·Cellulitisovertheveinsite(mustpickalternativelocation)·Per

2、ipheralIVaccessisadequatefortheclinicalneedsofthepatient·Operatorinexperience(unlesssupervisedbyanexperiencedpractitioner)·Uncooperativeorcombativepatients·Infectionovercathetersite·Clotintheselectedvein相对禁忌症：  部位选择：你的病人能够忍受相应的并发症吗？LocationAdvantagesDisadvantagesFemoralVe

3、inFast,easy,highsuccessHardtokeepthesitesterileNoCVPrateDoesnotinterferewithintubation0%riskofpneumothoraxmonitoringPreventspatientmobilizationHigherratesofthrombosisthanSCVHigherratesoflineinfectionFemoralarterypuncturemorefrequentthanSCVInternalJugularEasytocontrolbleed

4、ingPneumothoraxislesscommonStraightshotintoSVCDifficulttoaccessifptbeingintubatedorwithtrachorhasalargeneckDressingshardtomaintainPoorlandmarksinobesepatientsCarotidpuncturemorefrequentthanSCVHigherratesofthrombosisthanSCVSubclavianVeinMostcomfortableforpatientBonylandmar

5、ksinobesityHigherriskforpneumothoraxCompressionofbleedingsitedifficultLongpassfromskintovein(considerinobesity)LowestriskofthrombosisLowestriskoflineinfectionContraindicationsseriouslungdisease,coagulopathy  解剖： TheIJveintravelswiththecarotidartery;theveintypicallyliesant

6、erolateraltothecarotidartery.Itrunsunderthemedialportionoftheupperpartofthesternocleidomastoidmuscleandtravelsundertheapexofthetriangleformedbythesternalandclavicularheadsofthesternocleidomastoidmuscleandtheclavicle. Thesubclavianveiniseasilyfoundinalmosteverypatient,anda

7、catheterinthesubclavianveinismorecomfortableforthepatientthanoneplacedintheinternaljugularvein. Asthesubclavianveincrossesbehindthefirstrib,itliesposteriortothemedialthirdoftheclavicle,andhasadiameterof1-2cm. Atthispoint,thesubclavianarteryliessuperiorandposteriortothevei

8、n. Asthesevesselscontinuelaterally,theybothdropcaudallytoentertheaxillaryregion. Therightsideiso