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ID:6854086
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时间:2018-01-28
《icu深静脉插管技术详解美国旧金山加利福尼亚大学》由会员上传分享,免费在线阅读,更多相关内容在行业资料-天天文库。
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)·P
2、eripheralIVaccessisadequatefortheclinicalneedsofthepatient·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?LocationAdvantagesDisadvantagesFemor
3、alVeinFast,easy,highsuccessHardtokeepthesitesterileNoCVPrateDoesnotinterferewithintubation0%riskofpneumothoraxmonitoringPreventspatientmobilizationHigherratesofthrombosisthanSCVHigherratesoflineinfectionFemoralarterypuncturemorefrequentthanSCVInternalJugularEasytocontro
4、lbleedingPneumothoraxislesscommonStraightshotintoSVCDifficulttoaccessifptbeingintubatedorwithtrachorhasalargeneckDressingshardtomaintainPoorlandmarksinobesepatientsCarotidpuncturemorefrequentthanSCVHigherratesofthrombosisthanSCVSubclavianVeinMostcomfortableforpatientBon
5、ylandmarksinobesityHigherriskforpneumothoraxCompressionofbleedingsitedifficultLongpassfromskintovein(considerinobesity)LowestriskofthrombosisLowestriskoflineinfectionContraindicationsseriouslungdisease,coagulopathy 解剖: TheIJveintravelswiththecarotidartery;theveintypica
6、llyliesanterolateraltothecarotidartery.Itrunsunderthemedialportionoftheupperpartofthesternocleidomastoidmuscleandtravelsundertheapexofthetriangleformedbythesternalandclavicularheadsofthesternocleidomastoidmuscleandtheclavicle. Thesubclavianveiniseasilyfoundinalmostevery
7、patient,andacatheterinthesubclavianveinismorecomfortableforthepatientthanoneplacedintheinternaljugularvein. Asthesubclavianveincrossesbehindthefirstrib,itliesposteriortothemedialthirdoftheclavicle,andhasadiameterof1-2cm. Atthispoint,thesubclavianarteryliessuperiorandpos
8、teriortothevein. Asthesevesselscontinuelaterally,theybothdropcaudallytoentertheaxillaryregion. Therightsideiso
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