I-Central venous catheter (CVC): iyini, yenzelwe ini futhi iyanakekelwa

-Delile

• Yenzelwe ini
• Kwenziwa kanjani
• Izinhlobo zokufinyelela okuphakathi kwe-venous
• Ukunakekelwa okujwayelekile kwe-catheter emaphakathi
• Izinkinga ezingenzeka

I-central venous catheterization, eyaziwa nangokuthi i-CVC, inqubo yokwelashwa eyenziwa ukwelashwa kwezinye iziguli, ikakhulukazi ezimweni ezinjengesidingo sokufakwa kokuningi koketshezi egazini, ukusetshenziswa kokuthola i-venous isikhathi eside, ukuqapha okungcono kwe-hemodynamic, kanye nokufakwa kwegazi noma umsoco we-parenteral, ngokwesibonelo, okudinga ukufinyelela okuphephile emithanjeni yegazi.

I-catheter ye-venous emaphakathi yinde futhi ibanzi kunama-catheters ajwayelekile e-peripheral asetshenziswa emithanjeni yezindawo ezifana nengalo, futhi yakhelwe ukwethulwa emithanjeni emikhulu yomzimba, njenge-subclavia, etholakala ku-thorax, i-jugular, etholakala entanyeni, noma kwesifazane, etholakala esifundeni se-inguinal.

Ngokuvamile, le nqubo ivame ukukhonjiswa ezindaweni zokunakekelwa okunamandla (ICU) noma ezimeni eziphuthumayo, futhi kufanele yenziwe ngudokotela, ngokulandela inqubo edinga izinto zokuhlinza nemishini oyinyumba. Ngemuva kokubekwa, kuyadingeka ukuthi unakekelwe ukuze unakekele futhi uvikele izinkinga ezifana nokutheleleka noma ukopha.

Yenzelwe ini

Izinkomba eziyinhloko zokufinyelela kwe-venous central zifaka:

• Lungiselela ukugcinwa kokungena kwe-venous isikhathi eside, ugweme ukubhoboza okuningi;
• Faka inqwaba yeziphuzo noma imishanguzo, engasekelwa yimigwaqo ejwayelekile yemiphetho;
• Lawula imishanguzo engadala ukucasuka lapho ukuqhuma okwengeziwe kwenzeka endaweni engena emithanjeni, njenge-vasopressors noma izixazululo ze-hypertonic ze-sodium ne-calcium bicarbonate;
• Vumela ukuqapha kwe-hemodynamic, njengokulinganisa ingcindezi emaphakathi ye-venous nokuqoqa amasampula egazi;
• Ukwenza i-hemodialysis, ezimweni eziphuthumayo noma lapho i-arteriovenous fistula ingakazimisi. Qonda ukuthi i-hemodialysis yenziwa kanjani nokuthi ikhonjiswa nini;
• Fakela igazi noma izingxenye zegazi;
• Lungiselela ukwelashwa ngamakhemikhali;
• Vumela ukondla kwabazali lapho ukondla ngomgudu wamathumbu akunakwenzeka.

Ukusebenza kwe-venous access central kufanele kuthathe izinyathelo ezithile zokunciphisa ubungozi bezinkinga. Ngakho-ke, le nqubo ayikhonjisiwe ezimweni zokutheleleka noma ukukhubazeka kwesayithi okufanele kubhobozwe, ushintsho ekunqandeni igazi noma lapho kunezingozi ezinkulu zokopha, ngaphandle kwezimo ezikhethekile ezikhonjiswe ngudokotela.

Kwenziwa kanjani

Ngokusebenza kwe-catheterization emaphakathi ye-venous, kuyadingeka ukubeka umuntu, ovame ukulala ku-stretcher. Ngemuva kwalokho, udokotela uzokhomba indawo eqondile yokubhoboza, i-asepsis yesifunda kanye nesikhumba esizungezile okwenziwayo, kususwe ukugxila kokutheleleka.

Ngaphezu kwalokho, udokotela nethimba kumele ngabe bageza izandla ngokucophelela futhi bahlinzekwa ngemishini enciphisa ubungozi bokutheleleka, njengamagilavu ​​oyinyumba, imaski, isigqoko, ingubo yokuhlinza kanye nezindwangu eziyinyumba.

Inqubo esetshenziswa kakhulu ukwenza i-catheterization emaphakathi ye-venous ibizwa ngokuthi yi-Seldinger technique. Ukuze uyenze, ngaphezu kwemishini yokuvikela, isikhwama nemishini ye-serum, i-anesthetic, i-gauze oyinyumba, i-scalpel kanye ne-central catheter kit, equkethe inaliti, i-guidewire, i-dilator ne-catheter efakwa emthanjeni, kufanele isetshenziswe njengezinto zokwakha. inaliti nentambo yokunamathisela i-catheter esikhunjeni.

Njengamanje, abanye odokotela bakhetha ukusebenzisa i-ultrasound ukuqondisa ukufakwa kwe-catheter nokunciphisa ubungozi bezinkinga.

Kubalulekile futhi ukukhumbula ukuthi, njengoba kuyinqubo yokuhlasela, kuyadingeka ukwazisa nokuthola imvume yesiguli ngokusebenza kwaso, ngaphandle kwalapho kunezimo eziphuthumayo noma ingozi yokufa eseduze, lapho ukuxhumana kungenakwenzeka.

Izinhlobo zokufinyelela okuphakathi kwe-venous

I-catheterization esezingeni eliphakathi nendawo ingenziwa ngezindlela ezi-3, ngokusho komthambo okhethwe ukubhoboza:

• Umthambo we-Subclavia;
• Umthambo wangaphakathi wejugular;
• Umthambo wabesifazane.

Ukukhethwa kohlobo lokufinyelela ngemithambo yegazi kwenziwa ngudokotela ngokusho kwesipiliyoni, okuthandayo kanye nezimpawu zesiguli, konke okusebenzayo futhi okunenzuzo nobubi. Isibonelo, ezigulini eziye zaba nokuhlukumezeka kwe-thoracic noma lapho kudingeka khona ukuvuselelwa kwe-cardiopulmonary, ukubhoboza umthambo wesifazane kuboniswe kakhulu, ngenkathi ukufinyelela ngemithambo ye-jugular noma ye-subclavia kunamathuba amancane okuthi kungcoliswe.

Bheka ezinye izinhlobo ze-catheterization ezingadingeka.

Ukunakekelwa okujwayelekile kwe-catheter emaphakathi

Imvamisa, i-catheter ye-venous emaphakathi isetshenziswa kuphela endaweni yesibhedlela, njengoba idinga ukunakekelwa kahle, ukuvimbela ukungena kwama-microorganisms ku-copro, okungadala ukutheleleka okukhulu nokubeka impilo engcupheni.

Ngakho-ke, i-CVC ivame ukunakekelwa ngumhlengikazi, okumele abe nokunakekelwa okujwayelekile okufana nalokhu:

• Ukwenza i- ukugeleza kwepayipi elinosawoti, ukuyivimbela ingagcwali ngamahlule, isibonelo;
• Shintsha ukugqoka kwangaphandle, ikakhulukazi uma unanoma yiluphi uhlobo lwemfihlo;

Ngesikhathi sanoma yikuphi ukunakekelwa kwe-catheter ye-venous emaphakathi, kubalulekile ukuthi uhlale ugeza izandla zakho kuqala futhi usebenzise inqubo oyinyumba, okungukuthi, kufanele usebenzise i-CVC usebenzisa insimu oyinyumba, kanye namagilavu ​​oyinyumba, noma ngabe kungukuphatha nje uhlobo oluthile lomuthi.

Izinkinga ezingenzeka

Ukutholakala kwemithambo emaphakathi kungadala ezinye izinkinga njengokuphuma kwegazi, ukulimaza, ukutheleleka, ukuqhuma kwamaphaphu, i-arrhythmia noma i-venous thrombosis.