中心静脉穿刺图解

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：. 浅静脉通路困难；. 容量复苏。

绝对禁忌症:∙Cellulitis over the vein site (must pick alternative location) ∙Peripheral IV access is adequate for the clinical needs of the patient∙Operator inexperience (unless supervised by an experienced practitioner)∙Uncooperative or combative patients∙Infection over catheter site∙Clot in the selected vein相对禁忌症：部位选择：你的病人能够忍受相应的并发症吗？解剖：The IJ vein travels with the carotid artery; the vein typically lies anterolateral to the carotid artery. It runs under the medial portion of the upper part of the sternocleidomastoid muscle and travels under the apex of the triangle formed by the sternal and clavicular heads of the sternocleidomastoid muscle and the clavicle.easily found in almostevery patient, and acatheter in thesubclavian vein is morecomfortable for thepatient than one placed inthe internal jugularvein.As the subclavian veincrosses behind the firstrib, it lies posterior tothe medial third of the clavicle, and has a diameter of 1-2 cm. At this point, the subclavian artery lies superior and posterior to the vein. As these vessels continue laterally, they both drop caudally to enter the axillary region. The right side is often preferred for line insertions as the dome of the pleura of the lung may extend above the first rib on the left, but rarely extends this far on the right. Insertion on the right also avoids the risk of damage to the thoracic duct on the left.ConsentAlways obtain consent prior to the procedure.Be sure to inform the patient of the reason for the procedure, the proposed benefits, its major risks and the potential management of these complications (including insertion of a chest tube, surgery or cardioversion). It is also best to walk the patient through the stepsof the procedure to minimize their anxiety.Step-by-Step Procedures GuideEquipmentBefore you begin, you should be familiar with the kit. One should gather all needed materials before starting the procedure. In addition to a central venous access kit, you will need the following supplies:∙Insertion Checklist∙Sterile gloves, gown, cap, mask with face fluid shield for each member of the insertion team∙Chloraprep (if extra desired, provided in the kit)∙Large sterile drape∙Lidocaine 1% (in the kit, but it doesn’t hurt to have some extra just in case)∙Tegaderm∙Central line kit (cordis, triple or quad lumen kit)Before starting, be sure all of your materials are within reach and familiarize yourself with the kit you will be using.* Bold items are IHI guidelines and have been proven to reduce central line infections.Complications1.Venous Hematoma2.Arterial Dilitation3.Hemothorax4.Bleeding - arterial puncutre or injury: approximately 3% with theinternal jugular approach5.Pneumothorax: approximately 3% with the subclavian approach6.Infection: Insertion site infection, thrombophlebitis,bacteremia, sepsis, cellulitis7.Embolization of clot, air, guidewire or catheter8.Arrhythmia9.Phlebitis or thrombosis of veins10.Pericardial tamponade11.Injury to neighboring nerves (phrenic, recurrent laryngeal)12.DeathEvaluator Checklist for safe central line placement - Click Here Preventing Complications of Central Venous Catheterization- Click Here∙Coagulopathy and thrombocytopenia (relative goal plateletsare >50k and INR >1.5, but linescan be placed if these goals are not reached depending on the case) ∙Injury or previous surgery to superior vena cava (e.g., superior vena cava syndrome)∙Complications that can belife threatening (i.e pneumothorax or bleed). Do not put asubclavian line in a patient with a coagulopathy or in patient with severe parenchymal lungdisease and respiratory failure with little respiratory reserve) ∙Coagulopathy and thrombocytopenia (relative goal plateletsare >50k and INR >1.5, but linescan be placed if these goals are not reached depending on the case) ∙Injury or previous surgery to superior vena cava (e.g., superior vena cava syndrome)∙Complications that can belife threatening (i.e pneumothorax or bleed). Do not put asubclavian line in a patient with a coagulopathy or in patient with severe parenchymal lungdisease and respiratory failure with little respiratory reserve)。