并发症处理.教程分析.ppt

CR-BSI导管相关性血流感染 * 预防 严格无菌操作 减少不必要的导管留置 减少不必要的接头操作 ? 2008 Lynn Hadaway Associates, Inc. All rights reserved 菌膜和导管相关血流感染 菌膜可以在任何有水系统形成，包括血管内导管 细菌的细胞有序的排列，并被自我保护的基质围绕 微生物有机的相互合作得以在宿主体内存活 外观看上去很粘滑 IHI对中心导管的一揽子要求 中心静脉导管一揽子要求（集束护理）是一系列基于循证研究得出的中心静脉操作指南。研究也发现，集中实施这一揽子策略中的每一项，结果明显好于单独实施其中的每一项。 ? 一揽子要求中的重要内容 手卫生 穿刺点最大化无菌屏障 洗必泰皮肤消毒 选择最佳导管穿刺点，成人应避免选择股静脉进行中心静脉置管 对输液管路的必要性进行每日评估，停止不必要的管路 Maximal Barrier Precautions for PICC InsertionPICC置管时应采用最大化无菌屏障 CR-BSI导管相关性血流感染 措施 通知主治医师 根据成因和导管类型进行处理 主要处理包括: 培养 抗生素 拔除导管或更换 * 并发症发展的相关因素 Copyright 2011 Clinmarked, LLC All Rights Reserved 静脉炎/ 血栓性静脉炎 外渗/ 漏液 穿刺失败 导管打折扭曲 栓塞，等等 患者因素 静脉条件 皮肤状态 一般状况 免疫状态 之前静疗病史 医务人员因素 学术水平 操作技巧 技术水平 产品使用 不能改进 可以改进 * Size of vein at insertion site may not reflect the actual size of the vein along its course – discuss cephalic vein implications Need to accommodate introducer Characteristics of the vein may be affected by previous episodes of infusion therapy, age factors, and other considerations we discussed in the core competency Patient Considerations Beyond the point of insertion focus on the following and their implications at insertion and the development of complications Size Pathway Valves Tip placement – review the advantage of tip placement in an area of laminar flow Therapy and fluid requirements Introduce the concept of gravity flow versus flow on a pump Hemodilution * * Nerves 4 major nerves pass through the antecubital fossa Clinical considerations Insert introducer slowly to minimize nerve damage Remove the introducer as soon as possible Stop the insertion if the patient experiences extreme pain or “shock” like discomfort * Arteries Radial and Ulnar join in the antecubital fossa to form the brachial artery ULNAR IS NOT ON DIAGRAM POINT OUT Brachial lies between biceps tendon and median nerve Clinical considerations Palpate for pulsation prior to venipuncture Assess blood return for color and Pulsatile flow If an artery is punctured – withdraw the introducer and apply direct pres