培训课件--并发症处理.ppt

* 36 if a vessel is narrowed from previous therapy or disease - the flow will be slower if the patient is on vasoconstrictor drugs - the flow will be slower the smaller the vessel - the slower the flow if the vessel is filled with a catheter that is too large - the flow will be slower how does this apply to phlebits, infiltration and thrombosis? less flow through vessels means less hemodilution cardiac, renal respiratory patients utilize the smallest device - not the shortest - to obtain maximum hemodilution relate this information to vessel size and flow flow rates in the digital and metacarpal veins of the hand - 10 ml/min can you imagine the impact of infusing hypertonic solutions or drugs with extreme levels of pH through these veins have you seen it done? * Incidence of clinically detectable thomboses estimated at 5% sclerosis/stenosis increased risk of infectious complications post-thrombotic syndrome vascular perforation, infusate extravasation, cardiac tamponade pseudotumor cerebri pulmonary embolus loss of access, delay in treatment recatheterization * Any change in the functional ability of the device needs to be evaluated blood cannot be withdrawn and no other factors are present * * Controversy since Urokinase no longer available what do you use? Find some of my info on urokinase and tpa * Smallest gauge, not shortest catheter insertions: slow and gradual float in technique * To repair or to remove: length of time since catheter damage clinical situation setting - home vs. hospital management following catheter damage length of therapy remaining patient’s need for access other options Exchange:my personal practice only if the device cannot be repaired or patency restored and there are no other options * Migration of catheter in and out of exit site increases trauma to vessel, increases risk of phlebitis and sepsis Sutures: silk is best nylon does not tie well monofilament is preferred sutures may predispose patient to skin breakdown sutures ma