PICC使用中的问题及处理-1-14.ppt

六.静脉血栓 治疗 拔除导管(慎重） 抗凝治疗 溶栓治疗 介入取栓 六.静脉血栓 预防 根据血管粗细，选择能满足治疗需要的最细规格的导管 选择由不易生成血栓的材质做成的导管 穿刺过程中尽量减少对血管内膜的损伤 对易于生成血栓的病人考虑预防性的应用抗凝剂和溶栓治疗 保持导管末端在适当位置 七.纤维蛋白鞘 置管后几小时内就可能出现一种不能溶解的蛋白质紧紧贴附于导管表面的现象 漂浮在导管末端的尾状的纤维蛋白可致回抽困难 纤维蛋白鞘可完全包住导管而致所输注液体回流液体沿导管漏出或输液时疼痛 纤维蛋白鞘可成为细菌生长的培养基而引发感染 七.纤维蛋白鞘 处理 溶栓 使用捕获导管 更换导管 * * Catheter fibrin or thrombus may serve as a nidus for microbial colonization of intravascular devices and catheter thrombosis appears to be one of the most important factors associated with infection of long term catheters immediately following catheter insertion the catheter surface is coated with plasma and proteins ( fibrin, fibronectin) this is referred to as the host biofilm some microorganisms have high adherence to this host biofilm and produce a biofilm of their own to further enhance their adherence (extracellular slime) this extracellular slime permits the exchange of nutrients but protects the bacteria from phafocytic cells, antibodies and antibiotics although antimicrobial therapy may eradicate disseminated pathogens, the organsims within the bilfim are protected and may cause re-infection monitoring of long term devices as in the AA program will alert the clinician to re-occurences * * Anxiety can be a factor here as wel Thrombotic: fibirn sheath, endothelial thrombus Catheter malposition: coiling, knottingl * Tincture of Time * * Proper flushing techniques is imperative and one of the most critical factors in maintaining patency of devices catheter malposition - kinks, coils * Most common cause of catheter malfunction catheter related thrombosis is a consideration when blood cannot be withdrawn even if no other factor is present increased intrathoracic pressure cause retrograde blood flow or catheter malposition * Turbulent flush and positive pressure flushing are critical factors in maintaining device patency prophylactic anticoagulant (coumadin) and/or thrombolytic agents for high risk patients * Intact endothelium is completely non-thrombogenic and doe