CTPICC临床应用(长沙).pptVIP

CT PICC 临床应用 协和医院血液病研究所 血液肿瘤患者治疗特点 病程长，疗程多，难治疗 药物复杂 ，配伍禁忌多，补液量大 危重症多 特殊药物多、时间要求严格 干细胞移植 CECT PICC 材质：硅胶、聚氨脂 管腔：单腔、双腔、三腔等 带瓣膜、前端开口 耐高压的CT PICC CT PICC优势 CT PICC流速比较 CT PICC在血液肿瘤患者中的应用 聚氨脂抗张力强，留置时间长 满足多种药物治疗需要 前端开口，方便抽血检验 管腔大，满足流速、时间要求 管腔光滑，冲管彻底 导管移位、感染、血栓并发症低 CT PICC在干细胞移植中的应用 移植患者病情复杂，反复变化快 用药多，量大，配伍禁忌多 24h输注药液 干细胞输注要求 导管保留时间要求 A-C-L导管维护最佳实践标准 A- Assess the function of the catheter 导管功能评估（抽回血） 导管穿刺期间 导管留置期间 C- Clear 冲管 L – Lock 封管 Blood Return is Mandatory!通过回血判断导管通畅是必须的! All catheters should yield a brisk blood return prior to infusion of each dose of medication. 所有的导管在输液前都会有一些回血 Lack of blood return means a non-functioning catheter 无回血意味着导管功能下降 Related to how or where the catheter was placed 与导管留置的过程和部位等因素相关 Catheter Lumen Occlusion导管腔内堵塞 Causes原因 Thrombotic 血栓性 Drug precipitate 药物沉淀 Mechanical 机械性 Proper flushing and locking catheters will either prevent or identify these problems正确冲封管能预防此类问题 Precipitate Causes药物沉淀因素 Contact between two or more incompatible drugs or fluids 两种或多种不相容药物/液体 Alteration in drug pH 药物PH值变化 Precipitate forms inside catheter lumen 管内沉淀形成 Lipid sludge from fat emulsion 脂肪乳沉积 Waxy coating on internal catheter walls 管壁内蜡状沉淀 Mechanical Causes机械性原因 Peripheral and Midline Catheters 外周/中长导管 Catheter kinking usually at or near puncture site 导管打折 Venous valve 静脉瓣 Venous spasm 静脉痉挛 Infusing cold fluid such as blood 输入较冷液体(输血) Empty fluid container causing change in infusion pressure 输液袋滴空后出现压力的变化 美国INS标准和CDC标准说什么？ Catheter Flushing导管冲封管 Standards and Guidelines标准和指南 INS Standard #56 INS标准第56条 If resistance is met or an absent blood aspirate noted, the nurse should take further steps to assess patency of the catheter prior to administration of medications and solutions. The catheter should not be forcibly flushed.给药和输液前，如果遇到阻力或者抽吸无回血，护士应进一步确认导管的通畅性。不应强行冲洗导管。 The nurse should aspirate the catheter for positive blood return to confirm patency prior to administration of medications and solutions. 给药和输液前，护士应抽回血以确认导管是否通畅。 A-C-L导管维护最佳实践