课件：中心静脉置管(全).ppt

液体泄漏的观察  当导管老化，折断或自静脉内脱出时，都可造成液体自导管的破损处或进皮点外漏。如发现上述情况，应立即更换导管。因导管一旦破裂，整个输液系统的严密性就遭到破坏，如不及时将导管拔除，容易造成微生物的侵入而导致导管败血症。 敷料及输液管的更换 穿刺部位的敷料应每天更换1~2次。更换敷料时要严格遵循无菌操作原则。如进皮点有炎症反应或感染继续发展时，则应拔除导管。 另外，有条件者应使用输液终端滤器，以阻止微生物的侵入，减少导管败血症的发生，延长导管留置时间。 为防止导管内血液凝固，输液完毕应用肝素液或生理盐水10ml注入导管内 深静脉导管感染的处理 中心静脉压的监测 中心静脉压（central venous pressure，CVP）是指血液流经右心房及上、下腔静脉胸腔段压力。 正常值为6cmH2O~12cmH2O。 中心静脉压的监测 中心静脉压的监测 我们不满足于仅仅获得一个数值 中心静脉压的监测 中心静脉压波形 中心静脉压的监测 CVP 波形反映的是压力的变化，而不是容量的变化 Mnemonic for the CVP wave “a” wave due to atrial contraction “c” wave due to tricuspid closure and ventricular contraction “v” wave due to venous filling of atrium 中心静脉压的监测 房颤（Atrial Fibrillation） 交界性心律（Junctional Rhythm） 三尖瓣返流（Tricuspid Regurgitation） 心包缩窄（Pericardial Constriction） 心脏压塞（Cardiac Tamponade） 临床应用 房 颤 a波消失，代之以f波 C波高耸 Junctional Rhythm Atrial contraction occurs during systole (when the tricuspid valve is closed) The blood has no place to go so the pressure goes up much more than usual, resulting in a large “a” wave Cannon “a” wave Also seen with A-V dissociation, ventricular pacing, etc. Tricuspid Regurgitation The right atrium gains volume during systole - so the “c” and “v” wave is much higher The right atrium “sees” right ventricular pressures and the pressure curve becomes “ventricularized” Tricuspid Stenosis Problem with atrial emptying and a barrier to ventricular filling on the right side of the heart Mean CVP is elevated “a” wave is usually prominent as it tries to overcome the barrier to emptying “y” descent muted as a result of decreased outflow from atrium to ventricle Pericardial Constriction Limited venous return to heart, elevated CVP, end-diastolic pressure equalization in all cardiac chambers Prominent “a” and “v” waves, steep “x” and “y” descents Characteristic M or W pattern, dip and plateau (square root sign) Cardiac Tamponade Changes in atrial and ventricular volumes are coupled, so total cardiac volume does not change when blood goes from atrium to ventricle CVP beco