中心静脉导管常见问题的处理薛嵋.ppt

* Anxiety can be a factor here as wel Thrombotic: fibirn sheath, endothelial thrombus Catheter malposition: coiling, knottingl * * * 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coils * Most common cause of catheter malfunction catheter related thrombosis is a consideration when blood cannot be withdrawn even if no other factor is present increased intrathoracic pressure cause retrograde blood flow or catheter malposition * Turbulent flush and positive pressure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 does not react with platelets injury results in immediate disruption of venous endothelium producing vasoconstriction, inflammation and sloughing with exposure of the subendothelium subendothelium possesses a strong procoagulant and immediately releases potent coag. Factors to activate and recruit platelets platelet aggregation occurs with the formation of a heomstatic plug venous constriction results in exacerbation of venous stasis and prolongs exposure of blood products to thrombogenic subendothelium continued mechanical or chemical injury produces further inflammatory changes, venous constriction and thrombus formation * 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treatment recatheterization * Any change in the functional ability of the device needs to be evaluated blood cannot be withdrawn and no other factors are present * Smallest gauge, not shortest catheter insertions: slow and gradual float in technique * Controversy since Urokinase no longer available what do you