全新IABC穿刺流程.ppt

IABC操作的标准程序与注意事项 Arrow IAB 穿刺包 两种插入方法 经皮穿刺 有鞘方式 无鞘方式 外科手术 股动脉 经胸 经腋动脉 髂动脉 锁骨下动脉 穿刺处准备 Arrow IAB 穿刺包 穿刺进入股动脉 可以用或不用注射器 进导引钢丝 推送导引钢丝进入股动脉 注意事项一：推送导引钢丝到达主动脉弓 沿导丝在皮肤及筋膜做2mm 切口 这步操作可以在穿刺前做 用扩张器扩张 有鞘穿刺 何时最适合使用钢丝鞘？ 进 鞘 注意事项四：请事先剥下止血阀 注意事项五预先在体外确定插入导管的长度 从胸骨角到肚脐到穿刺点的“L”型的长度。 插入导管 IAB从头端沿导引钢丝进入 固定导引钢丝 推送IAB 进入血管鞘 IAB 推送到左锁骨下动脉下 2 cm 移除导引钢丝连接上高压连接管  从中央腔回抽3 – 5 cc 血 人工用3 - 5 cc肝素盐水冲; 然后连接到连续冲刷系统 插入止血阀 (无鞘方式) 如果穿刺处出血 : 按压穿刺处。 推送止血阀进入股动脉。 如果按压不能止血可能需要进行血管手术。 插入止血阀 (无鞘穿刺) 推送止血阀进入股动脉。 把保护套的袖套和血管鞘连接 反搏泵的准备 Collect pump and connections 检查氦气。 连接 ECG 血压信号到反搏泵 。 ECG 电极片连接到病人 打开反搏泵 连接压力传感器 氦气连接管 如果没有透视条件请拍摄胸片 移除单向阀氦气管连接到 IABP RediGuard? Stainless steel central lumen wrapped polyurethane ArmorGlide hydrophylic coating 6 sheath with or without sideport (2) .025 150cm guidewires 30cc 7Fr and 40cc 8Fr IAB Can be inserted sheathed or sheathless NarrowFlex? Nitinol central lumen Excellent kink resistance and pushability 6 introducer sheath and pre-mounted hemostasis device for sheathed or sheathless insertion .030 175cm guidewire (2) 30 and 40cc 8Fr Multi-sized (also called conventional or stainless steel) Stainless steel central lumen 30cc (8fr), 40cc (9fr), 50cc (10fr) Flexible, radiopaque tip Sheathed or sheathless with pre-mounted hemostasis device, Sheath is 6 .030 175cm guidewire (2) Precision volume console interface Ultra Series 8 Fr 30 cc and 40 cc Can be passed through an 8 Fr Sheath Braided stainless steel Central Lumen Central lumen accepts a .025 guidewire Surgical insertion was the first method used. Percutaneous began in the late 1970s, early 1980s. Surgical today is usually for long-term therapy (pre transplant), or for patient with severe atherosclerosis. Percutaneous Insertion 1. Prepare site palpate both arteries for strongest pulse prep and drape insertion site usually good idea to prep both groins, just in case Insertion Tray contains 2 guidewires pre-dilator dual taper dilator 18 g