PICC护理维护ACL2要点.pptVIP

回顾 Site Maintenance ACL标准PICC并发症 谢谢！ * ALL CVC manufacturers recommend 10cc syringes Issues: Small dose meds – transfer technique Pharmacy only sends 3 or 5 cc syringes – educate New prefilled syringes have the barrel size of a 10cc syringe It is the barrel size that dictates the amount or pressure * Controversies exist in flush protocols * Describe the differences in symptoms of thrombotic and non-thrombotic occlusions * Describe the differences in symptoms of thrombotic and non-thrombotic occlusions * Three-way stopcock technique Using sterile technique attach a three-way stopcock to the catheter – 1 empty 10cc syringe, and one prefilled syringe (occlusion removal agent) Close stopcock to the medication syringe – aspirate firmly with the empty 10 cc syringe While holding the plunger of the 10cc syringe open the stopcock to the medication syringe closing it to the empty 10cc syringe this will allow the appropriate amount of medication to be pulled to the occlusion within the catheter Close the stopcock to the catheter and allow the medication to dwell the appointed length of time according to PP Open the catheter to the empty 10 cc syringe and aspirate, if the catheter is open – aspirate and discard the required amount of blood then flush vigorously with normal saline. Alternative for treatment of fibrin sheath. Fill the catheter (must know fill volume) with the appropriate agent, allow to dwell, aspirate and flush * Discuss patient scenarios and treatment * Refer to Clinical Reference Card * See Clinical Reference Card * See clinical reference card * * * * PICC导管的护理维护 影响导管置入后使用效果的主要因素 一 PICC维护 ACL标准 A– Assess 导管机能的评估 C—Clean 正确的冲管 L----Lock 正确的封管 PICC的导管固定和更换敷料 二 PICC并发症处理 判断 Assess导管机能的评估 输液速度降低 无法抽取回血 冲管封管困难 原因 导管机能下降的原因 导管堵塞 症状：给药时感觉有阻力、输注困难、无法冲管、无法抽到回血、输液速度减慢或停止。 原因：药物性 机械性 血液性 药物配伍禁忌，药物之间不相溶，未经盐水冲管就用肝素封管。 未正压封管至血液返流，采血后未彻底冲管。 脂肪乳剂沉淀引起管腔阻塞。 导管顶端贴到静脉壁，因病人体位导管打折。 静脉血管内膜损伤。 预防： 尽量减少穿刺时静脉损伤 采用正确的冲管封管技术 注意药物间配伍禁忌 输注脂肪