ICU深静脉插管技术详解..docVIP

ICU深静脉插管技术详解 来自美国旧金山加利福尼亚大学的培训资料，彻底告别国内不专业的文献以及教科书。 深静脉插管主要适应症： 1. 给予药物-很多药物（升压药、化疗药、全胃肠外营养等）因为具有刺激性，不适合经浅静脉导管给药，故需要经中心静脉导管给药。 2.血液动力学检测-检测中心静脉压； 3.血浆过滤、血浆置换术、血液透析、持续静脉-静脉血液滤过。 次要适应症： 4.浅静脉通路困难； 5.容量复苏。 绝对禁忌症: Cellulitis over the vein site (must pick alternative location) Peripheral IV access is adequate for the clinical needs of the patient Operator inexperience (unless supervised by an experienced practitioner) Uncooperative or combative patients Infection over catheter site Clot in the selected vein 相对禁忌症： ? ? 部位选择： 你的病人能够忍受相应的并发症吗？ Location Advantages Disadvantages Femoral Vein Fast, easy, highsuccess rateDoes not interfere withintubation 0% risk of pneumothorax Hard to keep the site sterileNo CVP monitoringPrevents patient mobilizationHigher rates of thrombosis than SCVHigher rates of line infectionFemoral artery puncture more frequent than SCV Internal Jugular Easy to control bleedingPneumothorax is less commonStraight shot into SVC Difficult to access if pt being intubated or withtrach or has a large neckDressings hard to maintainPoor landmarks in obese patientsCarotid puncture more frequent than SCVHigher rates of thrombosis than SCV Subclavian Vein Most comfortable for patientBony landmarks in obesity Higher risk for pneumothoraxCompression of bleeding site difficultLong pass from skin to vein (consider in obesity)Lowest risk of thrombosisLowest risk of line infectionContraindications serious lung disease, coagulopathy ? ?解剖： ? The IJ vein travels with the carotid artery; the vein typically lies anterolateral to the carotid artery. It runs under the medial portion of the upper part of the sternocleidomastoid muscle and travels under the apex of the triangle formed by the sternal and clavicular heads of the sternocleidomastoid muscle and the clavicle. ? The subclavian vein is easily found in almost every patient, and a catheter in the subclavian vein is more comfortable for the patient than one placed in the internal jugula