2017經外周靜脉穿刺中心静脉置管术.ppt

PICC经外周静脉穿刺中心静脉置管 黎利媛;;PICC 的定义;一、静脉选择;（2）正中静脉PICC的次选。静脉粗、直，但个体差异较大，静脉瓣较多。理想情况下，肘正中静脉加入贵要静脉。形成最直接的途径，经腋静脉、锁骨下静脉、无名静脉、达上腔静脉。 ;;二、PICC置管的适应证;三、PICC的优点 ;;Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0. Copyright 2004-2011 Aspose Pty Ltd.; part5 目前开展现状（穿刺过程）; part5 目前开展现状（穿刺过程）;四、PICC置管的禁忌证;五 、操作步骤;;Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0. Copyright 2004-2011 Aspose Pty Ltd.;Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0. Copyright 2004-2011 Aspose Pty Ltd.;严格无菌操作;;;;Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0. Copyright 2004-2011 Aspose Pty Ltd.;Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0. Copyright 2004-2011 Aspose Pty Ltd.;Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0. Copyright 2004-2011 Aspose Pty Ltd.;Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0. Copyright 2004-2011 Aspose Pty Ltd.;;;六、护理要点;;;七、PICC导管的维护;评估;评估实例;评估实例;PICC维护操作流程;*;1-1.取得患者合作后，在穿刺肢体下铺治疗巾，用软尺测量肘窝上10CM处臂围，了解手臂有无肿胀的情况;1-2更换肝素帽后，A-C-L技术冲洗导管;1-4观察穿刺点，确认导管位置;1-5 75%酒精棉棒从中心向外周顺时针与逆时针方向交替清洁皮肤三遍，直径大于15cm.消毒时酒精棉棒距穿刺点直径1cm处去脂（酒精棉棒不能接触导管。;1-6碘伏棉棒以穿刺点为中心消毒皮肤及导管，消毒3次;1-7无菌胶布固定托盘;1-8C形固定;1-9以穿刺点为中心无张力地粘贴透明敷贴;1-10蝶形交叉固定圆盘与透明敷贴，在胶布上记录安置导管时间、更换敷贴时间、外露多少及签名;2-1皮肤保护剂擦拭思乐扣固定部位的皮肤;2-2思乐扣上箭头指向穿刺点摆放;2-3把延长管的缝合孔安装在支柱??，将两边锁扣扣住固定;2-4将思乐扣贴于皮肤;2-5透明敷料完全覆盖思乐扣，胶带交叉横向固定延长管;更换敷料;更换导管接头;冲管和封管;*;冲封管手法;肝素盐水的配制;导管拔除的指征及注意事项;导管拔除的指证及注意事项;导管拔除的指征及注意事项;*;*;八、PICC置管期间的常见并发症及护理常规;;;;九、健康教育;