PICC超声穿刺范例.ppt

* * * * * * * What better weapon do you need? * Depth marker * * Characteristic “Mickey Mouse” appearance of brachial artery flanked by 2 brachial veins, uncompressed * Modified Seldinger Technique: Venipuncture is made with a small gauge steel needle or catheter. The introducer needle is removed and a guidewire is advanced through the needle or catheter into the vein. The needle is removed, and a dilator/introducer sheath is advanced over the wire, through the skin and into the vein.. The dilator and wire are removed and the catheter is advanced, stabilized, and the sheath removed and torn away. Advantages: It requires small gauge venipuncture A variety of gauge sizes are available The risk of catheter damage is reduced It entails a familiar initial insertion procedure when using an intact IV cannula Potentially increased access success rate Disadvantages: The need for a “skin nick” Insertion costs more than other methods Potential catheter damage and embolus if inadvertently drawn back through needle (applies to steel needle usage only) * * * If necessary, a small incision may be made adjacent to the guidewire to facilitate insertion of the sheath and dilator. * If necessary, a small incision may be made adjacent to the guidewire to facilitate insertion of the sheath and dilator. * If necessary, a small incision may be made adjacent to the guidewire to facilitate insertion of the sheath and dilator. * Advance the small sheath and dilator together as a unit over the guidewire using a slight rotational motion. * Advance the small sheath and dilator together as a unit over the guidewire using a slight rotational motion. * Advance the small sheath and dilator together as a unit over the guidewire using a slight rotational motion. * Advance the small sheath and dilator together as a unit over the guidewire using a slight rotational motion. * * * Continue to advance the catheter, for central placement, when the tip has advanced to the shoulder, have