中心静脉置管（Central venous catheterization）.docVIP

中心静脉置管（Central venous catheterization） I. definition of CVP Central venous pressure is the pressure between the vena cava and the right atrium. It is an indicator of the preload of the right heart. The central venous pressure (Central, venous, pressure, CVP) was inserted into the central venous catheter from the vein, and the inferior vena cava was near the right atrium. The tube can be used for fluids and manometry. The central venous pressure should be measured at the midline of the fluid and between fourth and 0. The normal value is 6 to 12cmH2O. Two, indications and contraindications (I) CVP indications; 1, all kinds of severe shock, dehydration, blood loss and lack of capacity; 2 heart and lung dysfunction 3, cardiovascular surgery and other major and complex surgery; 4, a large number of blood transfusion and exchange transfusion therapy 5 、 long term intravenous infusion, administration and parenteral nutrition therapy (two) CVP contraindication; 1, thrombocytopenia or other serious disorders of coagulation mechanism to avoid the internal jugular and subclavian vein puncture, so as to avoid injury of artery in operation caused by big local hematoma; it is necessary to puncture, try from the external jugular vein puncture. 2, local skin infection should choose the location of the puncture; Three 、 central venous pressure catheterization: internal jugular vein (commonly used), external jugular vein (with coagulopathy), subclavian vein, femoral vein. (usually the upper vena cava is measured, and the inferior vena cava is measured accurately) Four, CVP purposes: Understand the comprehensive situation of effective blood volume, cardiac function and peripheral circulatory resistance. Identification of acute circulatory failure of unknown cause. To observe the dynamic changes of blood volume and the risk of circulatory overload when large amount of blood transfusion and fluid infusion are needed. For heavy risk patients, major surgery, and emergencies, as a means of