堵管原因分析及护理课件.ppt

脉冲与直冲比较 脉冲：产生正、负压形成涡流，可有力地将粘 在导管壁上的内容物冲洗干净 直推：水注只能在导管中心流动，无法冲洗导管壁，容易造成导管腔狭窄而堵塞导管 A-C-L冲管三步曲 A- Assess C- Clear L – 封管(在导管停止使用期间，防止血液进入导管) 负压方式使完全堵塞的导管再通（一） 脲激酶 20ml空注射器 保留20分钟 负压方式使完全堵塞的导管再通（二） 20ml生理盐水备用 回抽注射器活塞， 将导管中药物和 血液抽回，弃置 20ml生理盐水脉冲 负压方式使完全堵塞的导管再通（三） 目的：把由于使用而引发的潜在感染的危险降到最低 何时更换 每7天一次 可能发生损坏时 每次抽血后 不管什么原因取下肝素帽/正压接头后 更换肝素 帽/正压接头 更换肝素 帽/正压接头 打开包装，用生理盐水预充一下 把原来的接头去掉 连接新的接头 以脉冲方式用10ml生理盐水冲洗导管 牢固固定连接处 维护要点 脉冲冲管 正压封管 保证导管的通畅 导管评估 * Proper flushing techniques is imperative and one of the most critical factors in maintaining patency of devices catheter malposition - kinks, coils * What is your first intervention when a catheter is occluded? Visible sludge may be in the explanted device or in an external segment waxy buildup due to lipids drug or mineral precipitate Assessment verify tip placement observe for mechanical obstruction review therapies that have been infused attempt to aspirate/flush clinical assessment of patient choose appropriate intervention * Multi-lumen device for simultaneous infusion of incompatible therapies do you do periodic repeat x-rays? * When a drug precipitates, infuse a solution which will return the solution to it’s original pH and allow the precipitate to return to a soluble state Acid Drug Precipitate occlusion due to mineral/drug precipitate with a pH 5 volume is device specific dwell time - 20 min. may repeat x2 do not use in polyurethane catheters side effects: febrile reaction if infused rather than aspirated complications: fever, sepsis,phlebitis, catheter damage Alkaline Drug Precipitate 1 mEq/ml occlusion due to drug or mineral precipitate with a pH 7 dwell time - minutes ( 2-20 ) repeat if necessary side effects: no side effects noted in the literature * Most common cause of catheter malfunction catheter related thrombosis is a consideration when blood cannot be withdrawn even if no other factor is present increased intrathoracic pressure cause retrograde blood flow or catheter malposition * Pictoral example of typ