PICC完整培训内容.pptVIP

* Improper position of introducer: insert at same angle of venous pathway Improper positioning: supine, 90 degree angle, chin to shoulder Measurement: know your anatomy, which vein you are cannulating If in doubt, measure for longest course Existing intrathoracic devices:if inserting a PICC with another intravascular device in situ, use contralateral side if at all possible Chest Mass: lymphoma e.g. unable to advance, re-position, +++ flushing, x-ray * E.g. ICU patient - easy insertion, huge vein, basilic, good blood return, removed guidewire, applied dressing noticed wire all curled up!!! * Catheter insertion with existing intrthoracic intravascular device: may increase incidence of insertion-related malposition consider potential for catheter entanglement utilizing an ipsilateral or contralateral approach special considerations for radiographic confirmation -differentiating catheters may be difficult repeat x-ray if either device is discontinued consider image guided placement accurate pre-insertion measurement * Slow advancement!!! Flushing - have another clinician flush example of snow plow going before you relaxation - example - 15 yr. male with terminal ca * * * * Intact endothelium is completely non-thrombogenic and does not react with platelets injury results in immediate disruption of venous endothelium producing vasoconstriction, inflammation and sloughing with exposure of the subendothelium subendothelium possesses a strong procoagulant and immediately releases potent coag. Factors to activate and recruit platelets platelet aggregation occurs with the formation of a heomstatic plug venous constriction results in exacerbation of venous stasis and prolongs exposure of blood products to thrombogenic subendothelium continued mechanical or chemical injury produces further inflammatory changes, venous constriction and thrombus formation * Incidence of clinically detectable thomboses estimated at 5% sclerosis/stenosis increased risk of infectious co