PICC常见并发症和处理.ppt

六．接触性皮炎 原因： 1.过敏体质，尤其皮肤容易过敏的病人 2.病人用药后增加了皮肤的敏感性 预防处理： 1.使用通透性强的透明贴膜或无纺敷料 2.在透明贴膜前使用无痛保护膜（3M） 七．导管脱出移位 原因： 1.固定不当 2.活动过度 3.胸腔压力改变 预防处理： 1.良好固定导管：胶布、免缝胶带 2.穿刺时尽量避免肘窝，选择贵要静脉 3.更换敷料时，切忌将导管带出体外，消毒液晾干再贴敷贴 4.体外导管须完全覆盖透明敷料下 5.L或U型固定导管末端 6.每天监测体外导管长度 7.健康宣教：嘱患者脱穿衣服动作轻柔，睡觉时避免抓挠，肘部关节避免剧烈运动，少做屈肘动作，保持敷贴干燥 八．感染 原因： 1.透明贴膜覆盖区域及导管被污染 2.导管自由进出体内 3.未能按要求更换贴膜、输液接头 预防处理： 1.严格执行无菌操作原则 2.按时更换无菌敷料 3.使用固定翼固定导管 4.体外导管须完全覆盖透明敷料下 5.做好院外护理的宣教 6.患者体温38℃时不做置管计划 7.通过血培养选用敏感的抗生素 8.必要时拔除导管并做细菌培养 Literature and anecdotal reports of 1 year effective dwell times文献报道PICC留置时间可能放置超过1年 A recommendation is not a Standard推荐并不是标准 Reinforce Maximum Sterile Barrier Precautions加强无菌操作 THE LINES OF FIRST CHOICE, NOT LAST RESORT in an effective early assessment program Again, overview, details to follow in class Speak to the talking points AHRQ (Agency for Healthcare Quality and Research) division of US Department of Heath and Human Services recommendation that PICC are a preferred alternative to traditional short-term CVC CDC (2002) “Lower rates of infection than non-tunneled CVCs” CDC (2002) “Use totally implantable access devices for patients who require long-term, intermittent vascular access. For patients requiring frequent or continuous access, a PICC or tunneled CVC is preferable (256,257). Category II “ THE LINES OF FIRST CHOICE, NOT LAST RESORT in an effective early assessment program Again, overview, details to follow in class Speak to the talking points AHRQ (Agency for Healthcare Quality and Research) division of US Department of Heath and Human Services recommendation that PICC are a preferred alternative to traditional short-term CVC CDC (2002) “Lower rates of infection than non-tunneled CVCs” CDC (2002) “Use totally implantable access devices for patients who require long-term, intermittent vascular access. For patients requiring frequent or continuous access, a PICC or tunneled CVC is preferable (256,257). Category II “ THE LINES OF FIRST CHOICE, NOT LAST RESORT in an effective early asse