Cov ntshav pov tseg uas tsis muaj kab mobcatheter ntxuav ntshavthiab cov khoom siv pov tseg kom huv sicatheter ntxuav ntshavCov qauv kev ua haujlwm ntawm cov khoom thiab cov khoom sib xyaw ua ke cov khoom no muaj lub hau mos, lub rooj zaum txuas, lub raj txuas ntxiv thiab lub qhov (socket) cone; Lub catheter yog ua los ntawm polyurethane kho mob thiab polycarbonate. Nws yog ib qho catheter, ob chav catheter thiab peb qhov catheter. Cov khoom no yog siv rau kev ntxuav ntshav thiab kev txhaj tshuaj. Cov lus qhia tshwj xeeb qauv ob chav catheter, peb qhov catheter
Qhov av duct nrog lub tsho dacron
Nrog rau kev laus zuj zus ntawm lub zej zog, ntshav siab, ntshav qab zib, kab mob plawv (CHD) nrog rau cov neeg mob uas tsis ua haujlwm raum tau nce ntxiv, cov hlab ntsha tsis zoo, qhov tshwm sim ntawm cov teeb meem hauv lub cev kuj nce ntxiv, ua rau tus neeg mob lub neej thiab lub neej zoo dua qub. Yog li ntawd, siv txoj siv polyester tunnel catheter lossis catheter tau ntev heev, thiab tau siv dav hauv ntiaj teb, nws qhov zoo yog: Lub catheter muaj kev sib raug zoo zoo, thiab lub catheter tuaj yeem ruaj khov nrog daim tawv nqaij. Nws lub tes tsho polyester tuaj yeem tsim cov kab mob kaw hauv qhov av subcutaneous, txo qhov tshwm sim ntawm kev kis kab mob thiab ua rau lub sijhawm siv ntev dua.
Kev siv thiab kev saib xyuas cov catheter hemodialysis
1. Kev saib xyuas thiab kev ntsuam xyuas cov catheter
1. Qhov chaw tawm ntawm daim tawv nqaij catheter
Ua ntej thiab tom qab txhua zaus siv, yuav tsum tau soj ntsuam seb qhov tawm ntawm daim tawv nqaij ntawm qhov chaw ntxig raj puas liab, muaj kua tawm, mob, los ntshav thiab muaj cov kua tawm, thiab lwm yam. Yog tias nws yog ib lub catheter ib ntus, xyuas seb rab koob txuas puas tau txuas. Yog tias nws yog ib lub catheter ntev, saib seb CAFF puas raug rub lossis tawm los.
2. Sab nraud ntawm lub catheter
Txawm hais tias muaj kev tawg lossis tawg, qib ntawm qhov patency ntawm lumen, yog tias pom cov ntshav tsis txaus, nws yuav tsum tau tshaj tawm rau tus kws kho mob raws sijhawm, thiab qhov thrombus thiab fibrin sheath tsim hauv catheter yuav tsum tau txiav txim siab los ntawm ultrasound, imaging thiab lwm txoj hauv kev.
3. Cov cim qhia ntawm tus neeg mob
Txawm yog cov tsos mob thiab qib ntawm kev kub taub hau, mob khaub thuas, mob thiab lwm yam kev tsis xis nyob.
2. Kev sib txuas ua haujlwm txheej txheem
1. Kev Npaj
(1) Lub tshuab dialysis tau dhau qhov kev kuaj xyuas tus kheej, cov kav dej dialysis tau raug ntxuav ua ntej thiab nyob hauv lub xeev standby.
(2) Kev Npaj: lub laub kho mob lossis lub tais kho mob, cov khoom siv tua kab mob (iodophor lossis chlorhexidine), cov khoom siv huv (daim phuam kho mob, daim ntaub qhwv, koob txhaj tshuaj, hnab looj tes ntxuav, thiab lwm yam).
(3) Tus neeg mob yuav tsum tau muab tso rau hauv qhov chaw xis nyob, thiab tus neeg mob uas muaj lub caj dab intubation yuav tsum hnav lub npog ntsej muag kom pom qhov chaw intubation.
2. Txheej Txheem
(1) Qhib daim ntaub qhwv sab nraud ntawm lub catheter venous hauv nruab nrab.
(2) Hnav cov hnab looj tes.
(3) Qhib 1/4 sab ntawm daim phuam kho mob uas tsis muaj kab mob thiab muab tso rau hauv qab lub catheter ob-lumen ntawm cov leeg ntshav hauv nruab nrab.
(4) Siv cov ntsia hlau los ntxuav lub hau tiv thaiv catheter, lub qhov ncauj catheter thiab lub catheter clamp rau 2 zaug.
(5) Xyuas kom lub catheter clamp raug clamped, tshem lub txiv ntoo, thiab pov tseg. Muab lub catheter uas tau sterilized tso rau ntawm 1/2 sab sterile ntawm daim phuam kho mob.
(6) Tua kab mob rau lub nozzle dua ua ntej ua haujlwm.
(7) 2mL intracatheter sealing heparin kua tau raug pumped rov qab nrog 2-5ml koob txhaj tshuaj thiab thawb rau ntawm daim ntaub qhwv.
(8) Xyuas seb puas muaj cov ntshav txhaws ntawm daim ntaub qhwv. Yog tias muaj cov ntshav txhaws, rho tawm 1ml dua thiab thawb qhov txhaj tshuaj. Qhov nrug ntawm qhov txhaj tshuaj thiab daim ntaub qhwv yog ntau dua 10cm.
(9) Tom qab txiav txim siab tias lub catheter tsis muaj dab tsi thaiv, txuas cov hlab ntsha thiab cov hlab ntsha ntawm cov ntshav ncig sab nraud kom tsim kom muaj kev ncig sab nraud.
3. Xaus lub raj kaw tom qab ntxuav ntshav
(1) Tom qab kev kho mob thiab cov ntshav rov qab los, clamp lub catheter clamp, tua kab mob ntawm cov pob qij txha arteriovenous catheter, thiab txiav qhov sib koom ua ke nrog cov kav dej ntshav.
(2) Tua kab mob rau ntawm qhov nkag ntawm cov hlab ntsha thiab cov leeg ntawm lub catheter, thiab thawb 10ml saline ib txwm los yaug lub catheter los ntawm txoj kev pulse. Tom qab saib xyuas qhov muag liab qab, tsis muaj cov ntshav seem hauv qhov chaw uas raug nthuav tawm ntawm lub catheter, thawb cov kua nplaum tiv thaiv kev coagulation los ntawm pellet raws li tus kws kho mob qhia. (3) Siv lub hau heparin sterile los kaw qhov qhib ntawm lub raj arteriovenous thiab ob txheej ntawm sterile gauze los qhwv nws. Kho.
3. Hloov daim ntaub qhwv ntawm lub catheter venous hauv nruab nrab
1. Xyuas seb daim ntaub qhwv puas qhuav, ntshav thiab muaj cov xim av.
2. Hnav hnab looj tes.
3. Qhib daim ntaub qhwv thiab xyuas seb puas muaj los ntshav, muaj kua tawm, liab thiab o, tawv nqaij puas tsuaj thiab muaj xov xaws ntawm qhov chaw uas muab lub raj xa dej hauv nruab nrab tso rau.
4. Siv ib daim paj rwb iodophor thiab tig nws mus rau sab laug kom tua kab mob rau qhov chaw uas tau muab lub raj tso rau. Qhov ntau thiab tsawg tua kab mob yog 8-10cm.
5. Muab daim ntaub qhwv qhov txhab lo rau ntawm daim tawv nqaij ntawm qhov chaw uas muab lub raj tso rau, thiab qhia lub sijhawm hloov daim ntaub qhwv. Kev siv thiab kev saib xyuas cov catheter
1. Kev saib xyuas thiab kev ntsuam xyuas cov catheter
1. Qhov chaw tawm ntawm daim tawv nqaij catheter
Ua ntej thiab tom qab txhua zaus siv, yuav tsum tau soj ntsuam seb qhov tawm ntawm daim tawv nqaij ntawm qhov chaw ntxig raj puas liab, muaj kua tawm, mob, los ntshav thiab muaj cov kua tawm, thiab lwm yam. Yog tias nws yog ib lub catheter ib ntus, xyuas seb rab koob txuas puas tau txuas. Yog tias nws yog ib lub catheter ntev, saib seb CAFF puas raug rub lossis tawm los.
2. Sab nraud ntawm lub catheter
Txawm hais tias muaj kev tawg lossis tawg, qib ntawm qhov patency ntawm lumen, yog tias pom cov ntshav tsis txaus, nws yuav tsum tau tshaj tawm rau tus kws kho mob raws sijhawm, thiab qhov thrombus thiab fibrin sheath tsim hauv catheter yuav tsum tau txiav txim siab los ntawm ultrasound, imaging thiab lwm txoj hauv kev.
3. Cov cim qhia ntawm tus neeg mob
Txawm yog cov tsos mob thiab qib ntawm kev kub taub hau, mob khaub thuas, mob thiab lwm yam kev tsis xis nyob.
2. Kev sib txuas ua haujlwm txheej txheem
1. Kev Npaj
(1) Lub tshuab dialysis tau dhau qhov kev kuaj xyuas tus kheej, cov kav dej dialysis tau raug ntxuav ua ntej thiab nyob hauv lub xeev standby.
(2) Kev Npaj: lub laub kho mob lossis lub tais kho mob, cov khoom siv tua kab mob (iodophor lossis chlorhexidine), cov khoom siv huv (daim phuam kho mob, daim ntaub qhwv, koob txhaj tshuaj, hnab looj tes ntxuav, thiab lwm yam).
(3) Tus neeg mob yuav tsum tau muab tso rau hauv qhov chaw xis nyob, thiab tus neeg mob uas muaj lub caj dab intubation yuav tsum hnav lub npog ntsej muag kom pom qhov chaw intubation.
2. Txheej Txheem
(1) Qhib daim ntaub qhwv sab nraud ntawm lub catheter venous hauv nruab nrab.
(2) Hnav cov hnab looj tes.
(3) Qhib 1/4 sab ntawm daim phuam kho mob uas tsis muaj kab mob thiab muab tso rau hauv qab lub catheter ob-lumen ntawm cov leeg ntshav hauv nruab nrab.
(4) Siv cov ntsia hlau los ntxuav lub hau tiv thaiv catheter, lub qhov ncauj catheter thiab lub catheter clamp rau 2 zaug.
(5) Xyuas kom lub catheter clamp raug clamped, tshem lub txiv ntoo, thiab pov tseg. Muab lub catheter uas tau sterilized tso rau ntawm 1/2 sab sterile ntawm daim phuam kho mob.
(6) Tua kab mob rau lub nozzle dua ua ntej ua haujlwm.
(7) 2mL intracatheter sealing heparin kua tau raug pumped rov qab nrog 2-5ml koob txhaj tshuaj thiab thawb rau ntawm daim ntaub qhwv.
(8) Xyuas seb puas muaj cov ntshav txhaws ntawm daim ntaub qhwv. Yog tias muaj cov ntshav txhaws, rho tawm 1ml dua thiab thawb qhov txhaj tshuaj. Qhov nrug ntawm qhov txhaj tshuaj thiab daim ntaub qhwv yog ntau dua 10cm.
(9) Tom qab txiav txim siab tias lub catheter tsis muaj dab tsi thaiv, txuas cov hlab ntsha thiab cov hlab ntsha ntawm cov ntshav ncig sab nraud kom tsim kom muaj kev ncig sab nraud.
3. Xaus lub raj kaw tom qab ntxuav ntshav
(1) Tom qab kev kho mob thiab cov ntshav rov qab los, clamp lub catheter clamp, tua kab mob ntawm cov pob qij txha arteriovenous catheter, thiab txiav qhov sib koom ua ke nrog cov kav dej ntshav.
(2) Tua kab mob rau ntawm qhov nkag ntawm cov hlab ntsha thiab cov leeg ntawm lub catheter, thiab thawb 10ml saline ib txwm los yaug lub catheter los ntawm txoj kev pulse. Tom qab saib xyuas qhov muag liab qab, tsis muaj cov ntshav seem hauv qhov chaw uas raug nthuav tawm ntawm lub catheter, thawb cov kua nplaum tiv thaiv kev coagulation los ntawm pellet raws li tus kws kho mob qhia. (3) Siv lub hau heparin sterile los kaw qhov qhib ntawm lub raj arteriovenous thiab ob txheej ntawm sterile gauze los qhwv nws. Kho.
3. Hloov daim ntaub qhwv ntawm lub catheter venous hauv nruab nrab
1. Xyuas seb daim ntaub qhwv puas qhuav, ntshav thiab muaj cov xim av.
2. Hnav hnab looj tes.
3. Qhib daim ntaub qhwv thiab xyuas seb puas muaj los ntshav, muaj kua tawm, liab thiab o, tawv nqaij puas tsuaj thiab muaj xov xaws ntawm qhov chaw uas muab lub raj xa dej hauv nruab nrab tso rau.
4. Siv ib daim paj rwb iodophor thiab tig nws mus rau sab laug kom tua kab mob rau qhov chaw uas tau muab lub raj tso rau. Qhov ntau thiab tsawg tua kab mob yog 8-10cm.
5. Muab daim ntaub qhwv qhov txhab lo rau ntawm daim tawv nqaij ntawm qhov chaw uas muab lub raj tso rau, thiab qhia lub sijhawm hloov daim ntaub qhwv.
Lub sijhawm tshaj tawm: Lub Ob Hlis-25-2022