MindMap Gallery Special intravenous catheter care
Including the precautions, maintenance and health education of CVC, PICC, and infusion port, including central venous catheter CVC, peripherally implanted central venous catheter PICC, infusion port (implantable drug delivery device) PORT, etc.
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This is a mind map about plant asexual reproduction, and its main contents include: concept, spore reproduction, vegetative reproduction, tissue culture, and buds. The summary is comprehensive and meticulous, suitable as review materials.
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Special venous access care
1. Central venous catheter (CVC)
1.Definition
A catheter inserted through the subclavian vein, internal jugular vein, or femoral vein, with the tip located in the superior or inferior vena cava.
2.Indications
It can be used for drug infusion and hemodynamic testing of any nature. It should not be used for high-pressure syringe pumps to inject contrast media (except for high-pressure resistant catheters).
3. Precautions for use
① Assess the condition of the catheter every day, keep the catheter in a normal state, observe the infusion speed, and avoid the pipeline from being broken or falling off.
② During the infusion process, the liquid should be replaced and the tube should be sealed in a timely manner. It is strictly forbidden to leave the liquid empty, because the superior vena cava pressure is 2-4 mm water column lower than the surrounding venous pressure. It can drop to zero or negative pressure when the blood volume is insufficient or deep inhalation, which can easily allow air to enter. Air embolism or even death
③ Precautions for pulling out
CVC extubation distress syndrome
definition
The clinical course of complications such as hypertension and tachycardia after CVC extubation
clinical manifestations
Hypertension, tachycardia, hypoxemia and facial flushing; some may have muscle weakness and hemiplegia, which can also cause epilepsy
Cause Analysis
Air embolism or blood clots, previous severe heart disease, electrolyte imbalance, low potassium, hypoxia, acidosis
Before extubation
1) The patient should be in a supine position or with the pillow removed or in a head-down and foot-high position.
2) Avoid extubation when the patient is dehydrated
3) Instruct the patient to hold his breath during extubation
4) The disinfection range is larger than the film application range
After extubation
1) Place your index finger on the puncture point, middle finger, and ring finger along the direction of the blood vessel or press the puncture point with sterile gauze for 10 minutes after extubation.
2) Do not press excessively or rub the carotid artery hard after extubation
3) The puncture point should be sealed for 24 hours after extubation
4) After extubation, the patient lies still for 30 minutes
④Maintenance
flush pipe
Before infusing drugs, it is advisable to withdraw blood to confirm that the catheter is in the venous cavity. Use a 10ml or above syringe to flush or seal the tube, and pulse flush the catheter. After the infusion, normal saline or 10U/ml heparin saline can be used.
dressing change
Replace the patch within the first 24 hours after puncture
Under normal circumstances, replace it at least every 7 days
Change the dressing promptly when it becomes contaminated, moist, loose, detached or endangers the catheter.
program
Replace the infusion connector (at least once every 7 days) → flush the catheter → replace the transparent film
Retention time
2 weeks-4 weeks
4.Health education
Wear loose clothes and avoid tight-fitting or elderly sweaters; pay attention to protecting the pipeline when moving the body; keep the skin at the puncture site clean and dry; notify the nurse immediately if the dressing curls or falls off; if pain or itching occurs at the puncture point, notify the medical staff in time. Insist on making an effective fist every day, three times a day, 30 groups at a time
2. Implantation of central venous catheter (PICC) through peripheral veins
1. Definition
The catheter is punctured through the basilic vein of the upper limbs, median cubital vein, cephalic vein, brachial vein, and external jugular vein (newborn infants can also use the great saphenous vein of the lower limbs, temporal vein of the head, postauricular vein, etc.), with the tip located at the superior vena cava or Conduit of the inferior vena cava.
2. Indications
It is suitable for medium and long-term intravenous treatment and can be used for drug infusion of any nature. It should not be used for injection of contrast media with high-pressure syringe pumps (except for high-pressure resistant catheters).
3. Precautions during use
1. Assess the condition of the catheter every day, keep the catheter in normal condition, observe the infusion speed, and avoid the tube from being broken or falling off. Observe the skin condition for redness, swelling, bleeding, etc.
2. On the day of PICC catheter placement, the elastic bandage is applied under pressure for 4-6 hours and can be loosened without any discomfort after 6 hours. Special circumstances will depend on the situation. The arm where the catheter is placed is immobilized for 1-2 hours to prevent bleeding.
3. maintain
flush pipe
Before infusing drugs, it is advisable to withdraw blood to confirm that the catheter is in the venous cavity. Use a 10ml or above syringe to flush or seal the tube, and pulse flush the catheter. After the infusion, normal saline or 10U/ml heparin saline can be used.
dressing change
Replace the patch within the first 24 hours after puncture
Under normal circumstances, replace it at least every 7 days
Change the dressing promptly when it becomes contaminated, moist, loose, detached or endangers the catheter.
treatment interval
At least once every 7 days
Retention time
No more than one year or according to the product instructions
4. Health education
1. The first maintenance was carried out on the second day after the catheter was inserted, and we were instructed to perform fist clenching exercises (ten times a day, ten minutes each time, clenching for 5 seconds and loosening for two seconds) and wrist hanging exercises (five times a day, three minutes each time), which should be done every day , until extubation.
2. Patients with PICC catheters can perform general daily work, housework, and physical exercise, but they need to avoid using the arm on the side of the catheter to lift heavy objects (not exceeding 3kg), lift dumbbells, and do lifting exercises (such as badminton). Waiting for exercise
3. It is forbidden to sleep with the arm on the side where the PICC tube is inserted to prevent the arm on the side of the PICC tube from drooping for a long time and prevent edema.
4. People with PICC are advised to take a bath and shower, but not swimming or bathing. Before bathing, they can wrap it lightly with a highly absorbent towel, then wrap it tightly with plastic wrap, and tape the upper and lower edges tightly with tape. After bathing, check whether the dressing is soaked. If it gets soaked, please change the dressing in time.
5. You need to drink more water, at least 2000ml a day, to prevent thick blood from causing blood clots.
6. maintain
Unless there are special circumstances, maintenance will be carried out every 7 days. In special circumstances, maintenance can be carried out in advance but not later. Maintenance must be carried out by professionals and cannot be maintained at home without authorization.
If there is redness, swelling, bleeding, exudation, loose dressing, wet curling, contamination, etc. at the pinhole, seek medical attention promptly.
Infusion port (implantable drug delivery device) PORT
1. definition
A closed infusion device that is completely implanted in the human body, including the catheter part with the tip located in the vena cava and the injection seat embedded under the skin.
2. Be applicable
Can be used for drug infusion of any nature, and should not be used for high-pressure syringe pumps to inject contrast media (except for high-pressure resistant catheters)
3. Precautions when using
①Puncture
The end position of the infusion port catheter: The end position of the port catheter is best determined by chest thrust: it is located at the junction of the middle and lower 1/3 of the superior vena cava and the right atrium, and is shown on DSA between T5-T7·
Disinfection: Centering on the infusion port injection seat: first use alcohol and then iodophor from the inside to the outside in a range of more than 12 × 12 cm. The disinfection sequence is 3 positive and 3 negative turns.
Puncture: Confirm the edge of the injection seat, position and fix the injection seat with the thumb, index finger and middle finger of the left hand to form a triangle, arch the infusion port, determine the center of the three fingers, and insert the non-damaging needle vertically into the skin from the center of the three fingers with the other hand , slowly pass through the diaphragm in the center of the port body until you feel a sense of loss (the needle must be inserted vertically)
②Maintenance
flush pipe
opportunity
Before and after each use of the port
After drawing blood or infusing highly viscous liquids (blood transfusion, blood components, TPN, fat emulsion, etc.)
Between two incompatible liquids
Infusion of highly viscous liquids (blood transfusion, blood components, TPN, fat emulsion, etc.) should be flushed with normal saline every 4 hours
For intravenous infusion, use an infusion set of 10 ml or more to pulse-type closure, and seal the tube with 100 U/ml heparin diluent (100 ml NS 12500 u heparin sodium 1.6 ml)
During the infusion period, replace the infusion port’s non-damaging needle every seven days.
Treatment intervals should be maintained every 4 weeks
4. health education
Daily life, work and housework will not be affected
Avoid lifting heavy objects and excessive activities on the same side
Avoid large-scale shoulder and chest abduction movements, such as body upwards, playing ball, swimming, etc.
Avoid gravity impact, prevent the port from twisting, and move the arm on the same side more
If there is edema or pain in the shoulder, neck or upper limb on the same side, you should be alert to venous thrombosis and return to the hospital for review in a timely manner. Check chest X-ray and B-ultrasound regularly.
The infusion port should be removed promptly when it is no longer in use.