深静脉置管临床护理的应用进展.docVIP

深静脉置管临床护理的应用进展 徐丽丽 范斌、杨文拓、刘东东、李江涛、王冠 单位：中国人民解放军第五医院 普外科 [摘 要]：深静脉穿刺置管是监测和治疗危重患者的一种重要方法。深静脉置管，具有保留时间长、输液种类广泛等优点，在输血、补液、静脉营养支持、中心静脉监测及危重患者抢救方面已广泛应用[1-2]。它不仅提高了患者的抢救效率及质量，同时还避免了因反复穿刺给患者带来的痛苦，减轻了护士的工作量。但在使用过程中，如护理不当，会出现一些并发症，最常见的并发症是导管堵塞和感染，这不仅增加了患者的痛苦和费用，若处理不当可导致严重后果。因此，持续有效的导管护理是减少感染、延长置管时间最有效的方法[3]。现已广泛应用并逐步扩大，取得了较好的效果。操作方法及护理也有较大进展，现综述如下。 [关键词]：深静脉置管；应用；并发症；护理 [In this paper]:Deep vein puncture catheter is monitoring and an important method for the treatment of critically ill patients. Deep venipuncture, has the advantages of long retention time and transfusion wide variety, in the center of the transfusion, rehydration, parenteral nutrition support, vein monitoring and rescue has been widely used in critically ill patients [1-2]. It not only improve the patients rescue efficiency and quality, but also avoid the pain of the patients due to repeated puncture, reduce the workload of the nurse. But in use process, such as improper care, there will be some complications, are the most common complications of catheter jam and infection, which not only increased the patients pain and expense, if improper handling can lead to serious consequences. Therefore, sustained and effective catheter nursing is to reduce the infection, the most effective way to extend the time of catheter [3]. Has been widely used and gradually expand, good results have been achieved. Also have great progress, operation methods and nursing is summarized as follows. [key words] : deep venipuncture; Application; Complications; nursing 1.应用的扩展 1.1　多腔静脉置管：王世英［4］报告采用多腔深静脉插管运用于危重病救治，一次建立多路静脉通道，管腔分隔，有利于不同成分液体同时输入，避免了药物的配伍禁忌，亦减轻了病人因外周静脉多条通道穿刺的痛苦，减少并发症的发生，同时减轻了护理工作量。 1.2　建立长期血透通路：肾功能衰竭病人因组织间水肿，外周静脉穿刺困难。刘芸等采用颈内静脉留置双腔导管，较为有效地建立起长期的血液透析通路，有血流充分、操作方便、留置时间长、可重复置管、并发症较少等优点［5］。 1.3　引流心包及胸腔积液：由于留置导管的特性，王彩娣［6］和张晓荣［7］将同样 的技术用于心包液以及胸腔积液的引流，进一步扩大了置管术的使用。 1.4在化疗及骨髓移植中的应用:肿瘤病人因反复化疗及长期输液、静脉高营养等，导致静脉血管损伤造成静脉穿刺困难。采用中心静脉置管可保护上肢血管网，避免反复穿刺外周静脉给病人带来的痛苦，减轻化疗对周围血管的破坏[8]。骨髓移植前通过中心静脉置管药液可很快进入体循环，1