血管通路器材选择--6.ppt

MC-PP-349 BAS Confidential and Proprietary.For Internal Educational Purposes Only An Overview of Vascular Access Devices And Early Assessment 血管通道器材概述以及合理选择 巴德 宁海燕 新疆区域大客户经理 Types of Venous Catheters 静脉导管类型 PIV:peripherally intravenous catheter Very short term(days)外周静脉导管短期（天）Midline catheterLonger term than PIV(weeks)中线导管长于PIV（周）Peripherally inserted central catheter:PICC(up to one year)外周插管的中心导管：PICC（最长1年）Centrally inserted central venous catheter:CVC or CICC 中心插管的中心静脉导管：CVC或者 CICC Long term(years):Tunneled,cuffed Short term(days to weeks):Non-tunneled,“acute”CVC,non-cuffed 长期（年）：隧道式，套袖式 短期（数日至数周）：无隧道，“短期”CVC，无套袖 General Overview:Types of Devices 概览：产品类型 PIV 外周静脉导管 No BAS direct products BAS没有相关产品 PICC Lines 经外周植入的PICC导管 Triple,Power,Valved,Non-Valved,Silicone,Polyurethane 三腔，耐高压注射，有瓣膜，无瓣膜，硅胶，聚氨酯 CVC 中心静脉导管 Hickman*,Groshong*,Broviac*,PowerLine*,and PowerHohn*Catheters PORTs 植入式输液泵型中心静脉导管 Chest,Double,Single,Arm,Power 胸部，双腔，单腔，手臂，高压注射 Complications of PIVs Bleeding Vein injury Nerve injury Infiltration Phlebitis Thrombosis Infection 外周静脉导管的并发症 出血 静脉损伤 神经损伤 渗液 静脉炎 血栓形成 感染 Peripheral IVs:Poor Outcomes 外周静脉导管：效果差 Midline Catheters Overview概要 Placed in the upper arm or antecubital fossa 置于上臂或肘窝 Tip resides in peripheral vein,usually the axillary vein,and does not enter the central vasculature 头端位于外周静脉，一般为腋静脉而不可使其进入中心血管 NOT a central line 不是中心静脉导管 中线导管 Midline Catheters Advantages Longer dwell than PIV No chest x-ray required Complications Occlusion Phlebitis DVT Identification of complications may be delayed Often confused for a central line Less hemodilution,not appropriate for pH extremes or hyperosmolar solutions 中线导管 优势 留置时间长于外周静脉导管 无需进行胸片检查 并发症 导管堵塞 静脉炎 深静脉血栓形成 可能延迟的并发症诊断 常被误用作中心静脉导管 血液稀释作用轻微，不适用于极端pH值和高渗的静脉输液 Peripherally Inserted Central Catheter(PICC)Call Point IV/PICC Nurse Interventional Radiologist(IR)ICU Insertion Upper arm preferred Bedside or IR U/S and MST are best practice BAS products Per-Q-Cath*PICC Poly Per-Q-Cath*PICC Poly RadPICC*catheter PowerPICC*catheter PowerGroshong*PICC Groshong*PICC PowerPICC SOLO*catheter 使用者 IV/PICC护士 放射介入医师（IR）重症监护室 插管 优先选择上臂 床旁或放射介入科置管 U/S 和 MST是最佳方法 BAS 产品 Per-Q-Cath*PICC Poly Per-Q-Cath*PICC Poly RadPICC*导管 PowerPICC*导管 PowerGroshong*PICC Groshong*PICC PowerPICC SOLO*导管 Overview:PICC Lines PICC导管概述导管概述 PICC:Peripherally Inserted Central Catheter PICC：外周插管的中心静脉导管 IS a Central Line 属于中心静脉导管属于中心静脉导管 Can be used for delivery of any infusate,including those intended for central venous delivery 能够用于输送任何药物，包括那些需经中心静脉输送的药物 incompatible medications不相容的药物 pH extreme medications极端pH值的药物 Hyperosmolar medications高渗性的药物 Vesicant and irritant meds发泡剂及刺激性的药物 Reliable means for blood sampling 可靠的采血方法 Can be placed by a nurse at the bedside 可由护士在床旁放置 优势 途径可靠 可在床旁放置 并发症 阻塞 感染 机械性静脉炎 血栓 Peripherally Inserted Central Catheter(PICC)Advantages Reliable access Can be placed at bedside Complications Occlusion Infection Mechanical Phlebitis Thrombus Central Venous Injury Central Venous Catheters:CVCs 中心静脉导管中心静脉导管 Overview 概要概要 Inserted percutaneously by MDs,possibly RNs in the future 由医生经皮插管，可能未来由RN执行 Placed in internal jugular,subclavian or femoral vein 可放置在颈内静脉、锁骨下或股静脉 Intended for short term dwell(7-10 days)适用于短期使用（7-10 天）CRBSI rates vary by site of placement 在所有VAD中的CRBSI 率最高 Commonly placed in ICU/CCU with complex,critically ill patients 多用于ICU/CCU中病情危重患者 Can be placed emergently 可急性放置 Complications并发症 Insertion related:植入相关：Pneumothorax 气胸 Arterial puncture 误穿动脉 Nerve damage 神经损伤 Post insertion:植入后 Infection 感染 Accidental removal 意外脱出 Bleeding 出血 Thrombosis 血栓 Central Venous Injury 中心静脉损伤 Central Venous Catheters:CVCs 中心静脉导管中心静脉导管 Ports 植入式输液泵型中心静脉导管 Call point：Surgery 外科 Interventional Radiology 放射介入科 BAS Implantable Ports:巴德植入式输液泵巴德植入式输液泵 Power Injectable Ports:耐高压注射型 PowerPort*:duo M.R.I*,M.R.I.*,isp*(Titanium),isp MRI*device Non Power Injectable Ports:非耐高压注射型 M.R.I.*device:Dual-Lumen,Hard-Base,Low-Profile,Ultra SlimPort*device Peritoneal(Titanium)SlimPort*device Dual-Lumen Rosenblatt*Catheter Titanium:Dome*,Low-Profile,SlimPort*X-Port*device:duo*Dual-Lumen,inline*Dual-Lumen,isp*device 多种选择：Groshong导管或ChronoFlex聚氨酯材质导管或者普通的硅胶导管 Overview Totally implanted device Placed in IR or OR Most commonly placed in oncology patients Advantages Low infection rates Convenient for patient(showering,etc)Long term dwell Complications Pinch-off Syndrome Occlusion,DVT Expensive to replace Ports 植入式输液泵型中心静脉导管 概要 完全植入体内的静脉输液器材 在手术室或介入放射工作室放置 最常置于肿瘤患者体内 优势 在所有VAD中的感染风险最低 方便患者（洗浴等）使用时间长 并发症 导管夹闭综合症 阻塞，深静脉血栓形成 更换费用昂贵 MC-PP-349 BAS Confidential and Proprietary.For Internal Educational Purposes Only Port Advantages输液港的优势 Low infection risk 低感染率 Underneath the skin 埋于皮下 Less manipulation 操作简便 Convenient for patient 病人舒适 Showering/Swimming 便于洗澡、游泳 Less obvious 不影响外观和自身形象 Less flushing 不需要频繁冲管 Less care and maintenance 不需要频繁进行导管维护 Less needle sticks 不需要频繁穿刺 Preserving vasculature 保护血管 Long term dwell 留置时间长 Port and Catheter Placement 输液泵与导管的植入 Ports are usually placed in the upper chest,just below the c