Central venous setting of management targets has become a foundational technique in critical care science, monitoring hemodynamics or using fluid delivery pathways.
Central venous catheter is the insertion of a central venous catheter into the central venous cavity and right atrium. It is widely used in critically ill hemodynamic monitoring, long-term intravenous nutrition, rapid infusion, chemotherapy, etc., and can avoid repeated peripheral venous punctures. pain. At the same time, the care after central venous catheterization is also very important, which may directly affect the postoperative efficacy.
1. What kind of central venous access is suitable for critically ill patients?
Currently, there are three types of central venous access commonly used in clinical practice:
①Central venous catheter (CVC) inserted through the internal jugular vein, subclavian vein, and femoral vein;
②Peripherally inserted central catheter (PICC);
③ Completely implantable venous port via internal jugular vein or subclavian vein. Among them, CVC and PICC can be used as the first choice for indwelling central venous catheters in ICU patients.
2. What catheters are available for enhanced CT examination?
When performing enhanced CT examination, the requirements for the pressure resistance of the contrast agent injection catheter are relatively high. Currently, the available intravenous catheters include the following types: high pressure resistant intravenous indwelling needle, high pressure resistant injection PICC, and high pressure resistant implantable intravenous infusion port. CVC that are not resistant to high pressure are not recommended for enhanced CT examination.
3. What is the preferred location for indwelling central venous catheters in critically ill patients?
Indwelling central venous catheters in critically ill patients requires individual selection. Among them, the subclavian vein has the lowest risk of infection and thrombosis, but has a higher risk of pneumothorax. For CVC catheterization for hemodialysis purposes, the femoral vein is preferred.
4. What measures can prevent catheter-related thrombosis?
The preventive measures for catheter-related thrombus should be aimed at the risk factors of its formation, such as selecting the appropriate site for precise puncture and catheter placement according to the patient's condition, using the smallest caliber or few lumen catheters as much as possible, ensuring the correct position of the catheter tip, and avoiding the occurrence of severe thrombosis. Remove the catheter, as needed.
5. What is the difference between flushing and sealing?
①The purpose of flushing the catheter is to use normal saline to flush the residual drug solution in the catheter into the blood vessel to avoid drug precipitation in the catheter and cause catheter blockage; to avoid stimulating local blood vessels and reduce the incompatibility between drugs. It is applied between two drugs. Sometimes or before sealing the tube.
②The purpose of locking the tube is to fill the lumen with locking fluid to avoid blood reflux. The way of locking the tube is positive pressure, that is, leaving a little bevel of the needle in the heparin cap, injecting 0.5-1ml of the locking solution solution, and pulling out the needle while pushing. Lock solution, not medicine or blood.
6. Can gravity infusion of normal saline be used instead of flushing the catheter after blood is drawn and transfused through the catheter?
Gravity infusion of normal saline cannot replace effective flushing of the tube. It is strictly forbidden to use a syringe of
Table of Contents
- 1. What kind of central venous access is suitable for critically ill patients?
- 2. What catheters are available for enhanced CT examination?
- 3. What is the preferred location for indwelling central venous catheters in critically ill patients?
- 4. What measures can prevent catheter-related thrombosis?
- 5. What is the difference between flushing and sealing?
- 6. Can gravity infusion of normal saline be used instead of flushing the catheter after blood is drawn and transfused through the catheter?