Central Venous Catheter: Kalozera Wofunika

A Central Venous Catheter (CVC), yomwe imadziwikanso kuti mzere wapakati wa venous, ndi chubu chosinthika chomwe chimalowetsedwa mumtsempha waukulu wopita kumtima. Izichipangizo chachipatalaimathandiza kwambiri popereka mankhwala, madzi, ndi zakudya m'magazi mwachindunji, komanso kuyang'anira matenda osiyanasiyana. Ma catheter apakati ndi ofunikira pakuwongolera odwala omwe akudwala kwambiri, omwe akulandira chithandizo chamankhwala chovuta, kapena anthu omwe amafunikira chithandizo chanthawi yayitali. M'nkhaniyi, tiwona cholinga cha ma catheter apakati, mitundu yosiyanasiyana, njira yomwe amalowetsedwera, komanso zovuta zomwe zingachitike.

Cholinga cha Central Venous Catheters

Central venous catheters amagwiritsidwa ntchito pazifukwa zosiyanasiyana zachipatala, kuphatikiza:

Kayendetsedwe ka Mankhwala:Mankhwala ena, monga mankhwala a chemotherapy kapena maantibayotiki, amatha kukhala ankhanza kwambiri kwa mitsempha yotumphukira. CVC imalola kuti mankhwalawa aperekedwe motetezeka mumtsempha waukulu, kuchepetsa chiopsezo cha kupsa mtima kwa mitsempha.

Chithandizo chanthawi yayitali cha IV:Odwala omwe amafunikira chithandizo cham'mitsempha (IV) kwanthawi yayitali, kuphatikiza maantibayotiki, kuwongolera ululu, kapena zakudya (monga zakudya zonse za parenteral), amapindula ndi mzere wapakati wa venous, womwe umapereka mwayi wokhazikika komanso wodalirika.

Fluid and Blood Product Administration:Pazochitika zadzidzidzi kapena zachisamaliro chachikulu, CVC imathandizira kuyendetsa mofulumira kwa madzi, mankhwala a magazi, kapena plasma, zomwe zingathe kupulumutsa moyo pazovuta kwambiri.

Kuyesa Magazi ndi Kuwunika:Ma catheter apakati a venous amathandizira kuyesa magazi pafupipafupi popanda ndodo za singano. Ndiwothandizanso pakuwunika kuthamanga kwa venous wapakati, kupereka chidziwitso cha momwe mtima wa wodwalayo ulili.

Dialysis kapena Apheresis:Odwala omwe ali ndi vuto la impso kapena omwe akufunika apheresis, mtundu wapadera wa CVC ungagwiritsidwe ntchito kuti apeze magazi kuti athandizidwe ndi dialysis.

 

Mitundu yaCentral Venous Catheters

Pali mitundu ingapo ya catheter yapakati ya venous, iliyonse yopangidwira zolinga ndi nthawi yake:

Mzere wa PICC (Katheta Yapakati Yoyimiriridwa):

Mzere wa PICC ndi katheta yayitali, yopyapyala yomwe imalowetsedwa kudzera mumtsempha wapa mkono, nthawi zambiri mtsempha wa basilic kapena cephalic vein, ndikumangidwira mumtsempha wapakati pafupi ndi mtima. Amagwiritsidwa ntchito kwambiri pamankhwala apakati mpaka nthawi yayitali, kuyambira masabata mpaka miyezi.
Mizere ya PICC ndiyosavuta kuyiyika ndikuchotsa, ndikupangitsa kuti ikhale chisankho chokondedwa chamankhwala otalikirapo omwe safuna kuchitidwa opaleshoni.

Ma Catheters Opanda Tunnel:

Izi zimayikidwa mwachindunji mumtsempha waukulu wa khosi (internal jugular), chifuwa (subclavian), kapena groin (chikazi) ndipo nthawi zambiri amagwiritsidwa ntchito pazinthu zazing'ono, nthawi zambiri pa chisamaliro chovuta kapena zochitika zadzidzidzi.
Ma CVC opanda tunnels sali abwino kuti agwiritsidwe ntchito kwa nthawi yayitali chifukwa cha chiopsezo chachikulu cha matenda ndipo nthawi zambiri amachotsedwa mkhalidwe wa wodwalayo ukakhazikika.
Ma Catheter a Tunneled:

Ma catheter okhala ndi tunnel amalowetsedwa mumtsempha wapakati koma amadutsa mumsewu wa subcutaneous asanafike polowera pakhungu. Njirayi imathandizira kuchepetsa chiopsezo cha matenda, kuwapangitsa kukhala oyenera kugwiritsidwa ntchito kwa nthawi yayitali, monga odwala omwe amafunikira kutulutsa magazi pafupipafupi kapena chithandizo chamankhwala mosalekeza.
Ma catheterwa nthawi zambiri amakhala ndi chikhomo chomwe chimalimbikitsa kukula kwa minofu, kuteteza catheter m'malo mwake.

Madoko Obzalidwa (Port-a-Cath):

Doko lobzalidwa ndi kachipangizo kakang'ono, kozungulira koyikidwa pansi pa khungu, nthawi zambiri pachifuwa. Catheter imachokera ku doko kupita ku mtsempha wapakati. Madoko amagwiritsidwa ntchito pochiza kwanthawi yayitali ngati chemotherapy, chifukwa ali pansi pakhungu ndipo ali ndi chiopsezo chochepa chotenga matenda.
Odwala amakonda madoko kuti asamalire kwa nthawi yayitali chifukwa sakhala ovutikira ndipo amangofunika ndodo ya singano nthawi iliyonse yomwe amagwiritsa ntchito.

Njira ya Catheter yapakati
Kuyika kwa catheter yapakati ndi njira yachipatala yomwe imasiyana malinga ndi mtundu wa catheter yomwe imayikidwa. Nachi mwachidule za ndondomekoyi:

1. Kukonzekera:

Asanayambe ndondomekoyi, mbiri yachipatala ya wodwalayo imawunikiridwa, ndipo chilolezo chimapezeka. Mankhwala opha tizilombo amagwiritsidwa ntchito pamalo oyikapo kuti achepetse chiopsezo cha matenda.
Mankhwala oletsa ululu kapena sedation atha kuperekedwa kuti wodwalayo atonthozedwe.
2. Kuyika kwa Catheter:

Pogwiritsa ntchito chitsogozo cha ultrasound kapena zizindikiro za anatomical, dokotala amaika catheter mumtsempha woyenera. Pankhani ya mzere wa PICC, catheter imalowetsedwa kudzera mumtsempha wozungulira m'manja. Kwa mitundu ina, malo olowera pakati monga subclavia kapena mitsempha yamkati ya jugular imagwiritsidwa ntchito.
Catheter imapita patsogolo mpaka ikafika pamalo ofunikira, nthawi zambiri vena cava yapamwamba pafupi ndi mtima. X-ray kapena fluoroscopy nthawi zambiri amachitidwa kuti atsimikizire malo a catheter.
3. Kuteteza Catheter:

Katheta ikayikidwa bwino, imatetezedwa ndi sutures, zomatira, kapena kuvala kwapadera. Ma catheter okhala ndi tunnel amatha kukhala ndi cuff kuti ateteze chipangizocho.
Malo oyikapo amavekedwa, ndipo catheter imatsukidwa ndi saline kuonetsetsa kuti ikugwira ntchito bwino.
4. Kusamalira pambuyo:

Chisamaliro choyenera ndi kusintha kavalidwe kokhazikika ndikofunikira kuti tipewe matenda. Odwala ndi osamalira amaphunzitsidwa mmene angasamalire catheter kunyumba ngati kuli kofunikira.
Zovuta Zomwe Zingachitike
Ngakhale ma catheter apakati ndi zida zamtengo wapatali pazachipatala, alibe ngozi. Zina mwazovuta zomwe zingakhalepo ndi izi:

1. Matenda:

Vuto lofala kwambiri ndi matenda pamalo oyikapo kapena matenda a m'magazi (matenda apakati okhudzana ndi magazi, kapena CLABSI). Njira zolimba zosabala pakuyika ndikusamalira mosamala zitha kuchepetsa ngoziyi.
2. Kutsekeka kwa Magazi:

Ma CVC nthawi zina amatha kuyambitsa magazi m'mitsempha. Mankhwala ochepetsa magazi atha kuperekedwa kuti achepetse ngoziyi.
3. Pneumothorax:

Kuboola mwangozi m'mapapo kumatha kuchitika poikapo, makamaka ndi ma catheter omwe alibe tunneled omwe amayikidwa pachifuwa. Izi zimabweretsa kugwa kwa mapapu, zomwe zimafunikira chithandizo chamankhwala mwachangu.
4. Kusokonekera kwa Catheter:

Catheter ikhoza kutsekedwa, kutsekedwa, kapena kutulutsidwa, zomwe zimakhudza ntchito yake. Kuthamanga pafupipafupi komanso kugwiriridwa moyenera kungapewetse izi.
5. Kutaya magazi:

Pali chiopsezo chotaya magazi panthawi ya ndondomekoyi, makamaka ngati wodwalayo ali ndi vuto la kuundana. Njira yoyenera ndi chisamaliro chapambuyo pa ndondomeko zimathandizira kuchepetsa ngoziyi.

 

Mapeto
Ma catheter apakati ndi zida zofunika kwambiri pachipatala chamakono, zomwe zimapereka mwayi wodalirika wa venous pazifukwa zosiyanasiyana zochizira komanso kuzindikira. Ngakhale kuti njira yolowera mtsempha wapakati ndi yolunjika, imafunikira ukadaulo ndi kuwongolera mosamala kuti muchepetse zovuta. Kumvetsetsa mitundu ya CVCs ndi momwe amagwiritsidwira ntchito mwachindunji kumalola opereka chithandizo chamankhwala kuti asankhe njira yabwino pa zosowa za wodwala aliyense, kuwonetsetsa kuti chisamaliro choyenera ndi chotetezeka.