Malangizo okhudza kugwiritsa ntchito katheta yoyeretsera hemodialysis yotayidwa ndi katheta yoyeretsera hemodialysis ya nthawi yayitali

Magazi otayidwa opanda chotupakatheta yoyezera magazindi zowonjezera Zotayidwa zoyerakatheta yoyezera magaziKapangidwe ka ntchito ya chinthu ndi kapangidwe kake. Chinthuchi chimapangidwa ndi nsonga yofewa, mpando wolumikizira, chubu chowonjezera ndi soketi ya cone; Catheter imapangidwa ndi polyurethane yachipatala ndi polycarbonate. Ndi cavity imodzi, cavity iwiri ndi catheter zitatu. Chinthuchi chimagwiritsidwa ntchito kuchipatala poyeretsa magazi ndi kulowetsedwa. Mafotokozedwe a chitsanzo: cavity iwiri, cavity zitatu
Mpope wa ngalande wokhala ndi jekete la dacron

Ndi ukalamba wa anthu, kuthamanga kwa magazi, matenda a shuga, matenda a mtima (CHD) ndi odwala omwe ali ndi vuto la impso, matenda a mtima ndi osauka, matenda a mtima ndi osachiritsika, matenda a mtima a autogenous arteriovenous internal fistula ndi okwera kwambiri, zomwe zimakhudza kwambiri zotsatira za chithandizo cha dialysis cha wodwalayo komanso moyo wabwino, choncho gwiritsani ntchito catheter kapena catheter ya polyester lamba kwa nthawi yayitali, yakhala ikugwiritsidwa ntchito kwambiri padziko lonse lapansi, ubwino wake ndi wakuti: Catheter ili ndi biocompatibility yabwino, ndipo catheter imatha kukhazikika mwamphamvu ndi khungu. Chovala chake cha polyester chingapangitse chotchinga cha bakiteriya chotsekedwa mu ngalande ya subcutaneous, kuchepetsa kupezeka kwa matenda ndikuwonjezera nthawi yogwiritsira ntchito.
Kugwiritsa ntchito ndi kusamalira ma catheter a hemodialysis

1. Kuyamwitsa ndi kuwunika ma catheter

1. Chotulutsira khungu la catheter

Musanayambe komanso mutagwiritsa ntchito nthawi iliyonse, mawonekedwe a khungu pamalo otulutsira madzi ayenera kufufuzidwa kuti awone ngati pali kufiira, kutuluka kwa madzi, kupweteka, kutuluka magazi komanso kutuluka kwa madzi, ndi zina zotero. Ngati ndi catheter yakanthawi, yang'anani momwe singano yolumikizira imakhalira. Ngati ndi catheter ya nthawi yayitali, yang'anani ngati CAFF yatulutsidwa kapena yatuluka.

2. Cholumikizira chakunja cha katheta

Kaya pali kusweka kapena kusweka, kuchuluka kwa lumen, ngati magazi sakuyenda bwino, ziyenera kuuzidwa kwa dokotala pakapita nthawi, ndipo kupangika kwa thrombus ndi fibrin sheath mu catheter kuyenera kutsimikiziridwa ndi ultrasound, kujambula zithunzi ndi njira zina.

3. Zizindikiro za odwala

Kaya zizindikiro ndi kuchuluka kwa malungo, kuzizira, ululu ndi madandaulo ena okhudza kusasangalala.

2. Njira yogwirira ntchito yolumikizira

1. Kukonzekera

(1) Makina oyeretsera magazi adutsa mayeso odziyesa okha, payipi yoyeretsera magazi yatsukidwa kale ndipo ili mu mkhalidwe woyembekezera.

(2) Kukonzekera: ngolo yogulitsira mankhwala kapena thireyi yogulitsira mankhwala, zinthu zophera tizilombo toyambitsa matenda (iodophor kapena chlorhexidine), zinthu zoyeretsera (thaulo lochiritsira, gauze, sirinji, magolovesi oyeretsera, ndi zina zotero).

(3) Wodwalayo ayenera kukhala pamalo abwino okhala chagada, ndipo wodwalayo amene ali ndi chopondera pakhosi ayenera kuvala chigoba kuti awonetse malo ake opondera pakhosi.

2. Ndondomeko

(1) Tsegulani chogwirira chakunja cha catheter yapakati ya mitsempha.

(2) Valani magolovesi.

(3) Tsegulani theka la mbali ya thaulo loyeretsera ndi kuliyika pansi pa katheta wa lumen iwiri ya mtsempha wapakati.

(4) Kuyeretsa chivundikiro choteteza catheter, pakamwa pa catheter ndi chomangira cha catheter kawiri motsatana.

(5) Onetsetsani kuti chomangira cha catheter chatsekedwa, chotsani nati, ndikuchitaya. Ikani catheter yoyeretsedwa mbali imodzi mwa ziwiri za thaulo loyeretsedwa.

(6) Thiraninso mankhwala pa nozzle musanagwiritse ntchito.

(7) 2mL intracatheter sealing heparin solution inapompedwanso ndi sirinji ya 2-5ml ndikukankhira pa gauze.

(8) Yang'anani ngati pali magazi oundana pa gauze. Ngati pali magazi oundana, chotsaninso 1ml ndikukankhira jakisoniyo. Mtunda pakati pa jakisoni ndi gauze ndi woposa 10cm.

(9) Mukamaliza kuona kuti catheter si yotsekedwa, lumikizani mitsempha yamagazi ndi mapaipi a mitsempha yamagazi kuti mukhazikitse kayendedwe ka magazi kunja kwa thupi.

3. Malizitsani ntchito yotseka chubu mutatha dialysis

(1) Pambuyo pa chithandizo ndi kubweza magazi, gwirani cholumikizira cha catheter, thira mankhwala pa cholumikizira cha catheter cha mitsempha yamagazi, ndikudula cholumikiziracho ndi njira yoyendera magazi.

(2) Thirani mankhwala ophera tizilombo toyambitsa matenda m'mitsempha ya mtsempha ndi mtsempha wa catheter motsatana, ndikukankhira 10ml ya saline wamba kuti mutsuke catheter pogwiritsa ntchito njira ya pulse. Mukayang'anitsitsa maso anu, panalibe zotsalira za magazi m'mbali mwa catheter, kanikizani madzi otsekera oletsa magazi kutsekeka pogwiritsa ntchito mankhwala monga momwe dokotala wanenera. (3) Gwiritsani ntchito chipewa cha heparin chopanda tizilombo kuti mutseke potseguka pa chubu cha arteriovenous ndi zigawo ziwiri za gauze wopanda tizilombo kuti muyikulungire. Yokhazikika.

3. Kusintha kwa katheta ya mtsempha wapakati

1. Yang'anani ngati bandejiyo ndi youma, ndi magazi komanso ngati ili ndi madontho.

2. Valani magolovesi.

3. Tsegulani bandejiyo ndikuwona ngati pali kutuluka magazi, kutuluka kwa magazi, kufiira ndi kutupa, kuwonongeka kwa khungu ndi kutuluka kwa mphuno pamalo pomwe catheter yapakati ya mitsempha imayikidwa.

4. Tengani thonje la iodophor ndikulizunguliza mozungulira kuti muphe tizilombo toyambitsa matenda pamalo pomwe chubucho chayikidwapo. Malo ophera tizilombo toyambitsa matenda ndi 8-10cm.

5. Ikani chogwirira cha bala pakhungu pamalo pomwe chubucho chayikidwa, ndipo sonyezani nthawi yosinthira chogwiriracho. Kugwiritsa ntchito ndi kusamalira ma catheter

1. Kuyamwitsa ndi kuwunika ma catheter

1. Chotulutsira khungu la catheter

Musanayambe komanso mutagwiritsa ntchito nthawi iliyonse, mawonekedwe a khungu pamalo otulutsira madzi ayenera kufufuzidwa kuti awone ngati pali kufiira, kutuluka kwa madzi, kupweteka, kutuluka magazi komanso kutuluka kwa madzi, ndi zina zotero. Ngati ndi catheter yakanthawi, yang'anani momwe singano yolumikizira imakhalira. Ngati ndi catheter ya nthawi yayitali, yang'anani ngati CAFF yatulutsidwa kapena yatuluka.

2. Cholumikizira chakunja cha katheta

Kaya pali kusweka kapena kusweka, kuchuluka kwa lumen, ngati magazi sakuyenda bwino, ziyenera kuuzidwa kwa dokotala pakapita nthawi, ndipo kupangika kwa thrombus ndi fibrin sheath mu catheter kuyenera kutsimikiziridwa ndi ultrasound, kujambula zithunzi ndi njira zina.

3. Zizindikiro za odwala

Kaya zizindikiro ndi kuchuluka kwa malungo, kuzizira, ululu ndi madandaulo ena okhudza kusasangalala.

2. Njira yogwirira ntchito yolumikizira

1. Kukonzekera

(1) Makina oyeretsera magazi adutsa mayeso odziyesa okha, payipi yoyeretsera magazi yatsukidwa kale ndipo ili mu mkhalidwe woyembekezera.

(2) Kukonzekera: ngolo yogulitsira mankhwala kapena thireyi yogulitsira mankhwala, zinthu zophera tizilombo toyambitsa matenda (iodophor kapena chlorhexidine), zinthu zoyeretsera (thaulo lochiritsira, gauze, sirinji, magolovesi oyeretsera, ndi zina zotero).

(3) Wodwalayo ayenera kukhala pamalo abwino okhala chagada, ndipo wodwalayo amene ali ndi chopondera pakhosi ayenera kuvala chigoba kuti awonetse malo ake opondera pakhosi.

2. Ndondomeko

(1) Tsegulani chogwirira chakunja cha catheter yapakati ya mitsempha.

(2) Valani magolovesi.

(3) Tsegulani theka la mbali ya thaulo loyeretsera ndi kuliyika pansi pa katheta wa lumen iwiri ya mtsempha wapakati.

(4) Kuyeretsa chivundikiro choteteza catheter, pakamwa pa catheter ndi chomangira cha catheter kawiri motsatana.

(5) Onetsetsani kuti chomangira cha catheter chatsekedwa, chotsani nati, ndikuchitaya. Ikani catheter yoyeretsedwa mbali imodzi mwa ziwiri za thaulo loyeretsedwa.

(6) Thiraninso mankhwala pa nozzle musanagwiritse ntchito.

(7) 2mL intracatheter sealing heparin solution inapompedwanso ndi sirinji ya 2-5ml ndikukankhira pa gauze.

(8) Yang'anani ngati pali magazi oundana pa gauze. Ngati pali magazi oundana, chotsaninso 1ml ndikukankhira jakisoniyo. Mtunda pakati pa jakisoni ndi gauze ndi woposa 10cm.

(9) Mukamaliza kuona kuti catheter si yotsekedwa, lumikizani mitsempha yamagazi ndi mapaipi a mitsempha yamagazi kuti mukhazikitse kayendedwe ka magazi kunja kwa thupi.

3. Malizitsani ntchito yotseka chubu mutatha dialysis

(1) Pambuyo pa chithandizo ndi kubweza magazi, gwirani cholumikizira cha catheter, thira mankhwala pa cholumikizira cha catheter cha mitsempha yamagazi, ndikudula cholumikiziracho ndi njira yoyendera magazi.

(2) Thirani mankhwala ophera tizilombo toyambitsa matenda m'mitsempha ya mtsempha ndi mtsempha wa catheter motsatana, ndikukankhira 10ml ya saline wamba kuti mutsuke catheter pogwiritsa ntchito njira ya pulse. Mukayang'anitsitsa maso anu, panalibe zotsalira za magazi m'mbali mwa catheter, kanikizani madzi otsekera oletsa magazi kutsekeka pogwiritsa ntchito mankhwala monga momwe dokotala wanenera. (3) Gwiritsani ntchito chipewa cha heparin chopanda tizilombo kuti mutseke potseguka pa chubu cha arteriovenous ndi zigawo ziwiri za gauze wopanda tizilombo kuti muyikulungire. Yokhazikika.

3. Kusintha kwa katheta ya mtsempha wapakati

1. Yang'anani ngati bandejiyo ndi youma, ndi magazi komanso ngati ili ndi madontho.

2. Valani magolovesi.

3. Tsegulani bandejiyo ndikuwona ngati pali kutuluka magazi, kutuluka kwa magazi, kufiira ndi kutupa, kuwonongeka kwa khungu ndi kutuluka kwa mphuno pamalo pomwe catheter yapakati ya mitsempha imayikidwa.

4. Tengani thonje la iodophor ndikulizunguliza mozungulira kuti muphe tizilombo toyambitsa matenda pamalo pomwe chubucho chayikidwapo. Malo ophera tizilombo toyambitsa matenda ndi 8-10cm.

5. Ikani chopaka pachilonda pakhungu pamalo pomwe chubucho chayikidwa, ndipo sonyezani nthawi yosinthira chopaka.