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Nursing points of central venous catheter

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a. All operations related to central venous catheters should be strictly aseptic: nursing staff should strictly wash their hands, wear sterile gloves and masks during the nursing process of patients, and carry out nursing in accordance with the standard operating procedures. Strict implementation during the nursing process Aseptic operation.

b. Strengthen the care of the puncture site: check the skin around the puncture site daily to observe whether there is redness, swelling, exudation, and purulent secretions, etc.; disinfect the puncture site skin with iodophor, and the range should exceed the sterile patch, at least> 10cm; Choose a transparent dressing with good air permeability and histocompatibility. The puncture point must not be covered so as not to affect the observation; the dressing should be replaced as needed, if there is moisture, seepage, pollution, curling, or looseness, it should be replaced in time.

c. Strengthen the fixation of the catheter: fix the catheter with double needles during deep venous catheterization. After the disinfectant is dry, place the midpoint of the 7 cm×9 cm transparent dressing (IV3000) on the puncture point, and cover the deep venous pipeline without tension. To shape the duct, press the dressing from the center to the periphery to make it fully adhere to the skin. Do not leave air in the dressing. Take out the exposed duct from the notch, and then take the 6 cm×7 cm duct fixing paste to fix the duct wing. The role of fixing again, and then use the tape that comes with the transparent dressing to mark the date and name of the replacement.

d. Dedicated tube: Total parenteral nutrition, vasoactive drugs and central venous piezometer should be used exclusively for tube. Vasoactive drugs should be pumped in a separate channel to ensure that the speed of other liquids in the channel is basically uniform, and the speed of intravenous infusion is not less than 5ml/h. It is recommended to use an infusion pump for uniform infusion to avoid rapid volume expansion.

e. Correctly handle the infusion pipeline: the infusion set should be replaced every day. Some viscous liquids (such as whole blood, platelets, fat emulsion, etc.) are easy to deposit on the tube wall and cause clogging or clotting in the tube, so use normal saline after infusion Flush the catheter.

f. Seal the tube correctly: Before sealing the tube, use 20ml of normal saline to quickly flush the tube. Do not withdraw the syringe before injecting heparin saline. The heparin saline injection is pulsed, and the speed must be rapid. When the heparin saline is injected to reach the mark value (almost while the injection is still in progress) quickly clamp the clamp on the extension tube to maintain a certain positive pressure in the lumen to ensure The heparin saline reaches the tip of the catheter and prevents blood from returning to the lumen.

g. Catheter blockage: When the catheter is partially clogged, urokinase 1000IU/ml can be used, 3-5ml can be sealed for 3-5h, after the thrombus is dissolved, withdraw forcefully, if there is blood return, discard the blood 3-5ml and connect the infusion The needle is flushing the tube, do not inject the thrombus into the blood vessel.



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