Deep vein catheterization is widely used in clinical blood transfusion and fluid replenishment due to its long retention time, easy operation, wide range of infusion types, good catheter elasticity, and the ability to establish safe, rapid and reliable vascular access in a short time. It is widely used in total parenteral nutrition (TPN), central venous pressure monitoring (CVP), and rescue of critically ill patients, and has achieved good results in hemodialysis, chemotherapy, and elimination of body cavity effusion. Now its clinical application is The key points of care are summarized below.
1 Clinical Application
1.1 Infusion of blood is fast and effective, and it can also reduce the pain caused by repeated punctures, reduce the workload of nurses, and improve nursing care. Work efficiency, especially the use of multi-lumen cava cannulation, establishes multiple venous channels at one time, and divides the lumen, which facilitates the simultaneous input of liquids with different components and avoids drug incompatibility.
1.2 The application of large-dose multi-drug comprehensive chemotherapy and repeated punctures directly stimulate blood vessels in cancer patients can cause phlebitis and drug extravasation. Deep vein catheterization is used to inject chemotherapy drugs into cancer patients, which reduces the risk of chemotherapy. Drug stimulation of blood vessels reduces the incidence of phlebitis and leakage, ensuring the smooth implementation of chemotherapy.
1.3 Total parenteral nutrition (TPN). Compared with peripheral venipuncture, deep venous catheterization can inject high concentrations of glucose, amino acids, and fat emulsion. It has the advantages of long retention time, fast infusion speed, and reduced occurrence of phlebitis. and other advantages.
1.4 Central venous pressure monitoring (CVP) CVP is an important indicator to judge the patient’s blood volume and right atrial function. During the volume infusion process, CVP can be used as a safety indicator to judge the heart’s fluid load. In clinical During work, the condition is often judged based on arterial pressure, pulse pressure, urine output, clinical symptoms and signs, and changes in CVP to take corresponding measures.
1.5 Establishing temporary and permanent rapid hemodialysis access in patients with chronic renal failure due to interstitial edema and difficulty in peripheral venipuncture. The method of deep vein indwelling double-lumen catheter
can effectively establish Temporary critical dialysis access has the advantages of sufficient blood flow, convenient operation, easy fixation, and few complications. It is a commonly used safe and effective emergency access.
1.6 Drainage pleural effusion Pleural effusion is a common complication in patients with advanced tumors. It is generated quickly and is difficult to control. It requires repeated puncture and drainage, which not only brings difficulties to the operator, but also increases the cost to the patient. pain. The indwelling catheter is soft in texture, has good tissue compatibility, is less irritating, and is simple to operate. It can reduce the pain caused by repeated punctures to patients. It can also control the drainage speed according to the condition and can be administered directly into the chest for multiple times. Deep vein catheterization technology is used to regularly drain pleural effusion, and chemotherapy drugs are injected into the cavity, which not only achieves the purpose of controlling pleural effusion, but also avoids the shortcomings of repeated pleural puncture.
1.7 For hemodynamic monitoring and temporary cardiac pacing, the deep vein indwelling catheter can be inserted along the catheter for hemodynamic monitoring. It can directly measure the pressure of each part and calculate the cardiac index (CI). ) and pulmonary capillary pressure (PCWP) to assist clinical diagnosis and treatment. Mainly used for patients with various heart diseases complicated by cardiac insufficiency. In patients with cardiac arrest or high-grade atrioventricular block, a temporary pacemaker can be inserted along the cannula for temporary cardiac pacing to save the patient's life.
2 Catheter placement methods
Catheter options include single-lumen, double-lumen, and multi-lumen catheters. Routine skin preparation, disinfection of the surgical field, and sterile draping. After successful venipuncture, insert a guiding wire and apply a skin expander. After expanding the skin and subcutaneous tissue, insert an indwelling intravenous catheter to an appropriate depth, withdraw the guiding wire, and suture. Indwelling intravenous catheters can be used clinically.
3 Catheterization methods
Commonly used catheterization methods include right internal jugular vein puncture and catheterization, subclavian vein puncture and catheterization, and femoral vein puncture and catheterization. There are advantages and disadvantages, and the choice should be based on the patient's specific conditions and should not be strictly required. The first choice for inserting a single-lumen catheter is the subclavian vein, which is easy to fix and is comfortable and convenient for the patient, followed by the internal jugular vein. When inserting a double-lumen catheter, the internal jugular vein and femoral vein are preferred because the catheter is thick and can be left in for a long time, easily compressing and damaging blood vessels. The internal jugular venous catheter is located in the central circulation. The drug takes effect quickly and CVP can be measured. It is relatively safe and has few complications. It is difficult to insert a floating catheter into the subclavian vein, so it is often used when puncture of the internal jugular vein is difficult.
The femoral vein is used to rescue various critically ill patients. It can establish a long-lasting venous access in a short time. It is suitable for rescue infusion in the state of shock and failure and when superficial vein puncture is difficult. However, it is not suitable for TPN therapy and patients who are susceptible to abdominal pressure. It is not suitable for CVP monitoring and should not be used by patients with blood supply disorders in the lower limbs. It is not advisable to choose the internal jugular vein when there is a tracheotomy. It is not advisable to choose the femoral vein if there is limited movement of the lower limbs or is bedridden for a long time. The femoral vein should be chosen with caution in those with mental disorders or out-of-control behavior.
4 Nursing points for different clinical applications
Replace intravenous infusion pipes 24 hours a day [1]. If the three-way valve or heparin cap used at the joint is found to be loose or fallen off, immediately replace it Remove and replace it with a new three-way valve or heparin cap after strict disinfection. For various operations at the joint, such as infusion, drug administration, blood drawing, and infusion pump connection operations, aseptic operations must be strictly observed to prevent iatrogenic infections. For patients who are infused with intravenous high-nutrient solutions [2], inspections should be strengthened during the infusion process. After the infusion is completed, the lumen of the tube should be flushed with normal saline or a new infusion tube should be replaced before other fluids are infused.
When inserting deep vein catheters to treat pleural effusion, strictly implement aseptic techniques during puncture and drainage. After each drainage of pleural effusion, the connection between the catheter and the drainage bag should be routinely disinfected, and the heparin cap should be replaced once a week [3], sealed and fixed. When connecting the drainage bag for drainage or injecting chemotherapy drugs, avoid entering the air, and closely observe the connection and fixation of the indwelling tube to prevent the occurrence of pneumothorax. The drainage bag must not be higher than the puncture point to prevent retrograde infection.
Deep vein catheterization is the lifeline of hemodialysis patients and should be dedicated to it [4]. Do not use catheters for infusion or blood collection during dialysis. Pay attention to prevent cross-infection and blood-borne infection. Extend the use time. After hemodialysis, , first quickly rinse the blood in the double-lumen catheter with 10ml of normal saline on each side, and then seal the tube with heparin saline under positive pressure. The retained heparin saline will be withdrawn before dialysis next time.
When deep vein catheterization is used to monitor central venous pressure, psychological care of patients and their families should be particularly strengthened to enhance psychological security. When monitoring CVP for a long time, the catheter should be flushed with 5ml (30u) of dilute heparin solution prepared with normal saline every 24 hours to keep the manometry system unobstructed, reduce the incidence of infection, and prevent the formation of a fibrin sheath around the catheter end.
Deep vein catheterization is a simple, safe and effective clinical nursing technology. It is widely used in clinical rescue and treatment. It greatly reduces the workload of nurses and effectively improves the success of rescue of critically ill patients. Rate