#1
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Ïîäêëþ÷è÷íûé êàòåòåð
Ñóùåñòâóþò ëè íîðìàòèâíûå ñðîêè äëÿ ñìåíû (ïåðåñòàíîâêè) ïîäêëþ÷è÷íîãî êàòåòåðà, èëè, èíà÷å ôîðìóëèðóÿ âîïðîñ, íà ñêîëü äëèòåëüíîå âðåìÿ åãî ìîæíî îñòàâèòü ó ïàöèåíòà?
Çàðàíåå ñïàñèáî. |
#2
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Ýòî ñèëüíî çàâèñèò îò - êòî, ãäå, êîãäà è êàêîé èìåííî êàòåòåð ïîñòàâèë. Çà ðóáåæîì, íàñêîëüêî ìíå èçâåñòíî, äàæå ìíîãîìåñÿ÷íîå íàõîæäåíèå êàòåòåðà - íå ïðîáëåìà. Ó íàñ äàæå 10 äíåâíîå íàõîæäåíèå â âåíå ìîæåò çàêîí÷èòñÿ ïðîÌáëåìàìè.
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#3
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Irwin and Rippe's Intensive Care Medicine 5th edition (January 2003): By Richard S., Md. Irwin (Editor), James M., Md. Rippe (Editor), Herbert P. Goodheart By Lippincott Williams & Wilkins Publishers
"Replacement of administration sets every 72 to 96 hours is safe and cost efficient [ 172 ], unless there are specific recommendations for the infusate (e.g., propofol). The use of transparent, semiocclusive dressings is prevalent, but these may actually increase the risk of site colonization because of moisture trapping, and no dressing has been proved to be superior to gauze and tape [ 173 ]. Application of iodophor or polymicrobial ointments to the skin site at the time of insertion or during dressing changes does not convincingly reduce the overall incidence of catheter infection, and certain polymicrobial ointments may increase the proportion of Candida infections [ 174 , 175 ]. FREQUENCY OF CATHETER-ASSOCIATED INFECTION Observing the above recommendations for catheter insertion and maintenance will minimize but not eliminate catheter-associated infection. Colonization of the insertion site can begin within 24 hours and increases with duration of catheterization; 10% to 40% of catheters eventually become colonized [ 163 , 165 , 167 , 168 , 176 ]" |
#4
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ß êîãäà òî â íà÷àëå 90-õ ðàáîòàëà â ðåàíèìàöèè, òàê ìû ìåíÿëè ïîäêëþ÷è÷íûé êàòåòåð êàæäûå 7 äíåé.Ïëþñ åæåäíåâíûé óõîä çà íèì.Ñëîæíîãî â åãî çàìåíå íè÷åãî íåò,ò.ê. ïåðåä òåì êàê çàìåíèòü åãî íà íîâûé, âíà÷àëå âîäèòüñÿ ïðîâîäíèê, äàëåå óäàëÿåòñÿ ñòàðûé êàòåòåð, è ïîòîì ïî ïðîâîäíèêó ââîäèòüñÿ íîâûé.Ñëîæíîñòü ìîæåò áûòü ïðè ïîñòàíîâêå ïåðâîãî êàòåòåðà.
Áûëè ïàöèåíòû ó êîòîðûõ êàòåòåð â îáùåé ñëîæíîñòè ìîã ñòîÿòü íåñêîëüêî ìåñÿöåâ (ìåíÿÿ ñòîðîíû ïðàâóþ,ëåâóþ) |
#5
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"Due to the long duration of therapy, and the ongoing risk of catheter-associated infection, tunneled central venous catheters are generally preferred"
Êàòåòåð "ïðÿ÷óò" â òóííåëü, ïîä êîæó. Äëÿ èíúåêöèè ïðîêàëèâàåòñÿ èãëîé êîæà è ìóôòà êàòåòåðà, ïðåïàðàò ïîïàäàåò â êðîâü. Ðèñê èíôåêöèè ìèíèìàëåí. |
#6
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Öèòàòà:
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#7
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Öèòàòà:
ß ÷åñòíî ãîâîðÿ ýòèì â áëèæàéøåå âðåìÿ íå èíòåðèñîâàëàñü, íè ê ÷åìó. Ýòî áûëî äàíî, âñå òàêè 14 ëåò íàçàä. |
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#8
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äà è òàê ëîãè÷íî: ñòðóíà èäåò ïî åòèì êëàñòåðíûì ïëåíêàì â ñòàðîì êàòåòåðå- à ïîòîìà ñòðóíà èíôèöèðîâàíàÿ èäåò ÷åðåç íîâûé êàòåòåð....
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#9
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Ó íàñ ïîäêëþ÷è÷êè ñòîÿò â ñðåäíåì äâà ìåñÿöà. Ïîëüçóåìñÿ âîîñíîâíîì "BBraun" ,ïåðåâÿçêè ïîä ïëåíêó ðàç â òðè äíÿ. Èíîãäà äåëàåì ïðîôèëàêòèêó êàòåòåðíîé èíôåêöèè âàíêîìèöèíîì ( íå ó âñåõ è íå âñåãäà). Ìíå êàæåòñÿ, ÷òî ãëàâíîå ñ êàòåòåðîì àêóðàòíî ðàáîòàòü ñîáëþäàÿ ïðàâèëà àñåïòèêè è àíòèñåïòèêè , òîãäà è ïðîñòîèò äîëãî. íó è îò òîãî êàêîé êàòåòåð ýòî òîæå çàâèñèò, åñòü íàïðèìåð ÖÂÊ ñ àíòèáàêòåðèàëüíûì ïóôîì êîòîðûé âøèâàåòñÿ ïîîä êîæó è ïðåïÿäñòâóåò îáðàçîâàíèþ øòèôò-êàíàëëà, åñòü "õèêìàíû" - âíóòðèïðåäñåðäíûå êàòåòåðû êîòîðûå ñòàâÿòñÿ íà ïîëãîäà...
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#10
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[quote=terro Èíîãäà äåëàåì ïðîôèëàêòèêó êàòåòåðíîé èíôåêöèè âàíêîìèöèíîì ( íå ó âñåõ è íå âñåãäà). .[/QUOTE]
ãåïàðèíîâûé çàìîê ñ ïðèìåðíî 0,2 âàíêîìèöèíà???? |
#11
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[Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ]
Òàì ñêàçàíî, ÷òî íåò îùóòèìîé ðàçíèöû ìåæäó ìàðëåâûìè ïîâÿçêàìè è ïðîçðà÷íûìè íàêëåéêàìè, à åùå, ÷òî ðèñê êàòåòåð-àññîöèèðîâàííîé èíôåêöèè âûøå âñåãî ïðè êàòåòåðèçàöèè âíóòðåííåé ÿðåìíîé âåíû. Äà è òàê... Ìíîãî åùå ÷åãî ïîëåçíîãî ñêàçàíî. |
#12
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Öèòàòà:
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#13
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Êîðî÷å, âåçäå ñêàçàíî - 72-96 ÷àñîâ, åñëè ïðè ïîñòàíîâêå Ö êàòåòåðà íå áûëî âîçìîæíîñòè ñîáëþñòè àñåïòèêó - ñìåíà íå ïîçäíåå ÷åì ÷åðåç 48 ÷àñîâ.
Ïî ìîèì íàáëþäåíèÿì (ïðèãîòîâüòåñü êèäàòü ïîìèäîðû) - êàòåòåðû ñòîÿò äàæå äîëüøå áåçî âñÿêèõ ïðîáëåì ïðè íàäëåæàùåì óõîäå (è êîíå÷íî æå íå â äîìàøíèõ óñëîâèÿõ) |
#14
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äà, åùå ïðî ôèêñàöèþ? êàê ïðèíÿòî ôèêñèðîâàòü êàòåòåð ïî íàóêå?
ó íàñ ïðèÿíòà òàê íàçûâàåìàÿ "àôãàíàêà" (ÿêîáû òàì åòî äåëî ïðèäóìàëè è äàæå èíîãäà ïðîñòî ìàçàëè çåëåíêîé áåç ïîâÿçêè- è èíôåêöèé íåáûëà): èãëîé êàêáû ïîäêîæåé îõâàòûâàåòñÿ êàòåòåð ôîðìèðóÿ ñâîåîáðàçíûé êèñåò- ýòî äîëæíî ñíèçèòü äâèæåíèÿ íàäîêæíîé ÷àñòè êàòåòåðà ïîä êîæó, çàòåì "êîñè÷êà" äî "êðûëûøåê"-íåäàþùàÿ "âûâèõíóòñÿ" êàòåðåòðó.. |
#15
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Öèòàòà:
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