中心靜脈置管術中心靜脈置管術1什么是中心靜脈右心房連接的上下腔靜脈我們常用的穿刺路徑:鎖骨下、頸內、股靜脈、外周(PICC)什么是中心靜脈2深靜脈穿刺置管講義課件3監(jiān)測a危重病人搶救和大手術期行CVP監(jiān)測bSwan-Ganz導管監(jiān)測cPiCCO監(jiān)測監(jiān)測4●禁忌證廣泛上腔靜脈系統(tǒng)血栓形成米穿刺局部有感染*凝血功能障礙*不合作,燥動不安的病人●禁忌證5準備工作口談話簽字口患者的血小板計數(shù)、凝血功能、感染指標口選擇合適的穿刺點口體位鎖骨下靜脈穿刺需要墊肩頸內靜脈穿刺需要平臥甚至頭低腳高位股靜脈需要平臥準備工作6如何選擇穿刺部位并發(fā)癥不同穿刺部位頸內靜脈鎖骨下靜脈股靜脈氣胸(%<0.1-0.2血胸(%0.4-0.6感染(‰)6血栓形成(‰)1.2-30-138-34誤穿動脈(%6.25異位風險低風險高風險極低風險穿過右心房,(上行至頸內(腰靜脈叢)至下腔靜脈)靜脈,甚至穿至對側鎖骨下靜脈)如何選擇穿刺部位7所需材料中心靜脈穿刺套裝(我院用arow)治療包(消毒、鋪巾)無菌手套、口罩、帽子、手術衣·絡合碘、2%利多卡因、肝素鈉、生理鹽水5ml注射器、肝素帽、縫針、無菌敷料所需材料8深靜脈穿刺置管講義課件9頸內靜脈穿刺置管術頸內靜脈穿刺置管術10深靜脈穿刺置管講義課件11深靜脈穿刺置管講義課件12深靜脈穿刺置管講義課件13深靜脈穿刺置管講義課件14深靜脈穿刺置管講義課件15深靜脈穿刺置管講義課件16深靜脈穿刺置管講義課件17深靜脈穿刺置管講義課件18深靜脈穿刺置管講義課件19深靜脈穿刺置管講義課件20深靜脈穿刺置管講義課件21深靜脈穿刺置管講義課件22深靜脈穿刺置管講義課件23深靜脈穿刺置管講義課件24深靜脈穿刺置管講義課件25深靜脈穿刺置管講義課件26深靜脈穿刺置管講義課件27深靜脈穿刺置管講義課件28深靜脈穿刺置管講義課件29深靜脈穿刺置管講義課件30深靜脈穿刺置管講義課件31深靜脈穿刺置管講義課件32深靜脈穿刺置管講義課件33深靜脈穿刺置管講義課件34深靜脈穿刺置管講義課件35深靜脈穿刺置管講義課件36深靜脈穿刺置管講義課件37深靜脈穿刺置管講義課件38深靜脈穿刺置管講義課件39深靜脈穿刺置管講義課件40深靜脈穿刺置管講義課件41深靜脈穿刺置管講義課件42深靜脈穿刺置管講義課件43深靜脈穿刺置管講義課件44深靜脈穿刺置管講義課件45深靜脈穿刺置管講義課件46深靜脈穿刺置管講義課件47深靜脈穿刺置管講義課件48深靜脈穿刺置管講義課件49深靜脈穿刺置管講義課件50深靜脈穿刺置管講義課件51深靜脈穿刺置管講義課件52深靜脈穿刺置管講義課件53深靜脈穿刺置管講義課件54深靜脈穿刺置管講義課件55深靜脈穿刺置管講義課件56深靜脈穿刺置管講義課件57深靜脈穿刺置管講義課件58深靜脈穿刺置管講義課件59深靜脈穿刺置管講義課件60深靜脈穿刺置管講義課件61深靜脈穿刺置管講義課件62深靜脈穿刺置管講義課件63深靜脈穿刺置管講義課件64深靜脈穿刺置管講義課件65深靜脈穿刺置管講義課件66深靜脈穿刺置管講義課件67深靜脈穿刺置管講義課件68深靜脈穿刺置管講義課件69深靜脈穿刺置管講義課件70深靜脈穿刺置管講義課件71深靜脈穿刺置管講義課件72深靜脈穿刺置管講義課件73深靜脈穿刺置管講義課件74深靜脈穿刺置管講義課件75深靜脈穿刺置管講義課件76深靜脈穿刺置管講義課件77深靜脈穿刺置管講義課件78深靜脈穿刺置管講義課件79深靜脈穿刺置管講義課件80深靜脈穿刺置管講義課件81深靜脈穿刺置管講義課件82深靜脈穿刺置管講義課件83深靜脈穿刺置管講義課件84深靜脈穿刺置管講義課件85深靜脈穿刺置管講義課件86深靜脈穿刺置管講義課件87深靜脈穿刺置管講義課件88深靜脈穿刺置管講義課件89深靜脈穿刺置管講義課件90深靜脈穿刺置管講義課件91深靜脈穿刺置管講義課件92深靜脈穿刺置管講義課件93深靜脈穿刺置管講義課件94深靜脈穿刺置管講義課件95中心靜脈置管術中心靜脈置管術96什么是中心靜脈右心房連接的上下腔靜脈我們常用的穿刺路徑:鎖骨下、頸內、股靜脈、外周(PICC)什么是中心靜脈97深靜脈穿刺置管講義課件98監(jiān)測a危重病人搶救和大手術期行CVP監(jiān)測bSwan-Ganz導管監(jiān)測cPiCCO監(jiān)測監(jiān)測99●禁忌證廣泛上腔靜脈系統(tǒng)血栓形成米穿刺局部有感染*凝血功能障礙*不合作,燥動不安的病人●禁忌證100準備工作口談話簽字口患者的血小板計數(shù)、凝血功能、感染指標口選擇合適的穿刺點口體位鎖骨下靜脈穿刺需要墊肩頸內靜脈穿刺需要平臥甚至頭低腳高位股靜脈需要平臥準備工作101如何選擇穿刺部位并發(fā)癥不同穿刺部位頸內靜脈鎖骨下靜脈股靜脈氣胸(%<0.1-0.2血胸(%0.4-0.6感染(‰)6血栓形成(‰)1.2-30-138-34誤穿動脈(%6.25異位風險低風險高風險極低風險穿過右心房,(上行至頸內(腰靜脈叢)至下腔靜脈)靜脈,甚至穿至對側鎖骨下靜脈)如何選擇穿刺部位102所需材料中心靜脈穿刺套裝(我院用arow)治療包(消毒、鋪巾)無菌手套、口罩、帽子、手術衣·絡合碘、2%利多卡因、肝素鈉、生理鹽水5ml注射器、肝素帽、縫針、無菌敷料所需材料103深靜脈穿刺置管講義課件104頸內靜脈穿刺置管術頸內靜脈穿刺置管術105深靜脈穿刺置管講義課件106深靜脈穿刺置管講義課件107深靜脈穿刺置管講義課件108深靜脈穿刺置管講義課件109深靜脈穿刺置管講義課件110深靜脈穿刺置管講義課件111深靜脈穿刺置管講義課件112深靜脈穿刺置管講義課件113深靜脈穿刺置管講義課件114深靜脈穿刺置管講義課件115深靜脈穿刺置管講義課件116深靜脈穿刺置管講義課件117深靜脈穿刺置管講義課件118深靜脈穿刺置管講義課件119深靜脈穿刺置管講義課件120深靜脈穿刺置管講義課件121深靜脈穿刺置管講義課件122深靜脈穿刺置管講義課件123深靜脈穿刺置管講義課件124深靜脈穿刺置管講義課件125深靜脈穿刺置管講義課件126深靜脈穿刺置管講義課件127深靜脈穿刺置管講義課件128深靜脈穿刺置管講義課件129深靜脈穿刺置管講義課件130深靜脈穿刺置管講義課件131深靜脈穿刺置管講義課件132深靜脈穿刺置管講義課件133深靜脈穿刺置管講義課件134深靜脈穿刺置管講義課件135深靜脈穿刺置管講義課件136深靜脈穿刺置管講義課件137深靜脈穿刺置管講義課件138深靜脈穿刺置管講義課件139深靜脈穿刺置管講義課件140深靜脈穿刺置管講義課件141深靜脈穿刺置管講義課件142深靜脈穿刺置管講義課件143深靜脈穿刺置管講義課件144深靜脈穿刺置管講義課件145深靜脈穿刺置管講義課件146深靜脈穿刺置管講義課件147深靜脈穿刺置管講義課件148深靜脈穿刺置管講義課件149深靜脈穿刺置管講義課件150深靜脈穿刺置管講義課件151深靜脈穿刺置管講義課件152深靜脈穿刺置管講義課件153深靜脈穿刺置管講義課件154深靜脈穿刺置管講義課件155深靜脈穿刺置管講義課件156深靜脈穿刺置管講義課件157深靜脈穿刺置管講義課件158深靜脈穿刺置管講義課件159深靜脈穿刺置管講義課件160深靜脈穿刺置管講義課件161深靜脈穿刺置管講義課件162深靜脈穿刺置管講義課件163深靜脈穿刺置管講義課件164深靜脈穿刺置管講義課件165深靜脈穿刺置管講義課件166深靜脈穿刺置管講義課件167深靜脈穿刺置管講義課件168深靜脈穿刺置管講義課件169深靜脈穿刺置管講義課件170深靜脈穿刺置管講義課件171深靜脈穿刺置管講義課件172深靜脈穿刺置管講義課件173深靜脈穿刺置管講義課件174深靜脈穿刺置管講義課件175深靜脈穿刺置管講義課件176深靜脈穿刺置管講義課件177深靜脈穿刺置管講義課件178