沙丁格尔(Seldinger)穿刺技术 [复制链接]

农民

小学二年级

Rank: 7 Rank: 7 Rank: 7

护士币: 124 点
最后登录: 2014-6-26
注册时间: 2009-1-3
帖子: 400

电梯直达

1^#

发表于 2009-7-13 14:59:17 |只看该作者 |倒序浏览

·2015年护士执业资格考试网校保过班 ·2015年初级护师无忧通关班 ·2015年主管护师远程辅导精讲班

沙丁格尔穿刺法

viewfile.jpg (224.33 KB, 下载次数: 1)
Slowly insert the insertion needle or over the needle catheter into the vessel at a shallow angle (15-30 degrees), using standard technique.
Note:  If using insertion needle, attach a 10cc syringe to the needle to monitor flash back.
Observe for a blood return into the syringe or flashback chamber. Holding the needle stationary, advance the sheath into the vessel.
Release the tourniquet through the sterile drape without compromising the sterile field.
Maintain the stability of the introducer and advance it, if it passes easily.  Apply slight pressure on the vessel above the insertion site to minimize blood flow.
It is very important to observe the pattern of blood flow from the vessel to ascertain that a vein, not an artery, has been cannulated.  The color of the blood is not always a reliable indicator.  The pulsating flow of blood is the true indicator of arterial access, even in patients with low blood pressure.
Remove the needle from the introducer, leaving the introducer in place (only necessary for over the needle cannula).
Insert the flexible end of the guidewire into the introducer.  Advance the guidewire 5 to 10 cm into the vein
Caution:  If the guidewire must be withdrawn while the needle is inserted, remove both the needle and the guidewire as a unit to prevent the needle from damaging or shearing the guidewire.

穿入导丝

viewfile(1).jpg (218.88 KB, 下载次数: 0)
Gently withdraw and remove the introducer cannula, holding the guidewire in position.

撤出针头，加大针口

viewfile(2).jpg (171.88 KB, 下载次数: 0)
If necessary, a small incision may be made adjacent to the guidewire to facilitate insertion of the sheath and dilator.

插入扩张器

viewfile(3).jpg (187.44 KB, 下载次数: 0)
Advance the small sheath and dilator together as a unit over the guidewire using a slight rotational motion.

扩张器沿着导丝推入静脉内

viewfile(4).jpg (199.75 KB, 下载次数: 0)

留下套管，撤出导丝和扩张器

viewfile(5).jpg (169.03 KB, 下载次数: 0)

进管

viewfile(6).jpg (165.84 KB, 下载次数: 0)
Withdraw the dilator and guidewire, leaving the small sheath in place.
Place a finger over the orifice of the sheath to minimize blood loss and risk of air embolism. The risk of air embolism is reduced by performing this part of the procedure with the patient performing the valsalva maneuver.
Thread the PICC into the vein through the dilator to the depth determined by previous measurements, advancing the catheter slowly.
Note: Rapid entry may cause venospasam.

当导管进入测量长度时，剥离套管

viewfile(7).jpg (197.25 KB, 下载次数: 0)
Continue to advance the catheter, for central placement, when the tip has advanced to the shoulder, have the patient turn head (chin on shoulder) toward the insertion site to prevent possible cannulation into the jugular vein
WARNING: Avoid positioning the catheter tip in the right artium.
Complete catheter advancement to the desired location.

PICC固定器和敷贴

viewfile(8).jpg (57.53 KB, 下载次数: 0)
Step 9:  PICC/midline Securement and Dressing
Place two anchor tapes over suture wing or bifurcation.
Form “S” curve in the catheter.
Place a folded two by two gauze over the insertion site.  (during first 24 hours after placement)
Place a third anchor tape, sticky side up, under catheter just above the suture wing or bifurcation.
Chevron third anchor tape on top of first two anchor tapes.
Place transparent dressing over suture wing or bifurcation and catheter hub.
Obtain radiographic confirmation
Intermittent warm moist packs may be applied to the upper arm to prevent the occurrence of phlebitis.
Document entire procedure

Seldinger, 穿刺, 技术, 沙丁格尔