Amateka yo kwinjira mumitsi yo hagati
1. 1929: Umuganga ubaga w’umudage Werner Forssmann yashyize catheter yinkari mu mitsi y’imbere y’ibumoso, maze yemeza na X-ray ko catheter yinjiye muri atrium iburyo.
2. 1950: Catheters yo hagati yimitsi ikorwa cyane nkuburyo bushya bwo kugera hagati
3. 1952: Aubaniac yatanze igitekerezo cyo gutobora imitsi ya subclavian, Wilson yaje gusaba CVC catheterisation ishingiye kumitsi ya subclavian
4
5. 1956: Forssmann, Cournand, Richards yatsindiye igihembo cyitiriwe Nobel mu buvuzi kubera uruhare bagize muri catheterisiyumu yumutima
6. 1968: Raporo yambere mucyongereza cyimbere yimbere yimbere kugirango ikurikirane umuvuduko wamaraso
7. 1970: Igitekerezo cya catheter ya tunnel cyatanzwe bwa mbere
8. 1978: Venous Doppler locator kugirango imbere yimitsi yimbere yimbere
9. 1982: Ikoreshwa rya ultrasound mu kuyobora imiyoboro yo hagati y’imitsi yavuzwe bwa mbere na Peters n'abandi.
10. 1987: Wernecke n'abandi babanje kuvuga ko hakoreshejwe ultrasound kugirango bamenye pneumothorax
11. 2001.
12. 2008: Ishuri rikuru ry’abaganga bo muri Amerika ryihutirwa ryerekana urutonde rwinjira mu miyoboro ya ultrasound "nkibyingenzi cyangwa ibyihutirwa byihutirwa".
13.2017: Amir n'abandi bavuga ko ultrasound ishobora gukoreshwa kugirango hemezwe CVC kandi ukuyemo pneumothorax kugirango ubike igihe kandi urebe neza
Igisobanuro cyo kwinjira mumitsi yo hagati
1. Muri rusange CVC bivuga kwinjiza catheteri mumitsi yo hagati binyuze mumitsi yimbere, imbere ya subclavian veine na femorale femorale, mubisanzwe isonga rya catheter iherereye muri vena cava isumba iyindi, vena cava yo hasi, ihuriro rya caval-atrial, iburyo bwa atrium cyangwa imitsi ya brachiocephalic, muribwo vena cava isumba izindi.Ihuriro rya Venous cyangwa cavity-atrial irahitamo
2. Kwinjiza periferique hagati ya catheter yo hagati ni PICC
3. Kwinjira mu mitsi yo hagati bikoreshwa cyane cyane:
a) Gutera inshinge za vasopressine, inositol, nibindi.
b) Catheters nini yo kwinjiza amazi yubuzima nibikomoka kumaraso
c) Catheter nini yo kuvura impyiko cyangwa kuvura plasma
d) Gucunga imirire y'ababyeyi
e) Kuvura imiti ya antibiotique cyangwa chimiotherapie igihe kirekire
f) Catheter ikonje
g) Amabati cyangwa catheteri kumirongo yindi, nka catheters ya arteri yimpyiko, insinga zihuta hamwe nuburyo bwa endovaskulaire cyangwa uburyo bwo gutabaza umutima, nibindi.
Amahame shingiro ya ultrasound-iyobowe na CVC
1.Ibitekerezo bya kanseri ya CVC gakondo ishingiye ku bimenyetso nyaburanga: biteganijwe anatomiya y'amaraso hamwe na patenti y'imitsi.
2. Amahame yubuyobozi bwa Ultrasound
a) Itandukaniro rya Anatomical: aho imitsi iherereye, hejuru yumubiri ibimenyetso bya anatomique ubwabyo;ultrasound itanga igihe-nyacyo cyo kureba no gusuzuma imiyoboro hamwe na anatomiya yegeranye
b) Indwara y'amaraso: Ultrasonography mbere yo gutangira irashobora gutahura trombose na stenosis mugihe (cyane cyane kubarwayi barembye cyane bafite ikibazo kinini cyo kuvura imitsi)
c) Kwemeza imitsi yashizwemo hamwe na catheter tip umwanya uhagaze: kwitegereza mugihe nyacyo cyo kuyobora ubuyobozi bwinjira mumitsi, imitsi ya brachiocephalic, vena cava yo hasi, atrium iburyo cyangwa vena cava isumba izindi
d) Kugabanya ibibazo: trombose, tamponade yumutima, gutobora arterial, hemothorax, pneumothorax
Guhitamo Ubushakashatsi nibikoresho
1. Ibiranga ibikoresho: 2D ishusho niyo shingiro, Doppler yamabara na Doppler irashobora gutandukanya imiyoboro nimiyoboro, imicungire yubuvuzi nkigice cyubuvuzi bw’abarwayi, sterile probe cover / couplant itanga ubwigunge bwa sterile
2. Guhitamo iperereza:
a) Kwinjira: Imitsi y'imbere na femorale imbere iba ifite cm 1-4 zubujyakuzimu munsi yuruhu, naho imitsi ya subclavian ikenera cm 4-7
b) imyanzuro ikwiye hamwe nibishobora guhinduka
c) Ubunini buto: 2 ~ 4cm z'ubugari, byoroshye kureba amashoka maremare kandi magufi y'imiyoboro y'amaraso, byoroshye gushyira iperereza n'urushinge.
d) 7 ~ 12MHz umurongo muto ugereranije ukoreshwa muri rusange;ntoya ya convex munsi ya clavicle, umupira wamaguru wabana
Uburyo bugufi-axis hamwe nuburyo burebure
Isano iri hagati yiperereza ninshinge igena niba iri mu ndege cyangwa hanze yindege
1. Urushinge rw'urushinge ntirushobora kugaragara mugihe cyo gukora, kandi umwanya wurushinge rugomba kugenwa no guhinduranya iperereza;ibyiza: umurongo mugufi wo kwiga, kwitegereza neza ingirabuzimafatizo, no gushyira byoroshye iperereza kubantu babyibushye nijosi rigufi;
2. Umubiri winshinge wuzuye hamwe ninshinge zirashobora kugaragara mugihe cyo kubaga;biragoye kubika imiyoboro yamaraso ninshinge mu ndege yerekana amashusho ya ultrasound igihe cyose
gihamye kandi gifite imbaraga
1. Uburyo buhamye, ultrasound ikoreshwa gusa mugusuzuma mbere yo gutangira no guhitamo ingingo zinjizwamo inshinge
2. Uburyo butangaje: igihe nyacyo ultrasound-iyobowe na puncture
3. Uburyo bwo kwerekana ibimenyetso byumubiri <uburyo buhagaze <uburyo bwa dinamike
Ultrasound-iyobowe na CVC puncture na catheterisation
1. Gutegura mbere yo gutangira
a) Kwandika amakuru y'abarwayi kugirango babike imbonerahamwe
b) Sikana urubuga rugomba gutoborwa kugirango wemeze anatomiya y'amaraso na patenti, kandi umenye gahunda yo kubaga
c) Hindura inyungu zishusho, ubujyakuzimu, nibindi kugirango ubone ishusho nziza
d) Shira ibikoresho bya ultrasound kugirango umenye neza ko aho utobora, iperereza, ecran n'umurongo wo kureba ari collinear
2. Ubuhanga bwo gukorana
a) Saline ya Physiologique ikoreshwa hejuru yuruhu aho kugirango ihuze kugirango ibuze ko yinjira mumubiri wumuntu
b) Ukuboko kutiganje gufashe iperereza ryoroheje kandi ryegamiye byoroheje umurwayi kugirango ahamye
c) Komeza amaso yawe kuri ecran ya ultrasound, kandi wumve impinduka zumuvuduko woherejwe nurushinge n'amaboko yawe (kumva ko watsinzwe)
d) Kumenyekanisha insinga ziyobora: Umwanditsi arasaba ko byibura cm 5 z'insinga ziyobora zashyirwa mu cyombo cyo hagati (ni ukuvuga, insinga iyobora igomba kuba byibura cm 15 uvuye ku ntebe y'urushinge);Ukeneye kwinjiza 20 ~ 30cm, ariko insinga iyobora yinjira cyane, biroroshye gutera arththmia
e) Kwemeza umwanya wumugozi uyobora: Sikana kumurongo muto hanyuma umurongo muremure wamaraso uva kumpera ya kure, hanyuma ukurikirane aho insinga ziyobora.Kurugero, mugihe imitsi yimbere yimbere yacumiswe, birakenewe kwemeza ko insinga iyobora yinjira mumitsi ya brachiocephalic.
f) Kora uduce duto hamwe na scalpel mbere yo kwaguka, dilator inyura mubice byose imbere yumuvuduko wamaraso, ariko wirinde gutobora imitsi yamaraso.
3. Umutego w'imbere w'imbere
a) Isano iri hagati yimitsi ya karoti nu mitsi yimbere: Anatomique, imitsi yimbere imbere iba iri hanze yimitsi.Mugihe gito-axis yogusikana, kubera ko ijosi rizengurutse, gusikana ahantu hatandukanye bigira impande zitandukanye, kandi imitsi hamwe nimiyoboro yuzuye.Fenomenon.
b) Guhitamo aho urushinge rwinjirira: diameter yegeranye ya diameter ni nini, ariko yegereye ibihaha, kandi ibyago byo kurwara pneumothorax ni byinshi;birasabwa gusikana kugirango hemezwe ko imiyoboro yamaraso aho yinjirira inshinge ari 1 ~ 2cm ziva kuruhu
c) Suzuma imitsi yose yimbere imbere, usuzume anatomiya nubushobozi bwumuvuduko wamaraso, wirinde trombus na stenosis kumwanya wacyu hanyuma ubitandukanye nimiyoboro ya karoti.
d) Irinde gutobora imiyoboro ya karoti: Mbere ya vasodilasiyo, aho gutobora hamwe nu mwanya wumugozi uyobora bigomba kwemezwa mubitekerezo birebire kandi bigufi.Kubwimpamvu z'umutekano, ishusho ndende ya axe yubuyobozi ikeneye kugaragara mumitsi ya brachiocephalic.
e) Guhindura umutwe: Uburyo bwa gakondo bwo gutobora uburyo bwo gutanga inama burasaba guhindura umutwe kugirango ugaragaze ibimenyetso byimitsi ya sternocleidomastoid no kwerekana no gukosora imitsi yimbere, ariko guhindura umutwe dogere 30 bishobora gutera imitsi yimbere hamwe nimiyoboro ya karoti. 54%, na ultrasound-iyobowe na puncture ntibishoboka.Birasabwa guhindukira
4.Subclavian vein catheterisation
a) Twabibutsa ko ultrasound scan yimitsi ya subclavian itoroshye
b) Ibyiza: Umwanya wa anatomique wumuvuduko wizewe ugereranije, worohewe no gutobora indege
c) Ubuhanga: Iperereza rishyirwa kuri clavicle muri fossa munsi yaryo, ryerekana inzira-ngufi ireba, hanyuma iperereza ikamanuka gahoro gahoro;tekiniki, imitsi ya axillary yacumiswe hano;hindura iperereza kuri dogere 90 kugirango werekane uburebure-burebure bw'amaraso, iperereza ryerekeje gato ku mutwe;iperereza rimaze guhagarara, urushinge rwacumiswe hagati rwagati, hanyuma urushinge rwinjizwa munsi yubuyobozi bwa ultrasound.
d) Vuba aha, microconvex ntoya hamwe na frequency yo hasi yakoreshejwe mukuyobora, kandi iperereza ni rito kandi irashobora kubona byimbitse
5. Catheterisation yumugore
a) Ibyiza: Irinde inzira z'ubuhumekero n'ibikoresho byo gukurikirana, nta ngaruka za pneumothorax na hemothorax
b) Nta bitabo byinshi kuri ultrasound-iyobowe na puncture.Abantu bamwe batekereza ko byizewe cyane gutobora hejuru yumubiri hamwe nibimenyetso bigaragara, ariko ultrasound ntabwo ikora.Ubuyobozi bwa Ultrasound burakwiriye cyane guhinduka kwa FV anatomical no gufata umutima.
c) Igihagararo cy'ibikeri kigabanya guhuzagurika hejuru ya FV hamwe na FA, kizamura umutwe kandi kirambura amaguru hanze kugirango cyagure imitsi y'amaraso.
d) Tekinike ni kimwe no mumitsi yimbere yimbere
Cardiac ultrasound iyobora insinga
1. Ultrasound ya TEE yumutima ifite aho ihagaze neza, ariko irangiza kandi ntishobora gukoreshwa muburyo busanzwe
2. Itandukaniro ryogutezimbere uburyo: koresha mikorobe zinyeganyeza umunyu usanzwe nkikintu gitandukanye, hanyuma winjire muri atrium iburyo mumasegonda 2 nyuma yo gusohoka kwa laminari kuva kuri catheter
3. Irasaba uburambe bunini mugusuzuma ultrasound yumutima, ariko irashobora kugenzurwa mugihe nyacyo, gishimishije
Ibihaha ultrasound scan kugirango wirinde pneumothorax
1. Ultrasound iyobowe nu mitsi yo hagati yo mu mitsi ntabwo igabanya gusa indwara ya pneumothorax, ahubwo inagira sensibilité nini kandi yihariye yo kumenya pneumothorax (irenze igituza X-ray)
2. Birasabwa kubishyira mubikorwa byo kwemeza nyuma yibikorwa, bishobora kugenzura byihuse kandi neza kuriri.Niba ihujwe nigice cyabanjirije umutima wa ultrasound, byitezwe kugabanya igihe cyo gutegereza cyo gukoresha catheter.
3. Ultrasound yibihaha: (amakuru yinyongera yo hanze, kubisobanuro gusa)
Ishusho isanzwe y'ibihaha:
Umurongo A: Umurongo mwiza wa hyperechoic unyerera uhumeka, ugakurikirwa n'imirongo myinshi ibangikanye, iringaniza, kandi ihujwe n'ubujyakuzimu, ni ukuvuga kunyerera ibihaha
M.
Mu bantu bamwe basanzwe, umwanya wanyuma wa intercostal hejuru ya diaphragm urashobora gutahura amashusho ari munsi ya 3 ya laser beam imeze nkibishusho bituruka kumurongo wububiko bwamatora, bikaguka bihagaritse hepfo ya ecran, kandi bigasubirana no guhumeka - B umurongo
Pneumothorax Ishusho:
Umurongo B urazimira, kunyerera kw'ibihaha birashira, kandi ikimenyetso cyo ku mucanga gisimbuzwa ikimenyetso cya barcode.Byongeye kandi, ikimenyetso cyibihaha gikoreshwa mukumenya urugero rwa pneumothorax, naho ingingo yibihaha igaragara aho ikimenyetso cyinyanja nicyapa cya barcode kigaragara ukundi.
Ultrasound-Iyobowe na CVC Amahugurwa
1. Kutumvikana ku mahugurwa no gutanga ibyemezo
2. Kumva ko tekinike yo kwinjiza buhumyi yatakaye mukwiga tekinike ya ultrasound ibaho;icyakora, nkuko tekinike ya ultrasound igenda ikwirakwira, guhitamo hagati yumutekano wumurwayi no kubungabunga tekinike zishobora kuba nke zikoreshwa bigomba gutekerezwa
3. Isuzuma ryubushobozi bwamavuriro rigomba gutangwa mugukurikirana imyitozo yubuvuzi aho gushingira ku mubare wabyo
mu gusoza
Urufunguzo rwa CVC ikora neza kandi itekanye ni ukumenya imitego nimbogamizi zubu buhanga usibye amahugurwa akwiye
Igihe cyo kohereza: Ugushyingo-26-2022
