Nalane ea phihlello ea venous bohareng
1. 1929: Ngaka e buoang ea Lejeremane Werner Forssmann o ile a beha catheter ea ho ntša moroto ho tloha mothapong o ka pele oa kubita o ka letsohong le letšehali, ’me a tiisa ka X-ray hore catheter e kene atrium e nepahetseng.
2. 1950: Li-catheter tsa venous tse bohareng li hlahisoa ka bongata e le khetho e ncha bakeng sa phihlello e bohareng.
3. 1952: Aubaniac o ile a etsa tlhahiso ea ho phunya methapo ea subclavia, Wilson ka mor'a moo o ile a etsa tlhahiso ea CVC catheterization e thehiloeng ho subclavia vein.
4. 1953: Sven-Ivar Seldinger o ile a etsa tlhahiso ea ho nkela nale e thata sebaka ka catheter ea tšepe e tataisang terata bakeng sa ho phunya phuncture ea peripheral, mme mokhoa oa Seldinger e ile ea e-ba theknoloji ea phetoho bakeng sa ho beoa ha catheter e bohareng.
5. 1956: Forssmann, Cournand, Richards ba ile ba hapa Khau ea Nobel ea Bongaka ka lebaka la tlatsetso ea bona ho catheterization ea pelo.
6. 1968: Tlaleho ea pele ka Senyesemane ea phihlello ea ka hare ea venous bakeng sa tlhahlobo ea khatello ea methapo e bohareng.
7. 1970: Khopolo ea catheter ea kotopo e ile ea hlahisoa ka lekhetlo la pele
8. 1978: Sebaka sa Venous Doppler bakeng sa ho tšoaea bokaholimo ba 'mele oa mothapo oa jugular
9. 1982: Tšebeliso ea ultrasound ho tataisa phihlello ea methapo e bohareng e tlalehiloe pele ke Peters et al.
10. 1987: Wernecke et al o ile a tlaleha ka lekhetlo la pele tšebeliso ea ultrasound ho lemoha pneumothorax
11. 2001: The Bureau of Health Research and Quality Evidence Report e thathamisa venous access point-of-care ultrasound e le e 'ngoe ea mekhoa e 11 e lokeloang ke phahamiso e atileng.
12. 2008: American College of Emergency Physicians e thathamisa phihlello ea venous e tataisoang ke ultrasound e le "ts'ebetso ea mantlha kapa ea mantlha ea ultrasound ea tšohanyetso"
13.2017: Amir et al fana ka maikutlo a hore ultrasound e ka sebelisoa ho tiisa sebaka sa CVC le ho kenyelletsa pneumothorax ho boloka nako le ho netefatsa ho nepahala
Tlhaloso ea ho fihlella bohareng ba venous
1. Ka kakaretso CVC e bolela ho kenngoa ha catheter ka har'a mothapo o bohareng ka mothapo o ka hare oa jugular, subclavian vein le femoral vein, hangata ntlha ea catheter e teng sebakeng se phahameng sa vena cava, inferior vena cava, caval-atrial junction, atrium e nepahetseng kapa mothapo oa brachiocephalic, oo har'a oona ho nang le vena cava e phahameng.Ho khethoa venous kapa cavity-atrial junction
2. Catheter e bohareng ea venous e kentsoeng ka peripheral ke PICC
3. Ho kena ka har'a venous ho sebelisoa haholo bakeng sa:
a) Ente e matla ea vasopressin, inositol, joalo-joalo.
b) Li-catheter tse nang le li-catheter tse kholo bakeng sa ho tšeloa ha metsi a resuscitation le lihlahisoa tsa mali
c) Catheter e kholo ea bore bakeng sa phekolo ea renal replacement kapa plasma exchange therapy
d) Tsamaiso ea phepo ea batsoali
e) Kalafo ea nako e telele ea lithibela-mafu kapa chemotherapy
f) Ho pholisa catheter
g) Sheaths kapa catheters bakeng sa mela e meng, joalo ka pulmonary artery catheters, pacing wires and endovascular procedures or for heart interventions, etc.
Melao-motheo ea motheo ea ho beha CVC e tataisoang ke ultrasound
1. Likhopolo tsa CVC ea setso e ipapisitseng le matšoao a anatomical: anatomy e lebelletsoeng ea vascular le patency ea methapo.
2. Melao-motheo ea Tataiso ea Ultrasound
a) Phapang ea anatomical: sebaka sa methapo, matšoao a sebopeho sa 'mele ka bobona;ultrasound e lumella pono ea nako ea sebele le tlhahlobo ea likepe le anatomy e haufi
b) Vascular patency: Preoperative ultrasonography e ka lemoha thrombosis le stenosis ka nako (haholo-holo ho bakuli ba kulang haholo ba nang le ts'oaetso e phahameng ea methapo e tebileng ea thrombosis)
c) Tiisetso ea boemo ba mothapo o kentsoeng le catheter tip: pono ea nako ea 'nete ea ho kena ha guidewire ka har'a mothapo, brachiocephalic vein, inferior vena cava, atrium e nepahetseng kapa vena cava e phahameng.
d) Mathata a fokotsehileng: thrombosis, tamponade ea pelo, ho phunya ha arterial, hemothorax, pneumothorax.
Khetho ea Probe le Lisebelisoa
1. Likarolo tsa lisebelisoa: Setšoantšo sa 2D ke motheo, 'mala oa Doppler le Doppler ea pulsed e ka khetholla pakeng tsa methapo le methapo, tsamaiso ea rekoto ea bongaka e le karolo ea litlaleho tsa bongaka ba mokuli, sekoaelo sa sterile probe / couplant se tiisa ho itšehla thajana.
2. Khetho ea lipatlisiso:
a) Ho kenella: Methapo ea ka hare ea jugular le ea botšehali hangata e botebo ba 1-4 cm ka tlas'a letlalo, 'me mothapo oa subclavia o hloka 4-7 cm.
b) tharollo e loketseng le tsepamiso e ka fetolehang
c) Sesebelisoa sa boholo bo nyane: 2 ~ 4cm ka bophara, ho bonolo ho bona lilepe tse telele le tse khutšoane tsa methapo ea mali, ho bonolo ho beha probe le nale.
d) 7 ~ 12MHz tse nyenyane tse nang le mela e mengata e sebelisoang ka kakaretso;e nyenyane convex tlas'a clavicle, bana hockey thupa probe
Mokhoa oa axis e khuts'oane le mokhoa oa axis e telele
Kamano pakeng tsa probe le nale e etsa qeto ea hore na e ka sefofaneng kapa e tsoile sefofaneng
1. Nōka ea nale e ke ke ea bonoa nakong ea ts'ebetso, 'me boemo ba ntlha ea nale bo hloka ho khethoa ka ho sotha probe ka matla;melemo: nako e khuts'oane ea ho ithuta, pono e ntle ea lisele tsa perivascular, le ho behoa habonolo ha probe bakeng sa batho ba mafura le melala e mekhutšoanyane;
2. 'Mele o feletseng oa nale le ntlha ea nale e ka bonoa nakong ea ts'ebetso;ho thata ho boloka methapo ea mali le linale sefofaneng sa litšoantšo sa ultrasound ka linako tsohle
e tsitsitseng le e matla
1. Mokhoa o tsitsitseng, ultrasound e sebelisoa feela bakeng sa tlhahlobo ea pele ho ts'ebetso le khetho ea lintlha tsa ho kenya nale
2. Mokhoa o matla: ho phunya ka nako ea sebele ea ultrasound
3. Mokhoa oa ho tšoaea holim'a 'mele <mokhoa o tsitsitseng <mokhoa o matla
Ho phunya CVC e tataisoang ke Ultrasound le catheterization
1. Tokisetso pele ho opereishene
a) Ngoliso ea tlhahisoleseling ea mokuli ho boloka lirekoto tsa chate
b) Hlakola sebaka seo se tla phunngoa ho netefatsa anatomy ea vascular le patency, le ho tseba moralo oa ho buuoa.
c) Fetola phaello ea setšoantšo, botebo, joalo-joalo ho fumana boemo bo botle ba setšoantšo
d) Beha lisebelisoa tsa ultrasound ho etsa bonnete ba hore sebaka sa ho phunya, probe, skrini le mohala oa pono ke colinear
2. Tsebo ea Intraoperative
a) Letsoai la 'mele le sebelisoa holim'a letlalo sebakeng sa couplant ho thibela couplant ho kena' meleng oa motho.
b) Letsoho le sa laoleheng le tšoara mochine hanyenyane 'me le itšetlehile habobebe khahlanong le mokuli bakeng sa ho tsitsisa.
c) Boloka mahlo a hao a tsepame skrineng sa ultrasound, 'me u utloe khatello e fetoha e khutlisetsoa morao ke nale ka matsoho a hau (maikutlo a ho hloleha)
d) Ho hlahisa terata e tataisang: Mongoli o khothaletsa hore bonyane 5 cm ea terata e tataisang e kenngoe ka har'a sejana sa venous se bohareng (ke hore, terata ea tataiso e lokela ho ba bonyane 15 cm ho tloha setulong sa nale);U hloka ho kenya 20 ~ 30cm, empa mohala oa tataiso o kena ka botebo haholo, ho bonolo ho baka arrhythmia.
e) Netefatso ea boemo ba terata e tataisang: Skena ka har'a axis e khuts'oane ebe ho latela selikalikoe se selelele sa mothapo oa mali ho tloha pheletsong ea distal, 'me u latele boemo ba terata e tataisang.Ka mohlala, ha mothapo oa ka hare oa jugular o phunyeletsoa, ho hlokahala ho netefatsa hore mohala oa tataiso o kena mothapong oa brachiocephalic.
f) Etsa sekhahla se senyenyane ka scalpel pele se atolosoa, "dilator" e feta har'a lisele tse ka pele ho mothapo oa mali, empa qoba ho phunya mothapo oa mali.
3. Sefi sa ka hare sa Jugular Vein Cannulation
a) Kamano pakeng tsa mothapo oa carotid le mothapo oa ka hare oa jugular: Ka mokhoa oa anatomically, mothapo o ka hare oa jugular hangata o fumaneha ka ntle ho mothapo.Nakong ea ho hlahloba nako e khutšoanyane, hobane molala o pota-potile, ho hlahloba libakeng tse fapaneng ho etsa li-angles tse sa tšoaneng, 'me ho ka etsahala methapo le methapo ea mali.Phenomenon.
b) Khetho ea sebaka sa ho kena ka nale: bophara ba tube e proximal bo boholo, empa bo haufi le matšoafo, 'me kotsi ea pneumothorax e phahame;ho kgothaletswa ho hlahloba ho netefatsa hore mothapo oa mali sebakeng sa nale o botebo ba 1 ~ 2cm ho tloha letlalong.
c) Hlakola mothapo oohle oa ka hare oa jugular esale pele, lekola sebōpeho le patency ea methapo ea mali, qoba thrombus le stenosis sebakeng sa ho phunya ebe o e arola ho methapo ea carotid.
d) Qoba ho phunyeha ha methapo ea carotid: Pele ho vasodilation, ntlha ea ho phunya le boemo ba terata ea tataiso li hloka ho netefatsoa ka pono e telele le e khutšoanyane ea axis.Bakeng sa mabaka a tšireletso, setšoantšo se selelele sa axis sa terata ea tataiso se hloka ho bonoa mothapong oa brachiocephalic.
e) Ho fetola hlooho: Mokhoa o tloaelehileng oa ho tšoaea ho phunya o khothalletsa ho fetola hlooho ho totobatsa mesifa ea sternocleidomastoid le ho pepesa le ho lokisa mothapo o ka hare oa jugular, empa ho fetola hlooho ea likhato tse 30 ho ka etsa hore mothapo o ka hare oa jugular le mothapo oa carotid o kopane ho feta. 54%, mme ho phunya ka tataiso ea ultrasound ha ho khonehe.E kgothaletswa ho reteleha
4.Subclavia vein catheterization
a) Ho lokela ho hlokomeloa hore tlhahlobo ea ultrasound ea methapo ea subclavia e batla e le thata
b) Melemo: Boemo ba anatomical ba mothapo bo batla bo tšepahala, bo loketseng ho phunngoe ka sefofaneng.
c) Tsebo: The probe e behiloe haufi le clavicle ka fossa ka tlaase ho eona, ho bontša pono e khutšoanyane ea axis, 'me probe e thella butle-butle bohareng;ka botsebi, mothapo oa axillary o phunyeletsoa mona;fetola probe likhato tse 90 ho bontša pono ea nako e telele ea methapo ea mali , probe e sekametse hanyenyane hloohong;ka mor'a hore probe e tsitse, nale e phunyeletsoa ho tloha bohareng ba lehlakore la probe, 'me nale e kenngoa tlas'a tataiso ea nako ea sebele ea ultrasound.
d) Haufinyane tjena, phuncture e nyane ea microconvex e nang le maqhubu a tlase hanyane e sebelisitsoe ho tataisa, 'me probe e nyane mme e khona ho bona botebo.
5. Catheterization ea methapo ea botšehali
a) Melemo: Qoba hole le pampiri ea ho hema le lisebelisoa tsa ho beha leihlo, ha ho kotsi ea pneumothorax le hemothorax.
b) Ha ho na lingoliloeng tse ngata mabapi le ho phunya ka tataiso ea ultrasound.Batho ba bang ba nahana hore hoa tšepahala haholo ho phunya bokaholimo ba 'mele ka matšoao a hlakileng, empa ultrasound ha e sebetse hantle.Tataiso ea Ultrasound e loketse haholo bakeng sa phapang ea anatomical ea FV le ho tšoaroa ha pelo.
c) Boemo ba leoto la senqanqane bo fokotsa ho kopana ha bokaholimo ba FV le FA, bo phahamisa hlooho le ho lelefatsa maoto ka ntle ho atolosa lumen ea venous.
d) Thekniki e tšoana le ea ho phunya methapo ea ka hare ea jugular
Cardiac ultrasound guide wire positioning
1. TEE cardiac ultrasound e na le ntlha e nepahetseng ka ho fetisisa, empa e kotsi 'me e ke ke ea sebelisoa kamehla.
2. Mokhoa oa ho ntlafatsa phapano: sebelisa li-microbubble ka har'a saline e tloaelehileng e sisinyehang e le ntho e fapaneng, 'me u kenye atrium e nepahetseng nakong ea metsotsoana e 2 ka mor'a ho ntša laminar ho tsoa ntlheng ea catheter.
3. E hloka phihlelo e batsi ea ho hlahloba pelo ea ultrasound, empa e ka netefatsoa ka nako ea sebele, e khahlehang.
Tlhahlobo ea ultrasound ea matšoafo ho thibela pneumothorax
1. Ultrasound-guided central venous puncture ha e fokotse feela ketsahalo ea pneumothorax, empa hape e na le kutloisiso e phahameng le e khethehileng bakeng sa ho lemoha pneumothorax (e phahameng ho feta X-ray ea sefuba)
2. Ho kgothaletswa ho e kenyelletsa ts'ebetsong ea tiiso ea postoperative, e ka hlahlobang ka potlako le ka nepo haufi le bethe.Haeba e kopantsoe le karolo e fetileng ea ultrasound ea pelo, ho lebeletsoe ho khutsufatsa nako ea ho leta bakeng sa tšebeliso ea catheter.
3. Lung ultrasound: (lintlha tsa tlatsetso tsa kantle, bakeng sa litšupiso feela)
Setšoantšo se tloaelehileng sa matšoafo:
Mola A: Mola oa pleural hyperechoic o thellang ka ho phefumoloha, o lateloa ke mela e mengata e bapileng le eona, e lekanang, 'me e fokotsehile ka botebo, ke hore, ho thella ha matšoafo.
M-ultrasound e bontšitse hore mohala oa hyperechoic o khutlelang tseleng ea probe ka phefumoloho o ne o tšoana le leoatle, 'me mohala oa pectoral o ne o tšoana le lehlabathe, ke hore, letšoao la lebōpong la leoatle.
Ho batho ba bang ba tloaelehileng, sebaka sa ho qetela sa intercostal ka holim'a diaphragm se khona ho bona litšoantšo tse ka tlaase ho 3 tse kang li-laser tse tsoang moleng oa hlobo ea pectoral, li fetela holimo ka tlaase ho skrine, 'me li khutlela morao ka ho hema-B line.
Setšoantšo sa Pneumothorax:
Mohala oa B oa nyamela, ho thella ha matšoafo ho nyamela, 'me letšoao la lebōpo le nkeloa sebaka ke letšoao la barcode.Ho phaella moo, letšoao la ntlha ea matšoafo le sebelisoa ho fumana boholo ba pneumothorax, 'me ntlha ea matšoafo e hlaha moo letšoao la lebopo le letšoao la barcode le hlahang ka tsela e fapaneng.
Thupelo ea CVC e tataisoang ke Ultrasound
1. Khaello ea tumellano mabapi le maemo a koetliso le setifikeiti
2. Maikutlo a hore mekhoa ea ho kenya bofofu e lahlehile ho ithuta mekhoa ea ultrasound e teng;leha ho le joalo, ha mekhoa ea ultrasound e ntse e ata haholo, khetho pakeng tsa polokeho ea mokuli le tlhokomelo ea mekhoa e ka 'nang ea se ke ea sebelisoa e tlameha ho nkoa.
3. Tekanyetso ea bokhoni ba tleliniki e lokela ho fumanoa ka ho shebella boikoetliso ba tleliniki ho fapana le ho itšetleha ka palo ea lits'ebetso.
ha re phethela
Senotlolo sa CVC e tataisoang ke ultrasound e sebetsang hantle le e bolokehileng ke tlhokomeliso ea maraba le mefokolo ea mokhoa ona ho kenyelletsa koetliso e nepahetseng.
Nako ea poso: Nov-26-2022
