Central venous access devices (CVAD) yog cov hlab ntsha hauv cov hlab ntsha uas tuaj yeem nyob hauv qhov chaw rau lub lis piam, hli lossis qee xyoo. Muaj ntau hom CVADs, thiab nplooj ntawv no yuav tham txog qee yam uas koj tuaj yeem muab rau kuv. Lawv tau siv los xa koj cov kev kho mob ncaj qha rau hauv koj cov hlab ntshav (intravenously) thiab yog lwm txoj hauv kev muaj cannula.
CVADs tau muab tso rau hauv ntau txoj hauv kev, tab sis qhov kawg ntawm lub catheter ib txwm nyob hauv cov hlab ntsha loj saum koj lub siab.
Cov hauv qab no yog qee qhov laj thawj uas koj tuaj yeem thov, lossis tuaj yeem muab CVAD.
- Koj tab tom kho ntau tshaj 3 lub hlis
- Koj yuav tsum tau noj tshuaj ntau lossis kua dej hauv lub sijhawm luv luv
- Koj tab tom muaj cov tshuaj uas yuav ua rau muaj kev puas tsuaj rau cov hlab ntsha me
- Koj tab tom muaj cov txheej txheem apheresis (xws li khaws cov qia hlwb)
- Koj muaj cov hlab ntsha nyuaj rau cannulate
- Koj ntshai koob heev.
Hom ntawm central venous access devices
- Peripherally Inserted Central Catheter (PICC)
- Tsis-Tunnelled Catheter (CVC)
- Tunnelled Central Venous Catheter (Hickman).
- Implanted Chaw nres nkoj (Port-A-Cath)
saum toj no: Peripherally inserted central catheter (PICC)
Peripherally inserted central catheter (PICC)
PICC kab yog ib qho muag, me me, ntev, hollow raj (catheter) uas muab tso rau hauv cov hlab ntsha loj hauv koj sab caj npab saum toj ntawm lub luj tshib. Nws maj mam thawb mus rau hauv cov hlab ntsha hauv koj txhais caj npab thiab qhov kawg ntawm nws nres hauv cov hlab ntsha loj dua li ntawm koj lub siab.
Ib txoj kab PICC tuaj yeem muab tso rau hauv (ntxig), hauv chav haujlwm hluav taws xob, kev ua yeeb yam, ntawm koj lub txaj thaum nyob hauv tsev kho mob, lossis chav ua haujlwm. Tej zaum koj yuav tau txais tshuaj loog hauv zos ua ntej lawv ntxig PICC kom loog hauv cheeb tsam, yog li koj yuav tsum tsis txhob mob. PICC kab tuaj yeem muab tso rau ntawm koj tus kws kho mob, kws kho mob tshwj xeeb lossis kws kho mob hluav taws xob, nyob ntawm cov cai hauv koj lub tsev kho mob.
Koj tuaj yeem thov rau PICC kab, lossis nws tuaj yeem muab rau koj yog tias koj tau txais kev kho mob uas xav tias yuav kav ntev tshaj li ib lub lim tiam, tab sis tsawg dua 6 lub hlis. Yog tias koj qhov kev kho mob yuav tsum kav ntev tshaj li rau lub hlis, CVAD sib txawv yuav raug muab.
Koj tsis tuaj yeem ua luam dej nrog PICC lossis tso PICC hauv qab dej. Koj tseem yuav tau khaws nws npog thaum koj da dej. Koj tus kws saib xyuas neeg mob yuav tuaj yeem muab cov ntaub ntawv ntxiv rau koj txog kev tswj hwm nrog PICC hauv tsev.
Management
- Koj yuav tsum muaj PICC redresses thiab cov bungs hloov tsawg kawg ib zaug hauv ib lub lis piam. Qhov no feem ntau yog ua nyob rau hauv chav tsev hnub lossis hauv pawg ntseeg yog tias koj nyob hauv tsev kho mob. Qee zaum, tus kws saib xyuas neeg mob tuaj yeem ua qhov hnav khaub ncaws thiab hloov pauv ntawm koj tus kws kho mob hauv zos - txawm tias qhov no tsis muaj ib txwm muaj thiab tsis yog txhua tus kws saib xyuas neeg mob tau txais kev cob qhia hauv kev tswj PICCs.
- Koj tus PICC yuav tsum tau yaug yam tsawg ib zaug hauv ib lub lis piam yog tias koj tsis tau muaj tshuaj lossis lwm yam kua dej los ntawm nws.
- Yog tias koj tsis xav tau PICC ntxiv lawm, nws tuaj yeem raug tshem tawm los ntawm tus kws saib xyuas neeg mob hauv chav saib xyuas hnub lossis pawg ntseeg.
Totally Implantable Venous Access Device (TIVAD)
Ib qho implantable venous access ntaus ntawv (yav tas los hu ua qhov chaw nres nkoj-a-cath) yog ib qho cuab yeej tso rau hauv qab koj daim tawv nqaij mus rau hauv lub hnab tshos subcutaneous (fatty). Lub TIVAD muaj ib lub reservoir uas muaj peev xwm hnov nyob rau hauv koj daim tawv nqaij. Lub catheter yog muab tso rau hauv ib qho ntawm koj cov hlab ntsha loj. Nws yog siv thaum koj xav tau cov tshuaj intravenously - rau hauv koj cov leeg lossis cov hlab ntsha.
Thaum twg TIVAD yog qhov kev xaiv zoo?
TIVAD yog ib lub tswv yim zoo yog tias koj yuav tau txais kev kho mob ntau dua peb lub hlis, lossis yog tias koj pab neeg kho mob muaj teeb meem muab cov cannula rau hauv koj cov hlab ntsha. Thaum koj xav tau tshuaj lossis kuaj ntshav, koj tus kws saib xyuas neeg mob yuav muab ib rab koob los ntawm koj daim tawv nqaij thiab tso rau hauv lub pas dej. Koj yuav tau hnav khaub ncaws me me thaum nws muaj koob. Thaum cov tshuaj tiav lawm, lawv yuav muab rab koob tawm. Cov koob tuaj yeem nyob hauv mus txog 7 hnub.
Thaum koj muaj rab koob hauv TIVAD nws hais tias nkag tau. Thaum tsis muaj koob hauv TIVAD yog ua txhaum. Koj tseem tuaj yeem ua luam dej thiab da dej zoo li qub thaum koj TIVAD tsis tuaj yeem, tab sis koj tsis tuaj yeem ua luam dej thaum nws nkag. Koj tseem yuav tau khaws nws npog hauv da dej thaum nws nkag mus.
Lub TIVAD yog muab tso rau ntawm ib tug kws phais neeg los yog ib tug interventional radiologist nyob rau hauv cov tshuaj loog los yog lub teeb sedation.
Nws feem ntau yuav siv li 7-10 hnub los kho. Yog tias qhov chaw nres nkoj yuav tsum tau siv tam sim ntawd, tus kws phais tuaj yeem nkag mus rau nws thiab tawm ntawm rab koob thaum nws muab tso rau hauv. Txwv tsis pub nws yuav o tuaj yeem nkag tau li ntawm ib lub lis piam.
Kev paub ntawm tus neeg mob nrog qhov chaw nres nkoj-a-cath (TIVAD)
Hnov Venuja tham txog nws qhov kev paub nrog TIVAD (port-a-cath) thaum nyob hauv tsev kho mob.
Management of TIVAD
- Thaum TIVAD xav tau nkag mus, nws tau ua tiav nrog rab koob hu ua 'gripper' koob
- Ib rab koob gripper tuaj yeem nyob hauv ib lub lis piam ua ntej lawv yuav tsum tau hloov
- Thaum koj lub voj voog kho tau tiav lawm thiab cov koob gripper raug tshem tawm (koj TIVAD yog deaccessed)
- Qhov zoo tshaj plaws ntawm qhov chaw nres nkoj yog tias lawv tuaj yeem nyob twj ywm rau ntau xyoo thiab thaum lub koob gripper raug tshem tawm tsis muaj dab tsi dai ntawm qhov chaw nres nkoj thiab koj cov tawv nqaij tiv thaiv nws los ntawm kev kis kab mob.
- Thaum tshem tawm qhov chaw nres nkoj, qhov no yog txoj kev phais (hnub txheej txheem).
Tsis yog-tunnelled central venous catheter (CVC)
Tsis yog-tunnelled central venous catheters (CVCs) yog lub sij hawm luv luv catheters thiab yuav tsum tau muab tshem tawm sai li sai tau thaum lawv tsis tas yuav tsum tau.
CVCs uas tsis yog-tunnelled tuaj yeem muab tso rau hauv cov hlab ntsha subclavian, lossis cov leeg jugular hauv koj lub caj dab lossis cov leeg femoral hauv koj lub puab tsaig - txawm tias cov leeg femoral feem ntau siv rau cov menyuam yaus. Txawm hais tias cov hlab ntsha twg CVC tau muab tso rau hauv, qhov kawg qhov kawg yog nyob rau hauv lub superior lossis inferior vena cava - cov hlab ntsha loj nyob saum koj lub siab.
CVC yog tuav nyob rau hauv qhov chaw nrog stitches los yog ib tug tshwj xeeb clamp uas txuas rau koj daim tawv nqaij. Daim duab hauv qab no qhia txog CVC uas tsis yog-tunnelled nrog peb lumens, tuav nyob rau hauv qhov chaw nrog stitches.
Management
- Hnav khaub ncaws thiab lub kaus mom ntawm cov kab yuav tsum tau hloov tsawg kawg ib zaug hauv ib lub lis piam
- Txhua lumen ntawm kab yuav tsum tau yaug ib zaug hauv ib lub lis piam
- Lawv tuaj yeem raug tshem tawm yooj yim los ntawm kev rub tawm thaum tsis muaj kev siv ntxiv rau lawv
Tunnelled cuffed-centrally ntxig central catheter (tc-CICC)
Tej zaum koj yuav xav tau ib qho tunnelled cuffed - centrally inserted central catheter (tc-CICC) yog tias koj yuav mus rau cov tshuaj txhaj tshuaj mus ntev.
Lub tc-CICC yog lub hauv paus kab catheter uas muab tso rau ntawm sab xis ntawm koj lub hauv siab phab ntsa. Nws yog ib qho mos, me, ntev, hollow catheter uas muab tso rau hauv cov hlab ntsha hauv koj lub hauv siab thiab xaus rau hauv cov hlab ntsha loj dua li ntawm koj lub siab.
Hom tc-CICC
Cov hom tseem ceeb ntawm tc-CICC siv hauv Australian yog HICKMANs thiab Broviacs. Lawv tuaj yeem yog ib qho (1), ob (2) lossis triple (3) lumen catheter. Daim duab saum toj no qhia tias ob lub lumen HICKMAN zoo li cas.
Thaum tc-CICC thawj zaug muab tso rau hauv, koj yuav muaj qee qhov stitches tuav nws hauv qhov chaw thiab hnav khaub ncaws saum toj kawg nkaus. Muaj me ntsis cuff ntawm lub catheter uas zaum hauv qab koj daim tawv nqaij, thiab koj cov tawv nqaij loj hlob nyob rau sab saum toj ntawm lub cuff ua me ntsis qhov hauv qab koj daim tawv nqaij. Thaum lub qhov av tau tsim kom zoo, koj tuaj yeem lossis tseem tsis xav tau hnav khaub ncaws saum toj kawg nkaus.
Ib tug tc-CICC yog tso los ntawm ib tug kws phais los yog ib tug interventional radiologist nyob rau hauv tshuaj loog los yog lub teeb sedation. Feem ntau nws yuav siv li 7-10 hnub los kho.
Management
- Qhov no yuav nyob ntawm txoj cai ntawm lub tsev kho mob uas koj tab tom kho.
- Lawv feem ntau yuav tsum tau yaug ib lub lis piam.
- Cov kaus mom ntawm qhov kawg ntawm kab feem ntau yuav tsum tau hloov tsawg kawg ib zaug hauv ib lub lis piam
- Thaum koj tsis xav tau koj tc-CICC nws yuav raug tshem tawm. Koj tus kws kho mob lossis tus kws saib xyuas neeg mob yuav ntsuas koj thiab kab ua ntej nws raug tshem tawm los txiav txim seb txoj hauv kev zoo tshaj plaws los tshem tawm nws. Nws tuaj yeem raug tshem tawm hauv chav saib xyuas hnub, chav haujlwm hluav taws xob lossis chaw ua yeeb yam ua haujlwm.
Thaum twg yuav tsum hu rau koj tus kws kho mob
Hu rau koj tus kws kho mob lossis tus kws saib xyuas neeg mob yog tias koj muaj:
- Qhov kub ntawm 38 degrees lossis siab dua
- Txog siav ua tsis taus pa
- Mob hauv siab los yog lub plawv dhia ceev
- Liab, mob, o, los ntshav, los yog kua dej los ntawm los yog ib ncig ntawm koj CVAD
- Liab, mob lossis o ntawm koj txhais caj npab, caj dab, lossis hauv siab
- Kev puas tsuaj lossis tawg lossis tawg hauv PICC kab lossis CVC kab
- Qhov kub hnyiab lossis o ntawm koj CVAD thaum koj kho, lossis txhua lub sijhawm.
