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yxfbbiedtj · Wysłany: Nie 4:30, 06 Mar 2011

B-positioning micro-catheter indwelling percutaneous treatment of tuberculous pleural effusion nursing

Skin. Results 56 cases were successful the first puncture, smooth operation,[link widoczny dla zalogowanych], the shortest tube 5d, the longest 12d, the average 9d, amount of pleural fluid drainage (5670-4-1850) rnl, pleural effusion disappeared days (6.2-4 -2.2) d, 56 例 shortness of breath, chest tightness and other symptoms disappeared completely. Complications: catheter blockage occurred in 3 cases, 2 cases of poor drainage, 1 case of local skin flushing, 1 case of catheter loss, 1 case of no injury, bleeding, pneumothorax and other serious complications. Care First, the home of former missionary catheter care knowledge to patients and their families before the tube to explain the purpose, methods and precautions after catheterization, catheterization time. Poor understanding and low educational level of patients, we collected pictures, objects, cards were missionaries, so that patients fully understand and knowingly operating, while the advantages of the treatment to patients, this operation can be one puncture, less pain,[link widoczny dla zalogowanych], and tube soft, on the tissue damage is small, after the tube had no effect on patient activity, should be compared with the traditional preference. Mental clear this group of patients with varying degrees of psychological tension. And good state of mind essential to the success of the puncture. Superb medical technology and nurses were kind of language can get security and trust, thereby eliminating the positive psychological tension, with the treatment. Assessment evaluation before catheter condition and results of judgments based on B-thoracic fluid volume, such as chest tightness, shortness of breath,[link widoczny dla zalogowanych], if difficulty breathing, cyanosis, and make a record. View B of the same unit: 533 300 Baise City Hospital, location mark over whether to keep intact, empty stool. Gather the materials required for the beneficial use of the heart of the Shenzhen company's central venous catheter, containing double-lumen venous catheter,[link widoczny dla zalogowanych], Y puncture needle, guide wire with a scale, the expansion catheter to keep separate 5Ornl syringes, 3M transparent dressing paste membrane, heparin cap, 25u/rnl heparin saline 5rnl. Second, the appropriate position should take seats, put a soft pillow back after the patients arms around, and extreme difficulty breathing, severe disease who can not take seat, nurses should help patients to take sitting position, were sitting by the edge of the bed, bed intermediate step aside After the patient was placed in a soft V was on the soft. Nurses should protect patients for the tension in the patient side, patients with possible scattered attention, ease the tension. Intraoperative assessment of the patient assessment of feelings and reactions, such as the patient in the process of pumping fluid looking, breathing, pulse changes, if necessary, blood pressure measured. For the occurrence of pleural reaction should be to detect and stop the drainage, and drainage process should prevent the drain too fast, excessive drainage and changes in intrathoracic pressure caused by iatrogenic incentives reexpansion pulmonary edema, postoperative detailed record of care and record sheets,[link widoczny dla zalogowanych], according to medical advice must Remy letters, dexamethasone, amikacin and other drugs do chest intervention. Third, after-care tube 1, after catheter assessment: Observe and record each time the amount of pleural fluid drainage and color, drainage, degree of remission after the symptoms and signs, combined with B-ultrasound to eliminate the pleural fluid level of understanding, also observed after catheter No complications occurred and the results, after a comprehensive assessment of catheter treatment and inform patients. 2, complications, prevention and care ① catheter obstruction occurred in 2 cases in this group because of breast ductal fluid of small, thick, and blood clots, cell, fiber cable and membrane duct obstruction. Prevention and care: pleural fluid drainage after each use 25rnl heparin saline pressure sealed tube and put the end of the catheter heparin cap, blocking occurs when fluid pressure can be 0.9% sodium chloride injection, invalid use of q - chymotrypsin 8ooU in normal saline into the catheter lOml, 30rain after the catheter out of the catheter patency Dissolved J, 3 patients were treated unobstructed drainage. ② poor drainage: the group 2 cases, catheter displacement, angular, twisted, and carried out the nozzle on the surface as the main reason. Prevention and Care: Proper fixed duct, the specific method for catheter sutured to the skin after application, catheter coils exposed parts should be fixed after bending several times to reduce emissions of pleural effusion may Zhu Huanzhe after a deep breath and slowly withdraw catheter slightly pleural effusion leads until the until the group 2 patients after treatment could smooth drainage. ③ catheter loss in this group appeared in 1 case, due to the clothes to wear off accidentally pulled out. Prevention and Care: should be prepared before the mission catheter, catheter should wear loose clothes, to avoid the substantial activity, application of the primary activities if needed fixed catheter. ④ skin infections: 1 patient in this group of mild skin flushing around the catheter. Catheter should be strictly aseptic dressing replaced once a day, keep dry, clean, skin around the catheter daily with 0.5% iodophor disinfection. 3, support for repeated treatment of the pleural fluid emissions and wasting disease in itself, could easily lead to excessive protein loss caused by malnutrition, nutritional support should be strengthened, given high-protein diet, high in vitamins, digestible diet, poor appetite should be appropriate for from intravenous nutrition. [Received :2006-07-03]