A-C-L导管维护.ppt

,A-C-L导管程序化维护最佳实践标准,工作中是否遇到,?,Lynn Hadaway A-C-L导管维护程序系列课程的创始者及提倡者。 林恩.哈达维在静疗护理和成人继续教育领域有着30多年的丰富经验。具有静疗护士证书协会颁发的静疗护士证书和美国护理协会颁发的专业护理指导教育证书。 她曾就职于美国血管通路协会，先后担任轮值总监和主席；后又两次就任美国静疗护士协会东南部的主席，目前为美国INS学会高级顾问及美国INS输液治疗护理实践标准等教材的编委。,A- Assess 导管功能评估 C- Clear 冲管 L Lock 封管,常见静脉输液工具的种类,以导管尖端是否达到腔静脉为标准 外周静脉导管和中心静脉导管,A-C-L导管维护最佳实践标准,A- Assess the function of the catheter 导管功能评估（抽回血） 导管穿刺期间 导管留置期间 C- Clear 冲管 L Lock 封管,Blood Return is Mandatory! 通过抽回血判断导管通畅是必须的!,All catheters should yield a brisk blood return prior to infusion of each dose of medication. 所有的导管在输液前都会有一些回血 Lack of blood return means a non-functioning catheter 无回血意味着导管功能下降 Related to how or where the catheter was placed 与导管留置的过程和部位等因素相关,Catheter Lumen Occlusion 导管腔内堵塞,Causes原因 Thrombotic 血栓性 Drug precipitate 药物沉淀 Mechanical 机械性 Proper flushing and locking catheters will either prevent or identify these problems正确冲封管能预防此类问题,Precipitate Causes 药物沉淀因素,Contact between two or more incompatible drugs or fluids 两种或多种不相容药物/液体 Alteration in drug pH 药物PH值变化 Precipitate forms inside catheter lumen 管内沉淀形成 Lipid sludge from fat emulsion 脂肪乳沉积 Waxy coating on internal catheter walls 管壁内蜡状沉淀,Catheter Flushing导管冲封管,Standards and Guidelines标准和指南 INS Standard #56 INS标准第56条 If resistance is met or an absent blood aspirate noted, the nurse should take further steps to assess patency of the catheter prior to administration of medications and solutions. The catheter should not be forcibly flushed.给药和输液前，如果遇到阻力或者抽吸无回血，护士应进一步确认导管的通畅性。不应强行冲洗导管。 The nurse should aspirate the catheter for positive blood return to confirm patency prior to administration of medications and solutions. 给药和输液前，护士应抽回血以确认导管是否通畅。,A- Assess导管功能评估 C- Clear 冲管：将导管内残留的药液和血液冲入血管 L Lock 封管,A-C-L导管维护最佳实践标准,Purposes of Catheter Flushing 导管冲管的目的,Infusion Nursing Standards of Practice, Infusion Nurses Society 美国INS指南 To promote and maintain catheter patency 维持通畅 To prevent contact between incompatible medications and solutions 避免药物间反应 Many medications are incompatible 很多药物间都有配伍禁忌 Contact in the catheter lumen causes drug precipitate that occludes the lumen 药物沉淀在导管内形成堵塞,没有足够冲管会造成：,并发症 管腔阻塞 血液凝结 药物沉积,Flush Solution Containers 冲管液容器的选择,Single dose containers are preferred Single dose vials, e.g. 10 mL vial of preservative-free normal saline 独立包装容器，例如10ml不含防腐剂的生理盐水 Prefilled syringes 预冲式注射装置,采用推一下停一下的冲洗方法，使等渗盐水在导管内形成小旋涡，有利于把附着在导管和血管壁的残留药液冲洗干净。,冲管方法,不间断的冲洗方法,脉冲式的冲洗方法,Catheter Flushing导管冲封管,Standards and Guidelines标准和指南 INS Standard #56 INS标准第56条 The minimum volume of the flush solution should be equal to at least twice the volume capacity of the catheter and add-on devices.冲洗液的最少量应为导管和附加装置容量的2倍。 The nurse should be knowledgeable about medication and solution incompatibilities. 护士应具备有关药物和/或液体不相容性的知识。,Catheter Flushing导管冲封管,Standards and Guidelines标准和指南 INS Standard #56 INS标准第56条 Positive-end pressure shall be used 脉冲式的冲管手法 Syringe size should be in accordance with manufacturer recommendations 注射器规格与厂家一致 Consideration should be given to single-use flushing systems 使用一次性冲管装置,Standards and Guidelines标准和指南 CDC Based on recent HCV outbreak, CDC “strongly encourages” use of pre-fills or SDVs CDC强烈鼓励使用预充式导管冲洗器 JCAHO Sentinel Event Alert identifies “single-use IV flush vials” as important strategy to reduce the risk of nosocomial infections. 一次性使用的导管冲洗器是减少院内感染最重要的策略,Catheter Flushing导管冲封管,A- Assess导管功能评估 C- Clear 冲管 L- Lock 封管：输液完毕或在两次间断的输液之间，需用封管液封管，维持导管通畅。,A-C-L导管维护最佳实践标准,常用封管液,0.9%生理盐水 适用于所有短导管 稀释的肝素溶液 管内保留冲管液 肝素稀释浓度10或者100单位/ml INS推荐 - 10 单位/ml适用于所有类型静脉导管的封管操作,封管方法,方法 推封管液至剩余0