I-Central Venous Catheter: Umhlahlandlela Obalulekile

A I-Central Venous Catheter (CVC), owaziwa nangokuthi umugqa we-venous ophakathi, iyishubhu eguquguqukayo efakwe emthanjeni omkhulu oholela enhliziyweni. Lokhuidivayisi yezokwelaphaidlala indima ebalulekile ekunikezeni imithi, uketshezi, nemisoco ngqo egazini, kanye nokuqapha imingcele yezempilo ehlukahlukene. Ama-catheter e-venous abalulekile ekulawuleni iziguli ezinezifo ezinzima, lezo ezelashwayo eziyinkimbinkimbi, noma abantu abadinga ukwelashwa ngokufakwa emthanjeni isikhathi eside. Kulesi sihloko, sizohlola inhloso yama-catheter e-venous ephakathi, izinhlobo ezahlukene, inqubo ehilelekile ekufakweni kwawo, kanye nezinkinga ezingase zibe khona.

Inhloso yama-Central Venous Catheter

I-Central venous catheter isetshenziselwa izizathu ezihlukahlukene zezokwelapha, kuhlanganise:

Ukuphathwa Kwemithi:Imithi ethile, njengemithi ye-chemotherapy noma ama-antibiotics, ingase ibe nzima kakhulu emithanjeni yangaphandle. I-CVC ivumela ukulethwa okuphephile kwale mithi ngokuqondile emthanjeni omkhulu, okunciphisa ingozi yokucasuka kwe-vein.

Ukwelashwa kwe-IV yesikhathi eside:Iziguli ezidinga ukwelashwa nge-intravenous (IV) ende isikhathi eside, okuhlanganisa ama-antibiotics, ukuphathwa kwezinhlungu, noma ukudla okunomsoco (njengokudla okuphelele komzali), zizuza kulayini we-venous omaphakathi, ohlinzeka ukufinyelela okuzinzile nokuthembekile.

Ukulawulwa Komkhiqizo Wegazi Noketshezi:Ezimweni eziphuthumayo noma zokunakekelwa okukhulu, i-CVC inika amandla ukuphathwa okusheshayo koketshezi, imikhiqizo yegazi, noma i-plasma, engasindisa ukuphila ezimeni ezibucayi.

Ukusampula Kwegazi Nokuqapha:Ama-catheter e-venous ephakathi asiza ukusampula kwegazi njalo ngaphandle kwezinti zezinaliti eziphindaphindiwe. Zibuye zibe usizo ekuqapheni umfutho we-venous omaphakathi, unikeze imininingwane ngesimo senhliziyo nemithambo yesiguli.

I-Dialysis noma i-Apheresis:Ezigulini ezinokwehluleka kwezinso noma lezo ezidinga i-apheresis, uhlobo olukhethekile lwe-CVC lungasetshenziswa ukufinyelela emithanjeni yegazi ukuze kutholakale ukwelashwa kwe-dialysis.

 

Izinhlobo zeI-Central Venous Catheters

Kunezinhlobo eziningana zama-catheter e-venous emaphakathi, ngayinye yakhelwe izinhloso ezithile kanye nobude besikhathi:

Ulayini we-PICC (I-Peripherally Inserted Central Catheter):

Ulayini we-PICC yipayipi elide, elincanyana elifakwe emthanjeni osengalweni, ngokuvamile i-basilic noma i-cephalic vein, futhi ixhunywe emthanjeni ophakathi nendawo eduze kwenhliziyo. Ivamise ukusetshenziselwa ukwelashwa kwesikhathi esimaphakathi kuya kweside, kusukela emavikini kuye ezinyangeni.
Imigqa ye-PICC kulula ukuyibeka nokuyisusa, okuyenza ibe ukukhetha okuncanyelwayo kwezokwelapha ezinde ezingadingi ukufakwa ngokuhlinzwa.

Ama-Catheter angahunyushiwe:

Lezi zifakwe ngokuqondile emthanjeni omkhulu entanyeni (i-jugular yangaphakathi), isifuba (i-subclavian), noma i-groin (i-femoral) futhi ngokuvamile isetshenziselwa izinjongo zesikhashana, ngokuvamile ekunakekelweni okubucayi noma izimo eziphuthumayo.
Ama-CVC angenawo ama-tunnel awalungele ukusetshenziswa isikhathi eside ngenxa yengozi ephezulu yokutheleleka futhi ngokuvamile asuswa uma isimo sesiguli sesizinzile.
I-Tunneled Catheter:

Ama-catheter ashunqe afakwa emthanjeni omaphakathi kodwa ahanjiswa emhubheni ongaphansi kwesikhumba ngaphambi kokuba afinyelele endaweni yokungena esikhumbeni. Umhubhe usiza ukunciphisa ingozi yokutheleleka, uwenze afanelekele ukusetshenziswa isikhathi eside, njengasezigulini ezidinga ukutonyulwa kwegazi njalo noma ukwelashwa ngamakhemikhali okuqhubekayo.
Lawa ma-catheter avame ukuba ne-cuff ekhuthaza ukukhula kwezicubu, okuvikela i-catheter endaweni.

Izimbobo Ezitshaliwe (I-Port-a-Cath):

Imbobo etshaliwe iyithuluzi elincane, eliyindilinga elibekwe ngaphansi kwesikhumba, ngokuvamile esifubeni. I-catheter isuka ethekwini iye emthanjeni omaphakathi. Amachweba asetshenziselwa ukwelashwa okuhlala isikhathi eside okufana ne-chemotherapy, njengoba engaphansi kwesikhumba ngokuphelele futhi anengozi ephansi yokutheleleka.
Iziguli zincamela amachweba okunakekelwa isikhathi eside ngoba awaboli futhi adinga induku yenaliti kuphela ngesikhathi sokusetshenziswa ngakunye.

Inqubo ye-Catheter ye-Venous Ephakathi
Ukufakwa kwe-catheter ye-venous ephakathi kuyinqubo yezokwelapha ehluka kuye ngokuthi hlobo luni lwe-catheter olubekwe. Nakhu ukubuka konke okujwayelekile kwenqubo:

1. Ukulungiselela:

Ngaphambi kwenqubo, umlando wezokwelapha wesiguli uyabuyekezwa, futhi kutholakale imvume. Isixazululo se-antiseptic sisetshenziswa endaweni yokufaka ukunciphisa ingozi yokutheleleka.
Isibulali-zinzwa sasendaweni noma i-sedation ingase inikezwe ukuze kuqinisekiswe ukunethezeka kwesiguli.
2. Ukufakwa kwe-Catheter:

Esebenzisa isiqondiso se-ultrasound noma izimpawu zendawo ze-anatomical, udokotela ufaka i-catheter emthanjeni ofanele. Endabeni yomugqa we-PICC, i-catheter ifakwa ngomthambo we-peripheral engalweni. Kwezinye izinhlobo, izindawo zokufinyelela ezimaphakathi njenge-subclavian noma imithambo ye-jugular yangaphakathi isetshenziswa.
I-catheter ithuthukisiwe ize ifinyelele endaweni oyifunayo, ngokuvamile i-vena cava ephakeme eduze kwenhliziyo. I-X-ray noma i-fluoroscopy ivame ukwenziwa ukuze kuqinisekiswe indawo ye-catheter.
3. Ukuvikela i-Catheter:

Uma i-catheter ibekwe kahle, ivikelwe nge-sutures, i-adhesive, noma ukugqoka okukhethekile. Ama-catheter ashunwe angase abe ne-cuff ukuze avikele idivayisi ngokuqhubekayo.
Indawo yokushutheka iyagqokiswa, bese i-catheter igezwa ngosawoti ukuze kuqinisekiswe ukuthi isebenza ngendlela efanele.
4. Ukunakekelwa kwangemuva:

Ukunakekelwa okufanele kanye nezinguquko ezijwayelekile zokugqoka kubalulekile ukuvimbela ukutheleleka. Iziguli nabanakekeli bayaqeqeshwa ngendlela yokunakekela i-catheter ekhaya uma kudingeka.
Izinkinga Ezingenzeka
Nakuba i-central catheter ye-venous ingamathuluzi ayigugu ekunakekelweni kwezokwelapha, ayinazo izingozi. Ezinye izinkinga ezingaba khona zihlanganisa:

1. Ukutheleleka:

Inkinga evame kakhulu ukutheleleka endaweni yokufakwa noma ukutheleleka ngegazi (ukutheleleka okuhambisana nomugqa omaphakathi wegazi, noma i-CLABSI). Amasu aqinile oyinyumba ngesikhathi sokufakwa nokugcinwa ngokucophelela kunganciphisa le ngozi.
2. Amahlule Egazi:

Ama-CVC ngezinye izikhathi angabangela amahlule egazi emithanjeni. Imithi enciphisa igazi ingase inqunywe ukunciphisa le ngozi.
3. I-Pneumothorax:

Ukubhoboza iphaphu ngephutha kungenzeka ngesikhathi lifakwa, ikakhulukazi ngama-catheter angenawo ama-tunnel abekwe endaweni yesifuba. Lokhu kubangela ukugoqa kwephaphu, okudinga ukungenelela kwezokwelapha ngokushesha.
4. Ukungasebenzi kwe-Catheter:

I-catheter ingase ivinjwe, ikhishwe, noma ikhishwe, kuthinte ukusebenza kwayo. Ukushaywa njalo nokuphatha ngendlela efanele kunganqanda lezi zinkinga.
5. Ukopha:

Kukhona ingozi yokopha phakathi nenqubo, ikakhulukazi uma isiguli sinenkinga yamahlule. Indlela efanele kanye nokunakekelwa kwangemva kwenqubo kusiza ukunciphisa le ngozi.

 

Isiphetho
Ama-catheter e-venous aphakathi nendawo angamathuluzi abalulekile ekunakekelweni kwesimanjemanje, anikeza ukufinyelela okuthembekile kwe-venous ngezinjongo ezahlukahlukene zokwelapha kanye nokuxilonga. Nakuba inqubo yokufaka umugqa we-venous omaphakathi iqondile, idinga ubuchwepheshe nokuphatha ngokucophelela ukuze kuncishiswe izinkinga. Ukuqonda izinhlobo zama-CVC kanye nokusetshenziswa kwawo okuqondile kuvumela abahlinzeki bezempilo ukuthi bakhethe inketho engcono kakhulu yezidingo zesiguli ngasinye, ukuqinisekisa ukunakekelwa okusebenzayo nokuphephile.