I-Central Venous Catheter: Umhlahlandlela Obalulekile

A I-Central Venous Catheter (i-CVC), eyaziwa nangokuthi umugqa ophakathi wemithambo yegazi, ipayipi eliguquguqukayo elifakwa emthanjeni omkhulu oholela enhliziyweni.idivayisi yezokwelaphaidlala indima ebalulekile ekunikezeni imithi, uketshezi, kanye nezakhamzimba ngqo egazini, kanye nokuqapha imingcele ehlukahlukene yezempilo. Ama-catheter emithambo yegazi aphakathi abalulekile ekuphatheni iziguli ezinezifo ezinzima, labo abathola ukwelashwa okuyinkimbinkimbi, noma abantu abadinga ukwelashwa ngemithambo yegazi isikhathi eside. Kulesi sihloko, sizohlola injongo yama-catheter emithambo yegazi ephakathi, izinhlobo ezahlukene, inqubo ehilelekile ekufakweni kwawo, kanye nezinkinga ezingaba khona.

Inhloso yama-Central Venous Catheters

Ama-catheter emithambo yegazi asetshenziswa ngezizathu ezahlukene zezokwelapha, okuhlanganisa:

Ukuphathwa Kwemithi:Imithi ethile, njengemithi yokwelapha ngamakhemikhali noma ama-antibiotic, ingaba nzima kakhulu emithanjeni engaphandle. I-CVC ivumela ukulethwa kwale mithi ngqo emthanjeni omkhulu ngokuphepha, okunciphisa ingozi yokucasuka kwemithambo.

Ukwelashwa Nge-IV Yesikhathi Eside:Iziguli ezidinga ukwelashwa okuhlala isikhathi eside nge-intravenous (IV), okuhlanganisa ama-antibiotic, ukuphathwa kobuhlungu, noma ukudla okunomsoco (njengokudla okuphelele kwe-parenteral), ziyazuza emugqeni ophakathi wemithambo yegazi, ohlinzeka ngokufinyelela okuzinzile nokuthembekile.

Ukuphathwa Koketshezi Nomkhiqizo Wegazi:Ezimweni eziphuthumayo noma zokunakekelwa okujulile, i-CVC ivumela ukunikezwa okusheshayo koketshezi, imikhiqizo yegazi, noma i-plasma, okungasindisa impilo ezimweni ezibucayi.

Ukusampula Igazi Nokuqapha:Ama-catheter emithambo yegazi ephakathi enza kube lula ukuqoqwa kwegazi njalo ngaphandle kwezinti zezinaliti eziphindaphindwayo. Awusizo futhi ekuqapheni umfutho wegazi wegazi ephakathi, enikeza ukuqonda ngesimo senhliziyo yesiguli.

I-Dialysis noma i-Apheresis:Ezigulini ezinenkinga yezinso noma lezo ezidinga i-apheresis, uhlobo olukhethekile lwe-CVC lungasetshenziswa ukufinyelela egazini ukuze kutholakale ukwelashwa nge-dialysis.

 

Izinhlobo zeAma-Catheter E-Venous Ephakathi

Kunezinhlobo eziningana zama-catheter emithambo yegazi ephakathi, ngayinye eyenzelwe izinjongo ezithile kanye nobude besikhathi:

Umugqa we-PICC (I-Catheter Ephakathi Efakwe Ngaphakathi):

Umugqa we-PICC uyi-catheter ende, encane efakwa ngomthambo engalweni, ngokuvamile umthambo we-basilic noma we-cephalic, bese ifakwa emthanjeni ophakathi eduze kwenhliziyo. Ivame ukusetshenziswa ekwelashweni kwesikhathi esiphakathi kuya kweside, kusukela emavikini kuya ezinyangeni.
Imigqa ye-PICC kulula kakhulu ukuyibeka nokuyisusa, okwenza kube ukukhetha okuthandwayo kwezindlela zokwelapha ezinde ezingadingi ukufakwa ngokuhlinzwa.

Ama-Catheter Angenawo Umhubhe:

Lezi zifakwa ngqo emthanjeni omkhulu entanyeni (i-inner jugular), esifubeni (i-subclavian), noma esinqeni (i-femoral) futhi zivame ukusetshenziselwa izinjongo zesikhashana, ngokuvamile ezimweni zokunakekelwa okubucayi noma eziphuthumayo.
Ama-CVC angenawo ama-tunnel awalungele ukusetshenziswa isikhathi eside ngenxa yengozi ephezulu yokutheleleka futhi avame ukususwa uma isimo sesiguli sesizinzile.
Ama-Catheter Afakwe Umhubhe:

Ama-catheter afakwe emthanjeni ophakathi kodwa adluliselwa ngomhubhe ongaphansi komhlaba ngaphambi kokufika endaweni yokungena esikhumbeni. Umhubhe uyasiza ekunciphiseni ingozi yokutheleleka, okwenza afaneleke ukusetshenziswa isikhathi eside, njengasezigulini ezidinga ukukhishwa kwegazi njalo noma ukwelashwa ngamakhemikhali okuqhubekayo.
Lawa ma-catheter avame ukuba ne-cuff ekhuthaza ukukhula kwezicubu, eqinisa i-catheter endaweni yayo.

Amachweba Afakwe Emthini (iPort-a-Cath):

Imbobo efakiwe iyithuluzi elincane, eliyindilinga elifakwa ngaphansi kwesikhumba, ngokuvamile esifubeni. I-catheter isuka embobo iye emthanjeni ophakathi. Amambobo asetshenziselwa ukwelashwa kwesikhathi eside okungapheli njengokwelashwa ngamakhemikhali, njengoba engaphansi kwesikhumba ngokuphelele futhi enengozi encane yokutheleleka.
Iziguli zikhetha ama-ports okunakekelwa kwesikhathi eside ngoba awavali kakhulu futhi zidinga induku yenaliti kuphela ngesikhathi sokusetshenziswa ngakunye.

Inqubo Ye-Central Venous Catheter
Ukufakwa kwe-catheter yemithambo ephakathi kuyinqubo yezokwelapha ehlukahluka kuye ngohlobo lwe-catheter efakwayo. Nasi isifinyezo esijwayelekile senqubo:

1. Ukulungiselela:

Ngaphambi kwenqubo, umlando wezokwelapha wesiguli uyabuyekezwa, bese kutholakala imvume. Isixazululo se-antiseptic sisetshenziswa endaweni yokufaka ukuze kuncishiswe ingozi yokutheleleka.
Kungase kunikezwe umuthi wokubulala izinzwa wendawo noma wokudambisa ubuhlungu ukuqinisekisa induduzo yesiguli.
2. Ukubekwa kwe-Catheter:

Esebenzisa isiqondiso se-ultrasound noma izimpawu zokwakheka komzimba, udokotela ufaka i-catheter emthanjeni ofanele. Uma kwenzeka umugqa we-PICC, i-catheter ifakwa ngomthambo ongaphandle engalweni. Kwezinye izinhlobo, kusetshenziswa izindawo zokufinyelela eziphakathi njengemithambo ye-subclavian noma yangaphakathi ye-jugular.
I-catheter iyathuthukiswa ize ifike endaweni oyifunayo, ngokuvamile i-vena cava ephezulu eduze kwenhliziyo. I-X-ray noma i-fluoroscopy ivame ukwenziwa ukuqinisekisa indawo ye-catheter.
3. Ukuvikela i-Catheter:

Uma i-catheter isibekwe kahle, iqiniswa nge-sutures, i-glue, noma i-dressing ekhethekile. Ama-catheter afakwe i-tunnel angaba ne-cuff ukuze aqiniswe idivayisi.
Indawo yokufaka ibe isigqokwa, bese i-catheter ihlanzwa nge-saline ukuqinisekisa ukuthi isebenza kahle.
4. Ukunakekelwa Kwangemva Kokuhlinzwa:

Ukunakekelwa okufanele kanye nokushintsha njalo izingubo kubalulekile ukuvimbela ukutheleleka. Iziguli nabanakekeli baqeqeshwe ngendlela yokunakekela i-catheter ekhaya uma kudingeka.
Izinkinga Ezingaba Khona
Nakuba ama-catheter emithambo yegazi ephakathi eyithuluzi elibalulekile ekunakekelweni kwezokwelapha, anezingozi eziningi. Ezinye zezinkinga ezingaba khona zifaka:

1. Ukutheleleka:

Inkinga evame kakhulu ukutheleleka endaweni yokufaka noma ukutheleleka kwegazi (ukutheleleka kwegazi okuhlobene nomugqa ophakathi, noma i-CLABSI). Amasu aqinile ahlanzekile ngesikhathi sokufaka kanye nokugcinwa ngokucophelela kunganciphisa le ngozi.
2. Amahlule egazi:

Ama-CVC ngezinye izikhathi angabangela ukujiya kwegazi emthanjeni. Ama-blood thinner angase anikezwe ukuze kuncishiswe le ngozi.
3. I-Pneumothorax:

Ukubhoboza iphaphu ngengozi kungenzeka ngesikhathi sokufakwa, ikakhulukazi uma ama-catheter angenawo amapayipi ebekwe endaweni yesifuba. Lokhu kuholela ekuweni kwephaphu, okudinga ukungenelela kwezokwelapha ngokushesha.
4. Ukungasebenzi kahle kwe-Catheter:

I-catheter ingase ivaleke, iqhekeke, noma iphume, okuthinta ukusebenza kwayo. Ukuhlanza njalo nokuphathwa kahle kungavimbela lezi zinkinga.
5. Ukopha:

Kukhona ingozi yokopha ngesikhathi senqubo, ikakhulukazi uma isiguli sinenkinga yokujiya kwegazi. Ubuchwepheshe obufanele kanye nokunakekelwa ngemva kwenqubo kusiza ekunciphiseni le ngozi.

 

Isiphetho
Ama-catheter emithambo yegazi ephakathi ayizinto ezibalulekile ekunakekelweni kwezokwelapha kwanamuhla, anikeza ukufinyelela okuthembekile kwemithambo yegazi ngezinjongo ezahlukene zokwelapha nokuxilonga. Nakuba inqubo yokufaka umugqa wemithambo yegazi ephakathi ilula kakhulu, idinga ubuchwepheshe kanye nokuphathwa ngokucophelela ukuze kuncishiswe izinkinga. Ukuqonda izinhlobo ze-CVC kanye nokusetshenziswa kwazo okukhethekile kuvumela abahlinzeki bezempilo ukuthi bakhethe inketho engcono kakhulu yezidingo zesiguli ngasinye, baqinisekise ukunakekelwa okusebenzayo nokuphephile.