【Izimo zokuphikisana】

1) Ukungafaneleki ngokwengqondo noma ngokomzimba kokuhlinzwa ezimweni ezijwayelekile

2) Ukopha okukhulu kanye nezinkinga zokuqina kwamalunga.

3) Inani lamaseli amhlophe egazi lingaphansi kuka-3×109/L

4) I-allergy kuma-contrast media

5) Kuhlanganiswe nesifo esibi esingamahlalakhona sokuvimba amaphaphu.

6) Iziguli ezinolwazi noma ezisolwayo ngokungezwani komzimba nezinto ezisephaketheni ledivayisi.

7) Ukuba khona noma ukusolakala kokutheleleka okuhlobene nedivayisi, i-bacteriaemia noma i-sepsis.

8) Ukwelashwa ngemisebe endaweni okuhloswe ukufakwa kuyo.

9) Ukuthwebula izithombe noma ukujova izidakamizwa ze-embolic.

 

【Usuku Lokukhiqiza】 Bheka ilebula lomkhiqizo

 

【Usuku Lokuphelelwa Yisikhathi】 Bheka ilebula lomkhiqizo

 

【Indlela yokusebenzisa】

1. Lungisa idivayisi yembobo efakelwayo bese uhlola ukuthi usuku lokuphelelwa yisikhathi seludlulile yini; susa iphakheji yangaphakathi bese uhlola ukuthi iphakheji yonakele yini.
2. Kufanele usebenzise amasu okubulala amagciwane ukusika iphakethe langaphakathi bese ususa umkhiqizo ukuze ulungele ukusetshenziswa.
3. Ukusetshenziswa kwamadivayisi echweba angafakelwa kuchazwa ngokwehlukana kumodeli ngayinye kanje.

 

UhloboⅠ

1. Ukuhlolwa kokuhlanza, kokukhipha umoya, kokuvuza

Sebenzisa isirinji (inaliti yedivayisi yokufaka imbobo) ukubhoboza idivayisi yokufaka imbobo bese ufaka u-5mL-10mL we-saline yemvelo ukuze ugeze isihlalo somjovo kanye ne-catheter lumen bese uyikhipha. Uma kungekho noma kutholakala uketshezi oluhamba kancane, jika ingxenye yokulethwa kwemithi ye-catheter (ukuphela okukude) ngesandla ukuze uvule imbobo yokulethwa kwemithi; bese ugoqa ingxenye yokulethwa kwemithi ye-catheter, qhubeka nokucindezela usawoti (ukucindezela okungaphezu kuka-200kPa), qaphela ukuthi kukhona yini ukuvuza okuvela esihlalweni somjovo kanye nokuxhumeka kwe-catheter, ngemuva kwakho konke okujwayelekile. Ngemva kokuthi konke sekujwayelekile, i-catheter ingasetshenziswa.

1. Ukususwa kwe-cannulation kanye nokubopha

Ngokusho kocwaningo lwangesikhathi sokuhlinzwa, faka i-catheter (ukuphela kokulethwa kwemithi) emthanjeni wegazi ohambisanayo ngokuya ngendawo yesimila, bese usebenzisa izithungo ezingamuncwa ukuze ubophe i-catheter kahle emthanjeni. I-catheter kufanele iboshwe kahle (idlule kabili noma ngaphezulu) futhi ilungiswe.

1. ukwelashwa ngamakhemikhali kanye nokuvalwa

Umuthi we-chemotherapy ngesikhathi sokuhlinzwa ungafakwa kanye ngokwecebo lokwelashwa; kunconywa ukuthi isihlalo somjovo kanye ne-catheter lumen kuhlanjululwe nge-6-8 mL ye-physiological saline, kulandelwe yi-3 mL ~ 5 mL. I-catheter bese ivalwa nge-3mL kuya ku-5 mL ye-heparin saline ku-100U/mL kuya ku-200U/mL.

1. Ukufakwa kwesihlalo ngomjovo

Kudalwa umgodi we-cystic ongaphansi kwesikhumba endaweni yokusekela, okuqhele ngamasentimitha angu-0.5 kuya kwangu-1 ukusuka ebusweni besikhumba, bese isihlalo somjovo sifakwa emgodini bese siqiniswa, bese isikhumba sithungwa ngemva kokususwa kwe-hemostasis eqinile. Uma i-catheter inde kakhulu, ingagoqwa ibe yindilinga ekugcineni kwe-proximal bese iqiniswa kahle.

 

UhloboⅡ

1. Ukuhlanza nokukhipha umoya

Sebenzisa isirinji (inaliti yedivayisi yokufaka imbobo efakelwayo) ukufaka i-saline esihlalweni somjovo kanye ne-catheter ngokulandelana ukuze ugeze futhi ususe umoya ku-lumen, futhi ubheke ukuthi uketshezi lokuhambisa lubushelelezi yini.

2. Ukususwa kwe-cannulation kanye nokubopha

4. Ukuhlolwa kokuvuza

4. Ngemva kokuthi uxhumano seluqediwe, goqa bese uvala i-catheter ngemuva kwesiqeshana sokukhiya bese uqhubeka nokufaka i-saline esihlalweni somjovo ngesirinji (inaliti yomshini wokuhambisa umuthi ofakelwe) (ingcindezi engaphezu kuka-200kPa). (ingcindezi ingabi ngaphezu kuka-200kPa), bheka ukuthi kukhona yini ukuvuza okuvela ku-injection block kanye ne-catheter.

uxhumano, futhi lusetshenziswe kuphela uma konke sekujwayelekile.

5. Ukwelashwa ngamakhemikhali, ipayipi lokuvala

Umuthi we-chemotherapy ngesikhathi sokuhlinzwa ungafakwa kanye ngokwecebo lokwelashwa; kunconywa ukuhlanza isisekelo somjovo kanye ne-catheter lumen ngo-6 ~ 8mL we-physiological saline futhi, bese usebenzisa u-3mL ~ 5mL we-physiological saline.

I-catheter bese ivalwa nge-3mL kuya ku-5mL ye-heparin saline ku-100U/mL kuya ku-200U/mL.

6. Ukufakwa kwesihlalo somjovo

Kwadalwa umgodi we-cystic ongaphansi kwesikhumba endaweni yokusekela, kusuka ku-0.5 cm kuya ku-1 cm ukusuka ebusweni besikhumba, kwathi isihlalo somjovo safakwa emgodini futhi saqiniswa, futhi isikhumba sathungwa ngemva kokuphela kwesisu okuqinile.

 

Uhlobo Ⅲ

Kusetshenziswe i-syringe (inaliti ekhethekile yedivayisi yokufaka efakwayo) ukufaka usawoti ojwayelekile ongu-10mL ~ 20mL kudivayisi yokufaka imithi efakwayo ukuze kuhlanzwe isihlalo somjovo kanye nomgodi we-catheter, bese kususwa umoya ongaphakathi, bese kubonwa ukuthi uketshezi belungaphazamisi yini.

2. Ukususwa kwe-cannulation kanye nokubopha

Ngokusho kokuhlolwa kwangaphambi kokuhlinzwa, faka i-catheter odongeni lwesisu, bese ingxenye evulekile yengxenye yokulethwa kwemithi ye-catheter kufanele ingene emgodini wesisu futhi isondele kakhulu endaweni lapho kutholakala khona isimila. Khetha amaphuzu angu-2-3 ukuze ubophe futhi ulungise i-catheter.

3. i-chemotherapy, ipayipi lokuvala

Umuthi we-chemotherapy ngesikhathi sokuhlinzwa ungafakwa kanye ngokwecebo lokwelashwa, bese kuthi ithubhu livalwe nge-heparin saline engu-3mL~5mL engu-100U/mL~200U/mL.

4. Ukufakwa kwesihlalo somjovo

Kwadalwa umgodi we-cystic ongaphansi kwesikhumba endaweni yokusekela, kusuka ku-0.5 cm kuya ku-1 cm ukusuka ebusweni besikhumba, kwathi isihlalo somjovo safakwa emgodini futhi saqiniswa, futhi isikhumba sathungwa ngemva kokuphela kwesisu okuqinile.

Ukufakwa kwemithi nokunakekelwa

A.Ukusebenza okungenakubola ngokuphelele, ukukhetha kahle indawo yesihlalo somjovo ngaphambi kokujova, kanye nokubulala amagciwane okuqinile endaweni yomjovo.B. Uma ujova, sebenzisa inaliti yedivayisi yokufaka imbobo efakelwayo, isirinji engu-10 mL noma ngaphezulu, umunwe wokukhomba wesandla sobunxele uthinta indawo yokubhoboza kanye nesithupha siqinisa isikhumba ngenkathi silungisa isihlalo somjovo, isandla sokudla sibambe isirinji siqonde enalitini, sigweme ukuthuthumela noma ukujikeleza, bese ujova kancane kancane usawoti ongu-5 mL ~ 10 mL uma kunomuzwa wokuwa futhi isihloko senalithi kamuva sithinta phansi kwesihlalo somjovo, bese uhlola ukuthi uhlelo lokulethwa kwemithi lubushelelezi yini (uma lungabushelelezi, kufanele uqale uhlole ukuthi inalithi ivaliwe). Qaphela ukuthi kukhona ukuphakama kwesikhumba esizungezile lapho ucindezela.

C. Phusha umuthi we-chemotherapy kancane ngemva kokuqinisekisa ukuthi akukho phutha. Ngesikhathi sokucindezela, qaphela ukuthi isikhumba esizungezile siphakeme noma simhlophe, nokuthi kukhona yini ubuhlungu bendawo. Ngemva kokucindezela umuthi, kufanele ugcinwe imizuzu eyi-15 kuya kwengama-30.

D. Ngemva komjovo ngamunye, kunconywa ukuthi uhlanze isihlalo somjovo kanye ne-catheter lumen nge-6 ~ 8mL ye-physiological saline, bese uvala i-catheter nge-3mL ~ 5mL ye-100U/mL ~ 200U/mL ye-heparin saline, futhi lapho i-0.5mL yokugcina ye-heparin saline ijovwa, umuthi kufanele ucindezelwe ngenkathi ubuyela emuva, ukuze uhlelo lokungenisa umuthi lugcwale i-heparin saline ukuvimbela ukwakheka kwe-drug crystallization kanye nokujiya kwegazi ku-catheter. I-catheter kufanele ihlanzwe nge-heparin saline kanye njalo emavikini ama-2 ngesikhathi sokwelashwa ngamakhemikhali.

E. Ngemva komjovo, bulala imbobo yenaliti ngesibulali-magciwane sezokwelapha, uyimboze ngebhandeshi elihlanzekile, bese uqaphela ukugcina indawo yasendaweni ihlanzekile futhi yomile ukuze uvimbele ukutheleleka endaweni yokubhoboza.

F. Naka indlela isiguli esisabela ngayo ngemva kokunikezwa umuthi futhi uqaphelisise ngesikhathi sokufakwa umuthi.

 

【Isexwayiso, isixwayiso kanye nokuqukethwe okusikisela ucansi】

1. Lo mkhiqizo uhlanzwa nge-ethylene oxide futhi usebenza iminyaka emithathu.
2. Sicela ufunde incwadi yemiyalelo ngaphambi kokusebenzisa ukuqinisekisa ukuphepha kokusebenzisa.
3. Ukusetshenziswa kwalo mkhiqizo kumele kuhambisane nezidingo zemithethonqubo nemithethonqubo efanele yomkhakha wezokwelapha, futhi ukufakwa, ukusebenza nokususwa kwala madivayisi kufanele kukhawulelwe kodokotela abaqinisekisiwe. Ukufakwa, ukusebenza nokususwa kwala madivayisi kukhawulelwe kodokotela abaqinisekisiwe, futhi ukunakekelwa kwangemva kokuhlinzwa kufanele kwenziwe ngabasebenzi bezokwelapha abaqeqeshiwe.
4. Yonke inqubo kumele yenziwe ngaphansi kwezimo ezingezona eze-aseptic.
5. Hlola usuku lokuphelelwa yisikhathi komkhiqizo kanye nephakheji yangaphakathi ukuze ubone ukuthi awuwonakele yini ngaphambi kwenqubo.
6. Ngemva kokusebenzisa, umkhiqizo ungabangela izingozi zezinto eziphilayo. Sicela ulandele izindlela zokwelapha ezamukelekayo kanye nayo yonke imithetho nemigomo efanele yokuphatha nokwelapha.
7. Ungasebenzisi amandla amaningi ngesikhathi sokufakwa kwepayipi futhi faka umthambo ngokunembile nangokushesha ukuze ugweme ukuvaleka kwemithambo yegazi. Uma ukufakwa kwepayipi kunzima, sebenzisa iminwe yakho ukuze uphendule i-catheter kusukela kolunye uhlangothi kuya kolunye ngenkathi ufaka ipayipi.
8. Ubude be-catheter ebekwe emzimbeni kufanele bufaneleke, bude kakhulu kulula ukugoba bube yi-engeli, okuholela ekungeneni kahle komoya, bufushane kakhulu lapho imisebenzi yobudlova yesiguli inethuba lokuphuma emthanjeni. Uma i-catheter imfushane kakhulu, ingase iphume emthanjeni lapho isiguli sinyakaza ngamandla.
9. I-catheter kufanele ifakwe emgqonyeni inezimbobo ezingaphezu kwezimbili kanye nokuqina okufanele ukuqinisekisa ukuthi ijova umuthi ishelela futhi ivimbele i-catheter ukuthi ingasheleli.
10. Uma idivayisi yokufakelwa efakwayo iwuhlobo lwesibili, ukuxhumana phakathi kwe-catheter nesihlalo somjovo kumele kuqine. Uma kungadingeki umjovo wesidakamizwa ngesikhathi sokuhlinzwa, umjovo ojwayelekile wokuhlola usawoti kufanele usetshenziswe ukuqinisekisa ngaphambi kokuthunga isikhumba.
11. Lapho kuhlukaniswa indawo engaphansi kwesikhumba, kufanele kwenziwe i-close hemostasis ukuze kugwenywe ukwakheka kwe-hematoma yendawo, ukuqongelela koketshezi noma ukutheleleka kwesibili ngemva kokuhlinzwa; i-vesicular suture kufanele igweme isihlalo somjovo.
12. Izinamathiseli zezokwelapha ze-α-cyanoacrylate zingabangela umonakalo ezintweni eziyisisekelo zomjovo; ungasebenzisi izinamathiseli zezokwelapha ze-α-cyanoacrylate lapho welapha ukusikwa kokuhlinzwa okuzungeze isisekelo somjovo. Ungasebenzisi izinamathiseli zezokwelapha ze-α-cyanoacrylate lapho usebenza ngezinsika zokuhlinzwa ezizungeze isisekelo somjovo.
13. Qaphela kakhulu ukuze ugweme ukuvuza kwe-catheter ngenxa yokulimala ngengozi okuvela ezintweni zokuhlinzwa.
14. Uma ubhoboza, inaliti kufanele ifakwe iqonde phezulu, kufanele kusetshenziswe isirinji enamandla angu-10mL noma ngaphezulu, umuthi kufanele ufakwe kancane, futhi inaliti kufanele ikhishwe ngemva kokuphumula isikhashana. Ukucindezela kokucindezela akufanele kudlule u-200kPa.
15. Sebenzisa izinaliti ezikhethekile kuphela kumadivayisi okuhambisa imithi afakelwa.
16. Uma kudingeka ukumnika isikhathi eside noma ukushintshwa kwemithi, kufanelekile ukusebenzisa idivayisi yokulethwa kwemithi efakwa kanye enenaliti ekhethekile yokumnika noma i-tie, ukuze kuncishiswe inani lokubhoboza nokunciphisa umthelela esigulini.
17. Nciphisa inani lokubhoboza, nciphisa umonakalo emisipheni yesiguli kanye nezingxenye ezizivalayo. Ngesikhathi sokuyekiswa kokujova umuthi, umjovo we-anticoagulant uyadingeka kanye njalo emavikini amabili.
18. Lo mkhiqizo uwumkhiqizo osetshenziswa kanye kuphela, ongenamagciwane, ongenawo umthelela we-pyrogenic, obhujiswe ngemva kokusetshenziswa, ukusetshenziswa kabusha akuvunyelwe ngokuphelele.
19. Uma iphakheji yangaphakathi yonakele noma usuku lokuphelelwa yisikhathi komkhiqizo seludlulile, sicela uwubuyisele kumenzi ukuze ulahlwe.
20. Inani lama-punctures ebhulokhi ngalinye lomjovo akufanele lidlule u-2000 (22Ga). 21.
21. Umthamo omncane wokuhlanza u-6ml