Đang chuẩn bị nút TẢI XUỐNG, xin hãy chờ
Tải xuống
Thiết bị này kết dính được cung cấp trong các bộ Tesio, được dán vào ngực của bệnh nhân để ngăn chặn các ống thông bị kéo và chỉ kéo dài một vài ngày. Bệnh nhân phải được dạy để chăm sóc cho ống thông của họ để giảm thiểu các biến chứng. Ống thông không nên treo xuống một cách tự do | Dual Lumen Catheters for Dialysis 117 Fig. 5.21. This adhesive device supplied in the Tesio kit is taped to the patient s chest to prevent catheters from being pulled and only lasts a few days. Patients must be taught to care for their catheters to minimize complications. Catheters should not hang down freely which causes slow migration and eventually dacron cuff migration exposure in-fection. Catheters can be taped in a loose curvilinear fashion or secured in the bra females to allow free movements at the exit site avoiding pulling. 5 Removal of Cuffed Catheters Removal of cuffed catheters is indicated for tract infection sepsis positive blood cultures and is the catheter is no longer needed. Depending on where the cuff is located two techniques are used. 1. The cuff is located immediately adjacent to the exit site. In this case the exit site is anesthetized with 1 lidocaine Fig. 5.22A . The exit site is dilated slightly with a mosquito hemostat or incised with a knife and the catheter may be lodged out with this simple procedure Fig. 5.22B . In some cases where the cuff is more incorporated a small skin incision longitudinal to the catheter is used with sharp and blunt dissection around the cuff which will release the catheter. Usually there is back bleeding which is temporarily stopped by finger pressure Fig. 5.22C . Compression of the exit site for about 30 minutes with the patient sitting up will usually prevent further bleeding. However the author recommends a Figure-of-eight suture with nylon or PDS to prevent backbleeding Fig. 5.22D . The patient is asked to keep pressure on the site for the next 1-2 hours and avoid strenuous physical activity for the next 24-48 hours Appendix IV . 2. In cases where the cuff is located further up the subcutaneous tract the area on top of the dacron cuff is infiltrated with 1 Lidocaine. A transverse incision is made Fig. 5.23A . The catheter is isolated distal to the cuff clamped with a hemostat Fig. 5.23B and divided distal
