1例患儿PICC拔管困难的原因分析及护理对策

目的:分析经外周静脉留置中心静脉导管的患者拔管困难的原因分析及护理对策。150例中出现导管拔出困难1例,针对拔管困难的原因进行进一步分析及护理。针对原因,提出相应的护理对策:(1)PICC拔管时与患儿交谈分散注意力,缓解患儿紧张情绪,拔管前在穿刺点上方10～20cm局部湿观敷20～30min,以缓解血管痉挛及收缩;(2)发现导管异位时遵医嘱予静脉滴注扩张血管药物,给予患者饮用观饮料后缓慢轻柔地拔管;(3)出现静脉炎时,给予观敷并局部涂抹复方七叶皂苷钠,不可强行拔管,以免加重血管收缩导致导管断裂;(4)如彩超显示深静脉血栓形成时立即停止输液并通知医生,重新建立静脉通道,切忌强行拔管,遵医嘱给予溶栓治疗,复查彩超显示血栓已完全溶解后再行拔管。

Objective:to analyze the patients peripheral venous indwelling central venous catheter decannulation difficult reason analysis and nursing countermeasures. In 150 cases of catheter uproot difficulties in 1 case, for the cause of decannulation difficult for further analysis and nursing. For reasons, and puts forward corresponding nursing countermeasures:(1) the PICC tube drawing to distract talking with children, children with ease tension, before extubation in moist heat on the puncture point 10 ～ 20 cm above the local 20 ～ 30 min, to alleviate vasospasm and contraction;(2) found that when the catheter heterotopia prescribed to the intravenous drip to dilate blood vessels drugs, giving patients after drinking hot drinks slowly gently pull off;(3) appeared phlebitis, give hot compress and on-spot seven Ye Zao nucleoside compound sodium, cannot forced tube drawing, so as not to aggravate vasoconstriction catheter fracture cause;(4) if the display on the colour to exceed deep vein thrombosis immediately to stop the infusion and inform the doctor, re-established venous channel, avoid by all means to extubation, prescribed for thrombolysis treatment, review exceeds show thrombosis has completely dissolved after decannulation.