THÔNG TIN TÀI LIỆU
Procedures that can be accomplished by the generalist or ED personnel include establishing access, performing phlebotomy, and infusing fluids or medications The general procedure for establishing access and patency is similar for both tunneled and totally implanted devices ( Table 135.6 ) Aseptic technique is mandatory Because tincture of iodine solution can damage Silastic catheters, 2% chlorhexidine gluconate or povidone-iodine solution is used to clean the site Recent studies have demonstrated lower bloodstream infection rates with the use of 2% tincture of chlorhexidine and chlorhexidine-impregnated dressings Antimicrobial locks, including ethanol locks, and antibiotic/antifungal locks are often instilled daily in patients with long-term CVCs who have limited venous access and a history of recurrent central line infections, and those who are a highest risk of severe sequelae from an infection Locks dwell from to 24 hours Ethanol locks are highly recommended for at-risk patients, but can only be instilled into silicone catheters due to risk of degradation of polyurethane, in which case, and antibiotic lock may be ordered Clamps or hemostats with teeth should not be used, as these instruments can damage the external portion of the catheter In addition, smaller (less than mL) syringes can generate too much pressure inside the catheter, causing catheter breakage Therefore, 5- or 10-mL syringes are recommended to flush the system; never force flush against resistance Fluid or medications should never be infused until patency is established because the risk of administering these solutions into a nonvascular space is high To prevent air emboli, all clamps must remain closed when any part of the circuit is open For accurate blood test results, the amount of blood that needs to be withdrawn and discarded prior to obtaining a laboratory sample is mL from a tunneled CVC and mL from a totally implanted CVC Recent literature has demonstrated that compared with heparin, tissue-type plasminogen activator (tPA) is more successful in reducing the chances of clot formation in central venous hemodialysis catheters However, further research on other types of catheters and cost analyses remain to be performed to determine if tPA should replace heparin in this regard
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