中心静脉导管堵塞原因及对策

[4]ClarkNM.Managementofchronicdiseasebypatients[J].AnnuRevPublicHealth,2003,24:289-313.[5]CurtinRB,JohnsonHK,SchatellD.Theperitonealdialysisexperi2ence:Insightsfromlong-termpatients[J].NephrolNursJ,2004,31(6):615-624.[6]CurtinRB,MapesD,SchatellD,etal.Self-managementinpatientswithendstagerenaldisease:Exploringdomainsanddimensions[J].NephrolNursJ,2005,32(4):389-395.[7]CurtinRB,MapesDL.Healthcaremanagementstrategiesoflong-termdialysissurvivors[J].NephrolNursJ,2001,28(4):385-392.[8]BarlowJ,WhightC,SheasbyJ,etal.Self-managementapproachesforpeoplewithchronicconditions:Areview[J].PatientEducCouns,2002,48:177-187.[9]LorigKR,HolmanH.Self-managementeducation:History,definition,outcomesandmechanisms[J].AnnBehavMed,2003,26(1):1-7.[10]BrennanP,SafranC.Reportofconferencetrack3:Patientempow2erment[J].IntJMedInform,2003,69(2/3):301-304.[11]DiogenesMA,PagliucaLM.Self-caretheory:Criticalanalysisofitsusefulnessinnursingpractice[J].RevGauchaEnferm,2003,24(3):286-293.[12]EpsteinRM,AlperBS,QuillTE.Communicatingevidenceforpar2ticipatorydecisionmaking[J].JAMA,2004,291(19):2359-2366.[13],.[J].,2004,19(22):57-59.[14],,,.[J].,2002,1(2):46-47.[15]CurtinRB,SitterDC,SchatellD,etal.Self-management,knowl2edge,andfunctioningandwell-beingofpatientsonhemodialysis[J].NephrolNursJ,2004,31(4):378-386;396.[16]TsaySL.Self-efficacytrainingforpatientswithend-stagerenaldisease[J].JAdvNurs,2003,43(4):370-375.[17]ZrinyiM,JuhaszM,BallaJ,etal.Dietaryself-efficacy:Determi2nantofcompliancebehavioursandbiochemicaloutcomesinhemodial2ysispatients[J].NephrolDialTransplant,2003,18(9):1869-1873.[18],,,.[J].,2003,20(8):90-91.:(1949),,,,:300070,;:300070,(:2007-01-18;:2007-05-18)()Causativeanalysisofobstructionofcentralvenouscatheteranditsstrategies,,,WangXiaoyan,SheYanchao,GongQinghua,etal(No.456HospitalofPLA,Jiangsu250031China):,,,3:;;;AbstractWiththedevelopmentofnursingtechniques,centralvenouscatheterhasextendedandappliedinclinicextensively.However,obstructionofcatheteroftenoccurredduetovariouscauses.Thisarticlesummarizedthecausesofobstructionofcatheter,evaluationofitsriskfactorsandcorrespond2ingnursingstrategiestowardstheobstructionofcentralvenouscatheter.Keywordscentralvenouscatheter;obstruction;mechanicalfactor;throm2bus:R472:A:1009-6493(2007)6B-1519-03(centralvenouscatheter,CVCs),,[1],1,3:500,15%,2%26%[2],,1/4[3],,,,[4]Gould[5],57%,27%,16%1.1,,,,,,,,10%[6,7]1.2():;;,,,-,[8]915120076216(217)1.31.3.1,3,Virchow[9-11],(PICC),,PICC,,1.3.21.3.3:,;:,,,;:;:,[12]2,,[13]2.1,();,;,;;;[12]2.22.2.1,,,,,[14]70%,20%[15],[16]2.2.2,,,,[15]2.3,4[17],21.5%,1.9%(P0.001)[18],,,,,,[19]2.4,20%;33.1,,,,3.250gtt/min(80gtt/min)[19][20]3.3,CVCs,CVCs,,[21]3.4,;,,,,;,[22],,,10mL,,,,[15],,[22],,,,,[23]3.5;,;;[22],,20mL,,,,,,[24]3.6,,;[25];,;50gtt/min[21]PICC,,,[26];,3.7,[22],,pHpH,pH,,pH,,0251CHINESENURSINGRESEARCHJune,2007Vol.21No.6BpH[16]3.8,3[27],[27]pH,,0.1mol/L;,70%,150mL,1h[23,28]80%95%,(TPA)[29]2000U/mL,;,,1mL,15min,,5mL,,[3,30]4,,,,:[1]LevineM,KakkarAK.Catheter-associatedthrombosis:Thrombo2prophylaxisornot?[J].JournalofClinicalOncology,2005,23(18):4006-4008.[2]DavidC,McGeeMD,MichaelK,etal.Preventingcomplicationsofcentralvenouscatheterization[J].NEnglJMed,2003,348:1123-1133.[3],,.[J].,2005,40(9):709-710.[4]BagnallRH,RuccioneK.Practicalapplicationofanalgorithmforthethrombolytictreatmentofoccludedvascularaccessdevices[J].JournalofPediatricOncologyNursing,1993,10(2):79-82.[5]GouldJR,CarlossHP,SkinnerWL.Groshongcatheter-associatedsubclavianvenousthombosis[J].AmJMed,1993,95:419-423.[6]VeselyTM.Centralvenouscathetertipposition:Acontinuingcontro2versy[J].JVascIntervRadiol,2003,14:527-534.[7]WiseM,RichardsonD,LumP.Cathetertippositionasignofthingstocome[J].JVascAccessDevices,2001,6:18-27.[8]AndrisDA.Totalparenteralnutritioninsurgicalpatients[J].MedSurgNursing,1998,7(2):76-84.[9]WalsheLJ.Complicationratesamongcancerpatientswithperipheral2lyinsertedcentralcatheters[J].JClinOncol,2001,20:3276-3281.[10]VeselyTM,StranzM,MasoorliS,etal.Thediverseandconflictingstandardsandpracticesininfusiontherapy[J].JVascAccessDe2vices,2002,7:9-25.[11]MermelLA.Preventionofintravascularcatheter-relatedinfections[J].AnnInternMed,2000,132:391-402.[12]SherryMcKnight.Nursesguidetounderstandingandtreatingthromboticocclusionofcentralvenousaccessdevices[J].MedSurgNursing,2004,13(6):377-382.[13]KrzywdaE.Centralvenousaccesscatheters,technology,andphysi2ology[J].MedSurgNursing,1998,7(3):132-140.[14],,,.[J].,2003,20(9):4-6.[15].[J].,2002,17(11):859-861.[16]LeighA,BoweGeddes,HeatherA.Nichols:Anoverviewofperiph2erallyinsertedcentralcatheters[J].AdvancedPracticeNursingJour2nal,2005,5(3):1.[17]TimsitJF,FarkasJC,BoyerJM,etal.Centralveincatheter-relatedthrombosisinintensivecarepatients:Incidence,riskfactors,andrelation2shipwithcatheter-relatedsepsis[J].Chest,1998,114:207-213.[18]MerrerJ,DeJongheB,GolliotF,etal.Complicationsoffemoralandsubclavianvenouscatheterizationincriticallyillpatients:Aran2domizedcontrolledtrial[J].JAMA,2001,286:700-707.[19],,.[J].,2003,17(1B):96.[20]MoureauNL,MickinnonBY,DouglasCM.Multidisciplinaryman2ag