Cancer patients after intravenous fluid therapy, is not by mouth and gastrointestinal tract does not require implementation of other therapies were continued an active and effective treatment is to ensure that patients can achieve the desired post-operative rehabilitation of an important tool.
Cancer patients after high-nutrition approach a large vein (1) peripheral venipuncture or intravenous cut: common external jugular vein, followed by the jugular vein, basilic vein, cephalic vein and so on. Peripheral vein method is simple, easy to master, but little damage and few complications. By venipuncture or phlebotomy can be successfully completed. Disadvantage is the expense of peripheral veins, phlebitis, and the opportunity to place more. Therefore, not as an intravenous treatment of choice for high-nutrient approach.
Cancer patients after high-nutrition approach a large vein (2) of subclavian vein puncture: This method is more precise puncture, especially for cases of insufficient peripheral venous filling, but without sacrificing the vein. The disadvantage is unskilled when complications.
1) The bottom line clavicular subclavian vein catheterization method:
A patient supine, Trendelenburg 30. About the subclavian vein filling and reduce the chance of embolism, upper limb flat on the chest.
B strict aseptic technique, strictly in accordance with sterile surgical sterilization, sterile shop towels, sheets.
C choose a larger vein puncture and catheter needle into one end of the catheter and the other end 20mI syringe filled with isotonic saline. Catheter length measured from the midpoint of the piercing point of the subclavian superior vena cava in length, adults usually about 20cm, and make marks on the catheter. Diameter needle catheter diameter should fit, elastic fit. Catheter should be soft and tough quality, stimulating small and difficult to rupture and break. Silicon rubber or silicone plastic pipe is preferred, because of the tube less prone to clotting, and clinical use with the above requirements.
D along the midpoint of the clavicle about lcm for local anesthesia. The direction of the needle toward the sternal notch slow piercing, needle and the chest wall parallel or slightly to 5 – 10. Point of penetration of the skin, from a small catheter into the salt water to flush the needle may be brought within the organization, and then continue to sting. Such as the penetration of intravenous catheter in the blood that is returning, and then enter the pin several millimeters, so easy to tip completely in the vein prolapse. Fixed needle, quickly insert the catheter, while slowly into the salt water help to prevent blood coagulation catheter speculation until the catheter insertion site to the mark when the air suction needle should be light, such as the smooth country back to the blood, then the catheter needle from the rear slowly exit. Gently clamp meter before exiting in front of the catheter needle, and then remove the syringe and needle, place the gun to avoid air being inhaled plug, connected to the infusion had been prepared, open tube, adjust the infusion rate.
E catheters with suture fixation of the skin, the surrounding skin with a shy wine, alcohol again after disinfection with a sterile dressing bandage protection.
2) Operation should pay attention to:
A If the puncture is not successful, the needle should retreat into the skin, then slowly re-adjust the direction of stabbing people, should not probe or needle in the depths of the change of direction, so as to avoid pneumothorax, bleeding and other serious complications.
B intubation cases where the resistance can not be forced, a little change of direction after should exit tube, so as not to damage vein wall.
C infusion of hypertonic solution in the application of X ray film examination prior to catheter placement, contrast agent can be injected into 1ml blood for comparison, if the position does not fit should be timely adjusted.
Cancer patients after high-nutrition approach a large vein (3) interspersed through external jugular vein
A puncture position before, disinfection scope, catheter selection, insertion methods and issues with the former Kai injection.
B patients with head to the contralateral puncture, such as filling the external jugular vein is not easy or obvious, then, after the patient deep inspiration breath-hold, or help with a means to suppress the upper edge of the clavicle proximal vein to be filling it . In the external jugular vein and the angle formed by the clavicle Department for local anesthesia, needle into the skin after the first injection of the needle back a little biased saline flush needles within the organization, and then away from the skin puncture point 4 – 5cm external jugular vein at the piercing. After the tube back to the blood occurs, and then into the needle several millimeters, so as to avoid intubation prolapse, depending on the method into the catheter.
C intubation in case of resistance, can be adjusted the following methods: the catheter with guide wire and pulling outward slightly, so that the external jugular vein into the subclavian vein angle becomes smaller, the absence of special taboos, the best selection of the right external jugular vein, subclavian vein because of the angle with a small, easy to insert. help hold up the patient asked to shoulder and feet shoulder back development. To reduce the twin vessels recover from illness, should inject 1% Nu Fuka for 2-4ml. If indeed difficult, it is estimated retention time not a long catheter, the catheter into the subclavian or innominate vein can be. puncture method is relatively simple, fewer complications, but the weak and malnourished patients, due to less blood volume, venous filling is not easy, not easy to successfully puncture, then switch to puncture or venous cut incision. Incision inside the lock on the election at the edge of 2cm, this point of superior vena cava of adult distance of 15cm, children of about 5-10cm. This reduces the external jugular vein catheter in the distance. External jugular vein into the deep cervical fascia, the fascia attached to the vein wall and tight easy to collapse. When you breathe in, due to the risk of air embolism, so incision should not be too low. Vein after exposure, according to the method for catheterization, intravenous catheterization cut, the method and the same general vein incision.