《picc相关解剖》ppt课件.ppt

左右头臂静脉不同 the left brachicephalic vein crosses anteriorly though the mediastinum to the right side, where it joins the right brachicephalic vein to become the superior vena cava (SVC). Thus left-sided PICCs run a longer course to the SVC, which is important when determining optimum catheter length Malposition to the contralateral brachiocephalic vein Clinical Radiology (2009) The superior vena cava 上腔静脉 由左、右头臂静脉在右侧第一胸肋关节后合成，垂直下行，汇入右心房 在其汇入前有奇静脉注入上腔静脉 接纳头颈、上肢和胸部的静脉血 其属支有左、右头臂静脉和奇静脉 幸福的彼岸： Cardiac Anatomy SVC and Cardiac Anatomy Superior vena cava right atrial junction (CAJ) Recommendations forCVC Tip Position Organization Recommendation AVA (1998) Distal SVC close to the cavoatrial junction FDA CVC Working Group (1989, 1994) Lower one-third of SVC Catheter tip should not be placed in or allowed to migrate into heart ONS (2004) SVC at junction of RA PICCs: Lower one-third of SVC NKF/DOQI (2006) SVC / RA junction or RA SIR (2003) SVC / RA junction Thoracic Anatomy:Lungs and Pleura Heart is in the mediastinum Between the two lungs Lungs surrounded by double walled lining: pleura Pleura can be damaged with CVC placement 常见的导管易位 Azygos vein 术后常规 胸片很重要 最佳静脉的条件 软、直、有弹性 由完整的弹性皮肤支持 有弹力并可轻易触摸到 非硬化的或不平的 机密 仅供内部发行 同样条件下的选择 ： 静脉大小和 长度 选择适合给药需 要，能提供充分血液稀释而完成治疗的静脉 选择 长 度最短、直径最小的工具以适合静脉获得最佳疗效 机密 仅供内部发行 定位，定位，再定位 避免: 弯曲和伸展区域 缺乏抵抗力的区域 近期行静脉穿刺部位的下游区域 下肢？ 受限区域 PICC在B 超下定位 * Epidermis Composition First line of defense Resident bacterial flora exist beneath these cells 50 – 10,000/cm3 Dermis Composition Aging process results in loss of elasticity Superficial Fascia (Subcutaneous) Composition Contains a number of immune cells Mast cells respond to immunological stimulation Potential site for cellulitis Infection easily spreads in this layer Considerations in venipuncture Angle of entry Stabilization Skin preparation * Introduction slide * Arteries Radial and Ulnar join in the antecubital fossa to form the brachial artery ULNAR IS NOT ON DIAGRAM POINT OUT Brachial li