Summary

在重症监护病房的中央静脉导管上设置无针接头,带正位移

Published: July 13, 2019
doi:

Summary

我们提出了一个协议,以显示在中央静脉导管上安装带正位移的无针连接器。

Abstract

无针连接器最初是为避免卫生保健工作者的血液接触而设计和推广的。最近的一些数据表明,最新一代的连接器(带正位移)可能有利于减少中央静脉线感染。我们在重症监护病房中使用无针连接器已有数年,在这里我们提出了在中央静脉导管上安装这些连接器的协议。插入导管并控制线路的渗透性后,在连接之前,必须用 0.9% NaCl 清除连接器。连接器取代了输液止液塞和歧管上使用的所有一次性盖。所有连接器均按制造商建议每 7 天更换一次(除非存在宏观污染,需要立即更换连接器)。每次注射前,必须用 70% 的等丙醇对接头进行至少 3 秒的消毒。不得断开接头(除非更改),因为喷射是通过设备完成的。设置连接器会稍微增加放置导管所需的总时间,并且没有正式证据表明这些连接器可降低传染性或血栓并发症的发生率。然而,这些设备简化了中央静脉线路的管理,防止导管电路在无菌安装后”打开”。

Introduction

中央静脉导管相关感染 (CRI) 是重症监护病房 (ICU) 中静脉导管的严重并发症。CRI的下降仍然是一个始终存在的目标,最终目标是”零导管相关感染”1。无针连接器最初是为避免卫生保健工作者的血液接触而设计和推广的。连接器有两种主要设计:分离隔膜(无内部移动部件)和封闭阀系统(内部移动部件),但两种设计都可以组合在一个连接器2中。无针连接器根据雄性 Luer 阀断开后发生的流体位移类型进行分类:负(血液回流到导管中)、中性、正(用血从导管流明管中排出)2,3.

一些连接器被描述为与导管相关的感染的原因,特别是在重症监护病房(ICU)4,5,6。设计了新一代无针连接器,具有最小的内部复杂性,减少或消除间隙或死区,提供可见的流体路径,以帮助评估适当的冲洗技术,以及平坦的检修表面等,以降低风险感染。在体外,这些连接器已显示出低细菌殖民化7。制造这些连接器的实验室提出了全球建议;然而,没有实际的描述,如何将它们安装在导管8。因此,每个团队可能以不同的方式使用它们。因此,我们提出了一个正式的协议,用于在ICU的中央静脉线路上安装这些连接器。

我们在 ICU 中演示了带内部硅胶活塞的正压无针连接器 (PPNC),但此协议适用于任何正位移阀。此阀是带正位移的机械无针接头。

Protocol

1. 准备连接器和输液管 无菌检索连接器。 在 3 路扩展停止孔上,将 1 个接头拧入停止孔的每个插座,将 1 个连接器拧入延长线末端。使用 50 mL 注射器服用 0.9% NaCl 以清除延伸和管路。通过停止孔的 2 个接头,用 0.9% NaCl 清除每个 3 向扩展。 采取输注歧管。拧下每个一次性盖。将 1 个接头拧入歧管的每个插座以更换盖。通过按顺序转动每个止流孔,通过每个接头清除输注管。注…

Representative Results

一旦所有元件都就位,导管在两条输液线之间的几乎所有结点上都有接头(图1)。因此,它每条线路都有近端连接器,在 3 路扩展的插座上有两个连接器(图2)。每个输液管有连接器的所有母插座 (图3)。组件到位后,任何注射或输注(连续或不连续)都必须在消毒后通过输注管或延长线或延长件的连接器之一进行(图4)。…

Discussion

设置连接器会稍微增加放置导管所需的总时间。然而,它们的使用有几个优点:无需为非注入线路保持连续盐水灌注,必要时快速停止输液线路(例如,在紧急转运患者的情况下),无需使用一次性盖数一天几次关闭输液线。连接器的使用简化了导管输液管的每日使用,没有任何特殊的并发症。需要注意的是,在我们四年的PPNC连接器经验中,快速流体管理没有出现并发症,而其他类型的连接器11</sup…

Declarações

The authors have nothing to disclose.

Acknowledgements

作者感谢鲁昂大学医院尼基·萨布林-吉布斯在编辑手稿方面的帮助。作者感谢鲁昂大学医院的通讯部和医学培训中心的小组参与视频拍摄。

Materials

BD MaxZero™ needle-free connector Becton Dickinson MZ1000-07 we present the installation of the connector with MaxZero but this protocol is applicable with any positive displacement valve.
4-port mannifold with PE/PVC extension Cair-LGL RPB4310A
PE/PVC extension line with 3-way stopcock Cair-LGL PE3302M
NaCl 0.9% 250 ml Baxter 2B1322
BD Plastipak™ 50mL Luer-Lock Syringe BECTON DICKINSON MEDICAL 613-3925

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Clavier, T., Franchina, S., Lefevre-Scelles, A., Gouin, P., Besnier, E., Veber, B. A Protocol to Set Up Needle-Free Connector with Positive Displacement on Central Venous Catheter in Intensive Care Unit. J. Vis. Exp. (149), e59801, doi:10.3791/59801 (2019).

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