Podstawową kwestią przy kaniulacji żyły głównej jest zachowanie standardów aseptycznych i antyseptycznych, prawidłowe ułożenie pacjenta w pozycji Trendelenburga i kontrola położenia końca cewnika. W przypadku tego zabiegu nie należy również zapominać o dokładnej pielęgnacji cewnika, a jeżeli doszło do zakażenia lub zatkania w nim światła, o jego wymianie czy usunięciu.
Najczęstszymi powikłaniami tego zabiegu są powikłania w postaci uszkodzenia tętnicy i nerwów znajdujących się w pobliżu kaniulowanej żyły, odmy opłucnowej czy rozedmy podskórnej, a także krwiaka opłucnej.
Podczas kaniulacji żył głównych może również dojść do doopłucnowego przetoczenia płynów, zatoru powietrznego, przebicia żyły lub ściany serca oraz zakażenia bakteryjnego.
Jakie są wskazania do kaniulacji żył głównych?
Konulację żył centralnych przeprowadza się w przypadku konieczności szybkiego przetaczania płynów krystaloidowych, koloidowych i krwi, podawania silnie działających leków, np. naczynioskórczowych, a także żywienia pozajelitowego.
Dodatkowo zabieg ten wykonuje się w celu pomiaru ośrodkowego ciśnienia żylnego i monitorowania krążenia, a także wprowadzenia elektrody endokawitarnej lub cewnika Swana-Ganza. Kaniulację żył głównych stosuje się również w leczeniu narkozastępczym i przewidywanym długotrwałym leczeniu dożylnym.
Kaniulację żył głównych można wykonać przez:
- Dostęp obwodowy do żyły głównej górnej
- Dostęp przez żyłę podobojczykową do żyły głównej górnej
- Dostęp przez żyłę szyjną wewnętrzną do żyły głównej górnej
- Przezskórną długoterminową kaniulację żył centralnych z tunelizacją
Co szczególnie istotne, w przypadku resuscytacji podanie leku do żyły głównej górnej jest o wiele bardziej efektywniejsze, w porównaniu z podaniem do żył obwodowych.
Źródło: Noszczyk W., Chirurgia Repetytorium, Wydanie II uaktualnione, Warszawa 2019, s. 93-96
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