تعريف
A central catheter is a long, thin tube that is inserted into a large vein. A central catheter is used to deliver medicine, nutrition, IV fluids, and chemotherapy.
There are different types of central catheters, including:
- Peripherally inserted central catheter (PICC line)—The catheter is threaded through a vein in the arm until it reaches the larger vein close to the heart.
- Non-tunneled central catheter—It is inserted in a large vein in the neck or leg; the tube end is outside of the skin.
- Tunneled central catheter—It is inserted in the neck vein and “tunneled” under the skin. The end of the catheter is sticking out from under the skin, usually below the collarbone.
- Port catheter—It is inserted in a shoulder or neck vein. The port is under the skin, and the catheter is tunneled into the central vein. The port is accessed by putting a needle through the skin directly into the port.
أسباب هذا الإجراء
Central catheters are inserted when patients need:
- Long-term medicine or fluids
- العلاج الكيميائي
- Nutrition, but cannot get it through the digestive system
- Repeated blood draws
- Blood transfusions
- IV medicine when arm veins are difficult to access
- غسيل الكلى
A central catheter is commonly inserted by special types of doctors calledinterventional radiologists أو vascular surgeons. Once the line is in, it can be used for weeks to months.
المضاعفات المحتملة
Complications are rare, but no procedure is completely free of risk. If you are planning to have a central catheter inserted, your doctor will review a list of possible complications, which may include:
- Bloodstream infection —occurs when bacteria enters the bloodstream through or around the central line
- نزيف
- Collapsed lung
- Heart arrhythmias (changes in the way your heart beats)
- إصابة الأعصاب
- An air bubble or part of the catheter blocks a blood vessel, causing chest pain, shortness of breath, dizziness, and rapid heart beat
- Blood clots in the vein or on the catheter, potentially blocking the vein
تشمل العوامل التي قد تزيد من خطر حدوث مضاعفات ما يلي:
- التدخين
- Veins that are difficult to reach
- Blood clots
- السمنة
- Broken bones
- العدوى
- ضعف الدورة الدموية
- Clotting or bleeding tendencies
Discuss these risks with your doctor before your central catheter is inserted.
ما يمكن توقعه
قبل الإجراء
- At your appointment before the procedure:
- You may have a blood draw to check how well your blood clots.
- Your doctor may ask if you have any allergies.
- Arrange for a ride home after the procedure.
- التحدث مع طبيبك عن الأدوية الخاصة بك. قد يطلب منك التوقف عن تناول بعض الأدوية تصل إلى أسبوع واحد قبل العملية مثل:
- الأدوية المضادة للالتهابات (مثل الأسبرين)
- Blood thinners, like warfarin (Coumadin)
- كلوبيدوجريل (بلافيكس)
- If you think you may be pregnant, tell your doctor before the procedure.
التخدير
You will be given a local anesthetic at the insertion area. Depending on where your central catheter is placed, you may receive a sedative through an IV.
وصف الإجراء
This procedure may be done while you are in the hospital as part of your treatment or in an outpatient setting. If you are already in the hospital for another reason, this procedure is unlikely to extend your stay.
Having a catheter inserted increases your risk of a bloodstream infection. The hospital staff will begin the procedure by taking the following steps to reduce this risk:
- اختر بعناية موقعًا آمنًا لإدخال القسطرة.
- اغسل أيديهم جيدًا أو استخدم معقمًا لليدين.
- ارتداء العباءات الجراحية والأقنعة والقفازات وأغطية الشعر.
- Clean your skin with an antiseptic.
- ضع ورقة معقمة فوقك.
The next steps may differ depending on the type of catheter and the insertion site. In general, the staff will:
- Give you an anesthetic.
- Make a small incision.
- Use an x-ray or ultrasound to guide a wire into the vein.
- Before inserting the catheter, cut it to the correct length. Flush the catheter with saline (salt water).
- Insert the catheter using the guide wire. Then, remove the wire.
- Use sutures or tape to secure the catheter line. Place caps on the end of the catheter.
- Cover the insertion site with a bandage. Write the date of the insertion on or near the bandage.
If you have a port inserted, a small pocket for the port will be created under your skin. The incision will be closed over the pocket, usually with dissolving sutures.
مباشرة بعد الإجراء
You will be checked for bleeding, drainage, and bruising at the insertion site.
كم من الوقت سيستغرق ؟
30-45 minutes
كم هو مؤلم ؟
During the procedure, you will not feel any pain because of the anesthetic. There may be mild discomfort at the insertion site after the procedure.
متوسط الإقامة في المستشفى
This procedure is most commonly done in a hospital setting because it is needed for your treatment. The length of stay will depend on the reason you need the central catheter. If you are an outpatient receiving treatment through your central catheter, you may be sent home the same day as the procedure.
رعاية ما بعد العملية
في المستشفى
After the procedure, the staff may provide the following care to help you recover:
- Do an x-ray to make sure your catheter is in the correct position.
- Continue to check the insertion site for bleeding.
- Give you medicines, fluids, or nutrition through the catheter.
- Flush catheter ports to prevent blood clots.
- Take steps to reduce your risk of infection by:
- Thoroughly washing their hands and wearing gloves before touching the catheter or changing the bandage
- Using an antiseptic to clean the catheter opening
- Taking precautions when handling medicine, fluid, or nutrition that will be delivered through the catheter
- Watching you closely for signs of infections—These signs include fever, chills, and problems at the insertion site (eg, redness, swelling, drainage).
- Not allowing visitors in your hospital room when the bandage is being changed
- Keeping the catheter in place only as long as it is needed
هناك أيضًا خطوات يمكنك اتخاذها لتقليل خطر الإصابة بالعدوى:
- اطلب من الموظفين اتخاذ كل الاحتياطات اللازمة لمنع العدوى.
- أخبر الموظفين على الفور إذا كانت الضمادة بحاجة إلى تغيير أو إذا كان الموقع أحمر أو مؤلمًا.
- اطلب من جميع الذين يدخلون غرفتك في المستشفى أن يغسلوا أيديهم. لا تسمح للزوار بلمس القسطرة الخاصة بك.
في البيت
عند العودة إلى المنزل ، قم بما يلي للمساعدة في ضمان التعافي السلس:
- Keep your insertion site clean, dry, and covered with a bandage. Follow your doctor’s instructions for changing the bandage.
- قبل لمس القسطرة، اغسل يديك أو استخدم معقم اليدين. ارتداء القفازات عند لمس المنطقة.
- Ask your doctor about when it is safe to shower, bathe, or soak in water. If allowed by your doctor, cover the bandage with plastic when showering.
- Do not swim or bathe while your central line is in.
- Avoid lifting or any kind of activity that may loosen the central line.
- لا تسمح لأي شخص بلمس القسطرة أو الأنبوب.
- Check the insertion site daily for signs of infection (eg, redness, pain).
- Learn how to take care of your catheter.
- Flush the line with saline or heparin as directed.
- Take medicine as directed.
استدعاء الطبيب
بعد وصوله الى المنزل ، اتصل بطبيبك إذا كان أي من الحالات التالية:
- Signs of infection—fever and chills, redness or swelling at the insertion site
- Pain at the insertion site
- Drainage or leakage from the catheter
- Trouble flushing or inserting fluids into the catheter
- Catheter loosens or falls out
في حالة الطوارئ ، اتصل على المساعدة الطبية على الفور.