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Central venous access is widely used in anesthesiology, and can be used for perioperative vital sign monitoring and rapid and massive fluid replacement
Central venous access is widely used in anesthesiology, and can be used for perioperative vital sign monitoring and rapid and massive fluid replacement
Central venous catheterization is an invasive procedure, and some complications may occur during the application
Risk Factors for Catheter Thrombosis Risk Factors for Catheter Thrombosis
Some special patients are high-risk factors for venous thrombosis, such as surgical patients, malignant tumor patients, and long-term bedridden patients.
Some special patients are high-risk factors for venous thrombosis, such as surgical patients, malignant tumor patients, and long-term bedridden patients.
Catheter diameter is the most significant risk factor for venous thrombosis, such as large diameter and multi-lumen catheters
The material of the catheter is also one of the influencing factors.
Multiple punctures and repeated catheter withdrawals can also aggravate intimal injury and increase the risk of venous thrombosis
Drugs and infusion rates are also closely related to thrombosis
Some drugs (anti-angiogenic agents, erythropoietin, etc.
Prevention of Catheter Thrombosis Prevention of Catheter Thrombosis
Measures to reduce the risk of thrombosis in central venous catheters are very important, such as strengthening the training of personnel, reducing errors in implementation, and avoiding repeated entry and exit of puncture needles or catheters to improve the success rate of a puncture
Measures to reduce the risk of thrombosis in central venous catheters are very important, such as strengthening the training of personnel, reducing errors in implementation, and avoiding repeated entry and exit of puncture needles or catheters to improve the success rate of a puncture
Choose the appropriate catheter type, and choose the smallest type of catheter according to clinical needs
The indwelling length of the catheter should not be too long or too short, and the tip of the catheter should be located in the lower third of the superior vena cava or the junction between the right atrium and the superior vena cava
The venous catheter needs to be fixed more stably to avoid re-injury to the vascular endothelium caused by the catheter movement after the catheter is placed
treatment and treatment treatment and treatment
Ultrasound Doppler is the first choice for the detection of venous thrombosis.
Ultrasound Doppler is the first choice for the detection of venous thrombosis.
After thrombosis, local complications (phlebitis) and systemic complications (thrombotic embolic events) can occur.
Then the problem comes when the anesthesiologist finds an elective patient or an emergency What should be done when a patient has a venous catheter thrombosis?
It is important to first objectively and rationally assess the risk of thrombus shedding leading to embolism in order to avoid inappropriate clinical decisions
.
The incidence of pulmonary embolism caused by catheter-related thrombosis in the upper extremity is lower than that in the lower extremity, and the risk of symptomatic pulmonary embolism is lower
.
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The incidence of pulmonary embolism caused by catheter-related thrombosis in the upper extremity is lower than that in the lower extremity, and the risk of symptomatic pulmonary embolism is lower
.
Can the catheter with long thrombus be removed? Of course, it is to avoid pulling out the catheter in the acute stage of thrombosis, which is the simplest and most effective measure to reduce the occurrence of pulmonary embolism caused by thrombus shedding
.
Existing guidelines do not recommend routine removal of the catheter.
If the patient still needs this circuit, it can be retained under anticoagulation therapy and used for normal clinical treatment
.
.
Existing guidelines do not recommend routine removal of the catheter.
If the patient still needs this circuit, it can be retained under anticoagulation therapy and used for normal clinical treatment
.
guide
In terms of timing of extubation, it is recommended to extubate after receiving anticoagulation for a period of time, which is more conducive to the stability of thrombus
.
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Aggressive filter placement is also not recommended, and even for patients who have been removed in the acute phase due to medical conditions, the need for filter placement needs to be carefully assessed
.
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It should be noted that a small number of patients with a clear history of cardiac structural abnormalities may have the possibility of paradoxical embolism, and the evaluation should be combined with some cardiac ultrasonography results
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So finally, to sum up, if an elective patient is found to have catheter-related thrombosis, they can undergo treatment before surgery; if it is an emergency patient, leave the tube untouched and continue to use it
.
.
references:
references:[1]Practice Guidelines for Central Venous Access 2020: An Updated Report by the American Society of Anesthesiologists Task Force on Central Venous Access.
[J].
Anesthesiology,2020,132(1).
[J].
Anesthesiology,2020,132(1).
[2] Cheng Fang, Fu Qining, He Peiyi,
etc.
Chinese expert consensus on prevention and treatment of infusion catheter-related venous thrombosis ( 2020 edition) [J].
Chinese Journal of Practical Surgery, 2020 , 4, 40 ( 4 ) .
etc.
Chinese expert consensus on the prevention and treatment of infusion catheter-related venous thrombosis ( consensus 2020 version) [J].
Chinese Journal of Practical Surgery, 2020 , 4, 40 ( 4 ) .
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