Kurwanya】

1) Imitekerereze cyangwa imitekerereze idakwiye kubagwa mubihe rusange

2) Kuva amaraso menshi no kurwara.

3) Uturemangingo twamaraso twera tubara munsi ya 3 × 109 / L.

4) Allergic yo gutandukanya itangazamakuru

5) Ufatanije n'indwara zikomeye zidakira zifata ibihaha.

6) Abarwayi bafite allergie izwi cyangwa ikekwa kubikoresho biri mubikoresho byabikoresho .。

7) Kubaho cyangwa gukeka kwandura ibikoresho, bacteraemia cyangwa sepsis.

8) Radiotherapi ahabigenewe gushiramo.

9) Kwerekana cyangwa gutera inshinge.

 

Yakozwe】 Reba ikirango cyibicuruzwa

 

Kurangira】 Reba ikirango cyibicuruzwa

 

【Uburyo bwo gusaba】

1. Tegura icyambu cyatewe hanyuma urebe niba itariki izarangiriraho; kura pake y'imbere hanyuma urebe niba paki yangiritse.
2. Ugomba gukoresha tekinike ya aseptic kugirango ugabanye gufungura imbere hanyuma ukureho ibicuruzwa kugirango witegure gukoresha.
3. Ikoreshwa ryibikoresho byicyambu bisobanurwa bitandukanye kuri buri cyitegererezo nkibi bikurikira.

 

UbwokoⅠ

1. Kuzunguruka, guhumeka, kugerageza kumeneka

Koresha inshinge (inshinge kubikoresho byicyambu byatewe) kugirango utobore icyambu cyatewe hanyuma utere 5mL-10mL ya saline physiologique kugirango usukure intebe yatewe na catheter lumen hanyuma ukuyemo. Niba nta mazi cyangwa gahoro yabonetse, hinduranya imiti ya catheter (impera ya kure) ukoresheje intoki kugirango ufungure icyambu cyo gutanga ibiyobyabwenge; hanyuma Fold ifunga ibiyobyabwenge bitangirira kuri catheter, komeza usunike saline (umuvuduko utarenze 200kPa), urebe niba hari imyanda iva kumyanya yo gutera inshinge no guhuza catheter, nyuma yubusanzwe Nyuma yibintu byose nibisanzwe, catheter irashobora gukoreshwa.

1. Cannulation and ligation

Nk’uko iperereza ryakozwe ridashingiye ku mikorere, shyiramo catheter (iherezo ry’ibiyobyabwenge) mu cyombo gitanga amaraso ukurikije aho ikibyimba giherereye, kandi ukoreshe udusimba tudashobora kwinjizwa kugira ngo uhuze neza na catheter mu bwato. Catheter igomba guhuzwa neza (passes ebyiri cyangwa nyinshi) kandi igakosorwa.

1. imiti ya chimiotherapie hamwe na kashe

Imiti ya chimiotherapie intraoperative irashobora guterwa inshuro imwe ukurikije gahunda yo kuvura; birasabwa ko intebe yo gutera inshinge na catheter lumen yogejwe hamwe na 6-8 mL ya saline physiologique, hagakurikiraho 3 mL ~ 5 mL Catheter noneho igashyirwaho kashe ya 3mL kugeza 5mL ya saline ya heparin kuri 100U / mL kugeza 200U / mL.

1. Gutera intebe

Umuyoboro wa sisitemu yo munsi yubutaka ukorerwa ahantu hashyigikiwe, ni cm 0,5 kugeza kuri cm 1 uvuye hejuru yuruhu, kandi intebe yo gutera inshinge igashyirwa mu cyuho igashyirwaho, kandi uruhu rukadoda nyuma ya hemostasis ikaze. Niba catheter ari ndende cyane, irashobora gukusanyirizwa muruziga kumpera yegeranye kandi igakosorwa neza.

 

UbwokoⅡ

1.Kuzunguruka no guhumeka

Koresha inshinge (urushinge kubikoresho byinjira byatewe) kugirango utere saline mucyicaro cyatewe inshinge na catheter kugirango uhindure kandi ukureho umwuka muri lumen, hanyuma urebe niba amazi atwara neza.

2. Cannulation na ligation

4. Ikizamini gisohoka

4. (igitutu kitarenze 200kPa), reba niba hari imyanda iva mumashanyarazi na catheter

guhuza, kandi ukoreshe gusa nyuma yibintu byose nibisanzwe.

5. Chimiotherapie, umuyoboro wa kashe

Imiti ya chimiotherapie intraoperative irashobora guterwa inshuro imwe ukurikije gahunda yo kuvura; birasabwa guhanagura inshinge na catheter lumen hamwe na 6 ~ 8mL ya saline physiologique, hanyuma ugakoresha 3mL ~ 5mL ya saline physiologique.

Catheter noneho ifunzwe hamwe na 3mL kugeza 5mL ya saline ya heparin kuri 100U / mL kugeza 200U / mL.

6. Gutera intebe

Umuyoboro wa cystic utubuto twakozwe ahantu hashyigikiwe, cm 0,5 kugeza kuri cm 1 uvuye hejuru yuruhu, kandi intebe yatewe inshinge yashyizwe mu cyuho irashyirwaho, kandi uruhu rwarashizweho nyuma ya hemostasis ikaze.

 

Andika Ⅲ

Siringe (urushinge rwihariye rwibikoresho byinjira byatewe) yakoreshejwe mu gutera umunyu usanzwe wa 10mL ~ 20mL mu gikoresho cyo gutanga imiti yatewe kugirango usukure intebe yatewe inshinge na cavite ya catheter, hanyuma ukureho umwuka uri mu kavuyo, hanyuma urebe niba ayo mazi ntiyashishikazwaga.

2. Cannulation na ligation

Ukurikije ubushakashatsi bwakozwe, shyiramo catheter kurukuta rwinda, kandi igice gifunguye cyo gutanga imiti ya catheter kigomba kwinjira munda yinda kandi kikaba hafi yintego yibibyimba bishoboka. Hitamo amanota 2-3 kugirango uhuze kandi ukosore catheter.

3. chimiotherapie, umuyoboro wa kashe

Imiti ya chimiotherapie intraoperative irashobora guterwa inshuro imwe ukurikije gahunda yo kuvura, hanyuma umuyoboro ugafungwa hamwe na 3mL ~ 5mL ya 100U / mL ~ 200U / mL ya saline ya heparin.

4. Gutera intebe

Umuyoboro wa cystic utubuto twakozwe ahantu hashyigikiwe, cm 0,5 kugeza kuri cm 1 uvuye hejuru yuruhu, kandi intebe yatewe inshinge yashyizwe mu cyuho irashyirwaho, kandi uruhu rwarashizweho nyuma ya hemostasis ikaze.

Kwinjiza ibiyobyabwenge no kubitaho

A.Igikorwa gikomeye cya aseptic, guhitamo neza aho batera inshinge mbere yo gutera inshinge, no kwanduza cyane aho batewe.B. Mugihe utera inshinge, koresha urushinge kubikoresho byicyambu byatewe, syringe ya mL 10 cyangwa irenga, urutoki rwibumoso rwerekana urutoki rukora aho rwacumise kandi igikumwe cyiziritse uruhu mugihe utunganya intebe yatewe, ukuboko kwiburyo ufashe siringi uhagaritse mu rushinge, wirinda kunyeganyega cyangwa kuzunguruka, no gutera buhoro buhoro saline 5 mL ~ 10 mL mugihe hari kumva ko kugwa kandi isonga ryurushinge nyuma rikora munsi yintebe yinshinge, hanyuma urebe niba gahunda yo gutanga ibiyobyabwenge yoroshye (niba bitoroshye, ugomba kubanza gusuzuma niba inshinge zifunze). Reba niba hari ubutumburuke bwuruhu ruzengurutse mugihe usunika.

C. Shyira imiti ya chimiotherapeutique nyuma yo kwemeza ko ntakosa. Mugihe cyo gusunika, witondere kureba niba uruhu ruzengurutse ruzamutse cyangwa rwera, kandi niba hari ububabare bwaho. Umuti umaze gusunikwa, ugomba kubikwa kuri 15 ~ 30s.

D. Nyuma ya buri inshinge, birasabwa koza intebe yo gutera inshinge na catheter lumen hamwe na 6 ~ 8mL ya saline physiologique, hanyuma ugafunga catheter hamwe na 3mL ~ 5mL ya 100U / mL ~ 200U / mL ya saline ya heparin, nigihe uheruka 0.5mL ya saline ya heparin yatewe, imiti igomba gusunikwa mugihe cyo gusubira inyuma, kugirango sisitemu yo kwinjiza ibiyobyabwenge yuzuyemo saline ya heparin kugirango hirindwe korohereza ibiyobyabwenge no gutembera kw'amaraso muri catheter. Catheter igomba guhanagurwa na saline ya heparin rimwe mubyumweru 2 mugihe cya chimiotherapie.

E. Nyuma yo guterwa inshinge, kwanduza ijisho ry'urushinge ukoresheje imiti yica udukoko, uyipfundikire wambaye sterile, kandi witondere kugira isuku yaho kandi yumutse kugirango wirinde kwandura ahacitse.

F. Witondere uko umurwayi yitwaye nyuma yubuyobozi bwibiyobyabwenge kandi urebe neza mugihe cyo gutera ibiyobyabwenge.

 

Kwitonda, kuburira no gutanga ibitekerezo】

1. Ibicuruzwa byatewe na okiside ya Ethylene kandi bifite agaciro kumyaka itatu.
2. Nyamuneka soma igitabo gikubiyemo amabwiriza mbere yo gukoresha kugirango umenye umutekano wo gukoresha.
3. Imikoreshereze yiki gicuruzwa igomba kubahiriza ibisabwa n’amategeko agenga imyitozo n’amabwiriza agenga urwego rw’ubuvuzi, kandi kwinjiza, gukora no kuvanaho ibyo bikoresho bigomba kugarukira gusa ku baganga bemewe. Kwinjiza, gukora no gukuraho ibyo bikoresho ni bigarukira gusa kubaganga bemewe, kandi ubuvuzi bwa nyuma ya tube bugomba gukorwa nabaganga babishoboye.
4. Inzira zose zigomba gukorwa mugihe cya aseptic.
5. Reba itariki izarangiriraho ibicuruzwa nibipfunyika imbere kugirango byangiritse mbere yuburyo bukurikizwa.
6. Nyuma yo kuyikoresha, ibicuruzwa bishobora guteza ingaruka kubinyabuzima. Nyamuneka kurikiza ibikorwa byemewe byubuvuzi namategeko yose ajyanye no gufata no kuvura.
7. Ntukoreshe imbaraga zikabije mugihe cya intubation hanyuma ushyiremo imiyoboro neza kandi vuba kugirango wirinde vasospasm. Niba intubation igoye, koresha intoki zawe kugirango uhindure catheter kuruhande rumwe mugihe winjizamo umuyoboro.
8. Uburebure bwa catheter yashyizwe mumubiri bugomba kuba bukwiye, birebire cyane biroroshye gutumbagira mu nguni, bikaviramo guhumeka nabi, bigufi cyane ni igihe ibikorwa byubugizi bwa nabi by’abarwayi bifite amahirwe yo kuva mu bwato. Niba catheter ari ngufi cyane, irashobora kuva mu bwato mugihe umurwayi yimutse cyane.
9. Catheter igomba kwinjizwa mu cyombo hamwe na ligature zirenga ebyiri hamwe no gukomera kugira ngo ibiyobyabwenge byinjizwe neza kandi birinde catheter kunyerera.
10. Niba icyambu cyimurwa ari ubwoko bwa II, ihuriro hagati ya catheter nintebe yo gutera inshinge igomba kuba ikomeye. Niba inshinge zidasanzwe zidakenewe, inshinge zisanzwe za saline zigomba gukoreshwa kugirango zemeze mbere yo kudoda uruhu.
11. Mugihe cyo gutandukanya agace k'ubutaka, hakwiye gukorwa hafi ya hemostasis kugirango hirindwe kubaho kwa hematoma yaho, kwirundanya amazi cyangwa kwandura kabiri nyuma yo kubagwa; suture ya viticular igomba kwirinda intebe yo gutera.
12. α-cyanoacrylate imiti ivura irashobora kwangiza ibikoresho fatizo byatewe; ntukoreshe α- cyanoacrylate imiti yubuvuzi mugihe uvura ibice byo kubaga bikikije inshinge. Ntugakoreshe α-cyanoacrylate yivuza mugihe uhanganye nibice byo kubaga bikikije inshinge.
13. Koresha ubwitonzi bukabije kugirango wirinde gutemba kwa catheter kubera ibikomere biturutse kubikoresho byo kubaga.
14. Mugihe cyo gutobora, urushinge rugomba kwinjizwa mu buryo buhagaritse, hagomba gukoreshwa inshinge zifite ubushobozi bwa 10mL cyangwa zirenga, imiti igomba guterwa buhoro, kandi urushinge rugomba gukurwaho nyuma yo guhagarara gato. Umuvuduko wo gusunika ntugomba kurenga 200kPa.
15. Koresha gusa inshinge zidasanzwe kubikoresho byo gutanga imiti byatewe.
16. Iyo hasabwa gushiramo igihe kirekire cyangwa gusimbuza ibiyobyabwenge, birakwiye gukoresha igikoresho kimwe cyo gutera imiti hamwe nogushiramo urushinge rwihariye rwa infusion cyangwa tee, kugirango ugabanye umubare wibyimba kandi bigabanye ingaruka kumurwayi.
17. Mugabanye umubare wibyimba, gabanya kwangirika kwimitsi yumurwayi hamwe no kwifungisha ibice bya elastike. Mugihe cyo guhagarika inshinge, inshinge zirwanya anticoagulant zisabwa rimwe mubyumweru bibiri.
18. Iki gicuruzwa nigicuruzwa kimwe, sterile, kitari pyrogeneque, cyangiritse nyuma yo gukoreshwa, kongera gukoresha birabujijwe rwose.
19. Niba paki y'imbere yangiritse cyangwa itariki yo kurangiriraho ibicuruzwa yarenze, nyamuneka uyisubize uyikora kugirango ayijugunye.
20. Umubare wimyanya kuri buri gice cyo gutera inshinge ntugomba kurenza 2000 (22Ga). 21.
21. Umubare ntarengwa wo gutemba ni 6ml