,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,.,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,.,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,.,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,.,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,.,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,.,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,.,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,.,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,.,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,.,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,.,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,.,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,.,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,.,*,中心静脉穿刺置管方法和,Swan-Ganz,导管技术及并发症预防,首都医科大学附属北京安贞医院,任发成,1,.,一、解剖学,（一）颈内静脉和锁骨下静脉示图,来自上肢、颅内、颅外、颈部静脉血回流,2,.,（二）股静脉示图,来自下肢静脉血回流,3,.,二、中心静脉穿刺置管意义,1,、生命延续通路。,2,、监测血流动力学，为诊断治疗抢救病人提供科学数据。,4,.,三、穿刺置管方法,1,、前路：,在胸锁乳突肌内缘中点，颈总动脉外缘，平喉结或环甲膜处进针，针与皮肤呈,30,45,度，进针方向指向同侧乳头或锁骨中点。注射器带负压进针退针。,5,.,2,、中路：,在胸锁乳突肌胸骨头锁骨头锁骨形成三角的顶点进针，在三角内任何点都为中路。进针如在胸骨头肌外缘应向外偏斜指向锁骨中点；如在锁骨头肌内侧缘进针，应指向锁骨切迹，针干与皮肤呈,15,35,度。注射器带负压进退。,6,.,7,.,3,、后路：,在胸锁乳突肌锁骨头肌外侧缘的中下,1/3,分界处进针，指向胸骨上凹处。,8,.,THANK YOU,SUCCESS,2024/11/17,9,.,（二）锁骨下静脉穿刺置管法,选择胸锁关节肩锁关节的中点，在锁骨下,1.5-2.5cm,处进针。针干与胸壁皮肤贴紧，进针方向指向胸骨凹或喉结。注射器带负压进退。,10,.,11,.,（三）股静脉穿刺置管法,在腹股沟韧带下,2-3cm,触及到股动脉搏动，在搏动内侧进针，与皮肤呈,35,45,度方向，指向脐。注射器带负压进退。,12,.,（四）中心静脉穿刺置管,穿刺成功后，立即放置导引钢丝，扩张器，再置留置静脉导管，回抽是否通畅，然后固定导管。,13,.,三、,Swan-Ganz,导管技术,经颈内静脉或锁骨下静脉穿刺成功后，置入,3,腔，,4,腔或,6,腔,Swan-Ganz,导管，监测血流动力学。技术操作主要掌握如何把导管置入肺动脉。,14,.,CVP wave,RV wave,PA wave,PCWP wave,4-8mmHg,S 15-30mmHg,D 0-8mmHg,S 15-30mmHg,D 5-15mmHg,5-12mmHg,15,.,四、并发症及预防,血肿。,血、气胸。,气栓、血栓。,神经损伤。,胸导管损伤。,感染。,导管或导丝折断入心脏。,8.,心律失常。,9.,动静脉瘘。,10.,肺动脉出血。,11.Swan-Ganz,导管打结或被术者缝合固定。,12.,导管入异常通道。,16,.,预防措施,解剖要清楚。,操作熟练、规范。,17,.,THANK YOU,SUCCESS,2024/11/17,18,.,