摘要
2017年2月6日,浙江大学医学院附属第二医院收治1例25岁烧伤总面积99%体表总面积(TBSA)男性患者。患者伤后1 d由基层医院转入,其中Ⅲ度烧伤面积达95%TBSA。入院时患者意识清楚,气管切开呼吸机辅助通气,实施补液抗休克、抗感染及营养支持,清创植皮负压治疗等处理。住院期间病情危重,先后行28次中心静脉置管术和1次经外周穿刺中心静脉导管置入术。护士依托多学科合作,在做好充分风险评估的前提下,重点加强中心静脉导管相关性感染的护理,导管尖端附着物、创面分泌物和血微生物培养检出抗碳青霉烯类抗生素肺炎克雷伯菌后,改良中心静脉导管护理措施。积极预防中心静脉导管周围血栓形成。在翻身床使用、浸浴治疗、患者躁动期间重点做好非计划性拔管的预防。入院第171天,静脉治疗专科护士在右上臂瘢痕形成处行经外周穿刺中心静脉导管置入术,留置55 d后拔除导管,患者康复出院。随访18个月,恢复良好。
On February 6,2017,one male patient aged 25 years with total burn area of 99%total body surface area(TBSA)and full-thickness burn area of 95%TBSA was transferred from a primary hospital to the Second Affiliated Hospital of Zhejiang University School of Medicine one day post injury.On admission,the patient was clearly conscious,with tracheotomy ventilator assisted ventilation,and received rehydration,antishock,anti-infection,nutritional support,debridement,skin grafting,and negative pressure treatment.During the hospitalization,the patient was in critical condition and 28 central venous catheterizations and 1 peripherally inserted central catheter were performed.Based on multidisciplinary cooperation and on the premise of full risk assessment,nurses focused on strengthening the nursing of central venous catheter related infection.The measures for central venous catheter care were improved after detection of carbapenems resistant Klebsiella pneumoniae from catheter tip attachment,wound exudate,and blood culture,active prevention measure targeted at thrombosis around central venous catheter was performed,and prevention of unplanned extubation was emphasized during the use of rotating bed,soaking bath,and agitation of patient.On the 171st day of admission,peripherally inserted central venous catheter was performed by intravenous therapy nurse specialist on the scar formation site of the right upper arm.The catheter was withdrawn after indwelling for 55 days and the patient recovered and was discharged.During follow-up of 18 months,the patient recovered well.
作者
卢福长
沈鸣雁
陈华清
徐婷
韩春茂
Lu Fuchang;Shen Mingyan;Chen Huaqing;Xu Ting;Han Chunmao(Department of Burns,the Second Affiliated Hospital of Zhejiang University School of Medicine,Hangzhou 310009,China)
出处
《中华烧伤杂志》
CAS
CSCD
北大核心
2020年第7期600-602,共3页
Chinese Journal of Burns
基金
浙江省医药卫生科技计划(2019KY083)。
关键词
烧伤
护理
导管插入术
中心静脉
外周静脉穿刺
并发症
Burns
Nursing care
Catheterization,central venous
Peripheral venipuncture
Complication
