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Access technique and its problems in parenteral nutrition – Guidelines on Parenteral Nutrition, Chapter 9

机译:肠外营养中的获取技术及其问题–肠外营养指南,第9章

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摘要

Catheter type, access technique, and the catheter position should be selected considering to the anticipated duration of PN aiming at the lowest complication risks (infectious and non-infectious). Long-term (>7–10 days) parenteral nutrition (PN) requires central venous access whereas for PN 3 weeks subcutaneous tunnelled catheters or port systems are appropriate. CVC (central venous catheter) should be flushed with isotonic NaCl solution before and after PN application and during CVC occlusions. Strict indications are required for central venous access placement and the catheter should be removed as soon as possible if not required any more. Blood samples should not to be taken from the CVC. If catheter infection is suspected, peripheral blood-culture samples and culture samples from each catheter lumen should be taken simultaneously. Removal of the CVC should be carried out immediately if there are pronounced signs of local infection at the insertion site and/or clinical suspicion of catheter-induced sepsis. In case PN is indicated for a short period (max. 7–10 days), a peripheral venous access can be used if no hyperosmolar solutions (>800 mosm/L) or solutions with a high titration acidity or alkalinity are used. A peripheral venous catheter (PVC) can remain in situ for as long as it is clinically required unless there are signs of inflammation at the insertion site.
机译:应根据预期的PN持续时间选择导管类型,通路技术和导管位置,以期将并发症风险降至最低(传染性和非传染性)。长期(> 7-10天)肠胃外营养(PN)需要中央静脉通路,而对于PN 3周,皮下隧道导管或端口系统是合适的。在应用PN之前和之后以及在CVC闭塞期间,应使用等渗NaCl溶液冲洗CVC(中央静脉导管)。中央静脉通路的放置需要严格的指示,如果不再需要,应尽快移除导管。不应从CVC采集血液样本。如果怀疑导管感染,则应同时采集外周血培养样本和每个导管腔的培养样本。如果在插入部位有明显的局部感染迹象和/或临床怀疑导管诱发败血症,应立即进行CVC切除。如果指示PN的时间很短(最多7-10天),如果不使用高渗溶液(> 800 mosm / L)或使用高滴定酸度或碱度的溶液,则可以使用外周静脉通路。除非临床上有炎症迹象,否则外周静脉导管(PVC)可以在临床上一直保持原位。

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