長期にわたる中枢静脈カテーテルによる閉塞と血栓の管理
Jacquelyn L Baskin1, Ching-Hon Pui, Ulrike Reiss
1Department of Oncology and International Outreach Program, St Jude Children's Research Hospital, Memphis, TN 3105-2794, USA.
Lancet (London, England)
|July 15, 2009
まとめ
中枢静脈カテーテル (CVCs) は閉塞したり,血栓を形成したりすることがあり,血栓の阻害に対して血栓解離剤のような特殊な治療が必要となる. 予防戦略は,適切なカテーテル設置と感染制御に焦点を当てており,現在,抗凝固予防は推奨されていません.
科学分野:
- 血管医学 血管医学とは
- 介入放射線学とは,介入放射線学です.
- ネフロロジーはネフロロジーを用います.
背景:
- 長期中央静脈カテーテル (CVC) は慢性疾患の管理に不可欠ですが,合併症に罹患する傾向があります.
- カテーテル閉塞およびカテーテル関連の血栓は,CVCの機能と患者の健康に影響を与える頻繁な問題です.
研究 の 目的:
- CVCの閉塞およびカテーテル関連の血栓の管理戦略をレビューし,要約する.
- これらのCVC合併症の危険因子,診断方法,治療オプションについて議論します.
主な方法:
- CVC閉塞と血栓の管理に関する現在の証拠を要約した文献レビュー.
- ドップラー超音波検査と静脈検査を含む診断技術の分析.
- 血栓解消療法と抗凝固薬を含む治療方法の評価.
主要な成果:
- 機械的なCVC閉塞は,特定の原因に合わせた治療を必要とします.
- 血栓閉塞は通常,アルテプラスなどの血栓解消剤に良好な反応を示します.
- カテーテル関連の血栓は,以前の感染や位置不良などの要因と関連しており,肺栓塞などの深刻な結果につながる可能性があります.
結論:
- CVCの閉塞および血栓の効果的な管理には,標的治療が必要です.
- CVCを適切に配置し,感染を抑制するなど,予防的な対策が不可欠です.
- 血栓解離性予防は,CVC感染と血栓の予防に有望であることが示されているが,さらなる研究と費用対効果に関する研究が必要である.
関連する概念動画
01:29Venous Thrombosis III: Interprofessional Care
Venous thrombosis requires effective prevention and treatment strategies to improve patient outcomes and reduce potential complications.Prevention StrategiesHealthcare providers must prioritize preventing venous thromboembolism (VTE) for all adult patients upon admission. Interventions depend on bleeding and thrombosis risk, medical history, current medications, diagnoses, planned procedures, and patient preferences. Patients on bed rest should change positions every two hours and, if not...
01:30Venous Thrombosis IV: Nursing Management
Nursing management begins with a thorough assessment of the patient's health history. Key factors include trauma to veins, peripherally inserted central catheters, varicose veins, recent pregnancy or childbirth, surgery, bacteremia, prolonged bed rest, atrial fibrillation, COPD, heart failure, cancer, coagulation disorders, myocardial infarction, spinal cord injury, stroke, prolonged travel, recent bone fractures, and dehydration. Review medication intake, particularly oral contraceptives,...
01:23Peripheral Artery Disease V: Postoperative Nursing Management
During the postoperative period, it is crucial to focus on maintaining circulation, identifying and managing potential complications, and planning for discharge.Nursing AssessmentVital signs monitoring: Regularly monitor vital signs, including blood pressure, heart rate, respiratory rate, and temperature, to detect early signs of complications such as bleeding and infection.Circulation assessment: Monitor pulses, perform Doppler assessments, and check capillary refill, color, temperature, and...
01:29Endocarditis IV: Nursing Management
Infective endocarditis (IE) is a chronic infection of the heart's endocardium, primarily affecting the heart valves. A detailed nursing assessment for a patient with IE involves collecting subjective and objective data to ensure an accurate diagnosis and timely intervention.Subjective DataThe nurse gathers information about the patient's symptoms and complaints during the subjective assessment. Patients with infective endocarditis often report non-specific symptoms that can mimic other...
01:30Venous Thrombosis I: Introduction
Venous thrombosis, the most common disorder of the veins, involves the formation of a thrombus or blood clot associated with vein inflammation. It can be classified as either superficial vein thrombosis or deep vein thrombosis.Superficial Vein Thrombosis: This involves the formation of a thrombus in a superficial vein, usually the greater or lesser saphenous vein. Though less severe than deep vein thrombosis (DVT), SVT can lead to complications if untreated.Deep Vein Thrombosis (DVT): This...
01:20Venous Thrombosis II: Clinical Manifestations and Diagnostic Studies
The key difference between Superficial Vein Thrombosis (SVT) and Deep Vein Thrombosis (DVT) lies in their location and severity.Clinical ManifestationsSVT typically presents with localized pain, tenderness, and redness along the course of a superficial vein, often accompanied by a palpable, cord-like structure under the skin. This condition is usually less dangerous than DVT but can be uncomfortable and may lead to complications such as cellulitis or, rarely, a clot extension into the deep...