BC L TNH MCH

I. MC CH: To ng truyn tnh mch khn cp m chch tnh mch khng thc hin c. t catheter tnh mch trung tm nui n tnh mch, o p lc tnh mch trung tm. II. MC TIU: To thun li cho Bc s bc l tnh mch. Phng nga tn thng bnh nhn. III. DNG C: Gng v trng. Gng sch. B bc l tnh mch. ng tim 5 ml. Catheter lun vo tnh mch. gc gn v trng. Dung dch st trng povidone-iodine hay alcohol 70o. Thuc: + An thn Midazolam hoc Diazepam v + Gy t Lidocaine. ng tim c kim nh 23-25G. Dung dch Natri Clorua 0,9% v trng. Bng keo, ko. IV. NGUYN TC AN TON: Dng k thut v trng. V. CC BC TIN HNH: 1. Gii thch bnh nhn v gia nh. 2. Mang khu trang, ra tay. 3. Chun b dng c. 4. Mang gng sch. 5. Tim thuc an thn theo y lnh. 6. iu dng gi bn chn tr xoay ngoi. H tr Bc s st trng da, chch thuc t. BS tin hnh th thut: Rch da 1-2 cm trn mc mt c trong 1-2 cm, dng kp kelly bc tch m di da, cn nng tm TM. Dng thng lng mng nng tnh mch ln v lun 2 si ch: 1 ct phn xa v tht sn 1 vng si ch th hai u gn TM.

 Ct ra TM (gia hai u ch) v lun catheter vo lng tnh mch n v tr mong mun. Rt th xem c mu chy ra hay khng hay bm thy nh tay l catheter lun vo TM. Ct si ch u gn. Khu da, c nh catheter. 7. Sau khi khu da, lau sch mu quanh ni bc l bng dung dch st trng. 8. Bng li vi gc v trng, dn bng keo v ghi ngy gi thc hin trn bng keo. 9. Dn dp dng c, ra tay. 10. Quan st mi gi trong vi gi u xem c nght hay thot mch khng. Thay bng hng ngy hoc khi d v ghi nhn bin chng nu c. 11. Ghi ch iu dng: Ngy, gi. V tr bc l. Bc s thc hin. Loi v kch thc catheter. Thuc s dng. Phn ng bnh nhn (nu c). BNG KIM: Gii thch bnh nhn v gia nh. Mang khu trang, ra tay. Chun b dng c. Mang gng. H tr BS trong qu trnh lm th thut. Lau li ni bc l vi dung dch povidone-iodine. Bng v trng, ghi ngy gi. Quan st ni bc l khi cho chy dch truyn hoc tim thuc. Ghi ch iu dng.