Name: a protocol to set up needle-free connector with positive displacement on central venous catheter in intensive care unit
Uploaded: 2019-07-13T15:00:00
Description: Watch this Scientific Journal Video about A Protocol to Set Up Needle-Free Connector with Positive Displacement on Central Venous Catheter in Intensive Care Unit at JoVE.com

作者感谢鲁昂大学医院尼基·萨布林-吉布斯在编辑手稿方面的帮助。作者感谢鲁昂大学医院的通讯部和医学培训中心的小组参与视频拍摄。

1. 准备连接器和输液管
<ol><li>无菌检索连接器。</li>
	<li>在 3 路扩展停止孔上,将 1 个接头拧入停止孔的每个插座,将 1 个连接器拧入延长线末端。使用 50 mL 注射器服用 0.9% NaCl 以清除延伸和管路。通过停止孔的 2 个接头,用 0.9% NaCl 清除每个 3 向扩展。</li>
	<li>采取输注歧管。拧下每个一次性盖。将 1 个接头拧入歧管的每个插座以更换盖。通过按顺序转动每个止流孔,通过每个接头清除输注管。 注...

<ol>
	<li>Worth, L. J., McLaws, M. L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Is+it+possible+to+achieve+a+target+of+zero+central+line+associated+bloodstream+infections.">Is it possible to achieve a target of zero central line associated bloodstream infections.</a> Current Opinion in Infectious Diseases. 25 (6), 650-657 (2012).</li><li>Kelly, L. J., Jones, T., Kirkham, S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Needle-free+devices:+keeping+the+system+closed.">Needle-free devices: keeping the system closed.</a> British Journal of Nursing (Mark Allen Publishing). 26 (2), 14-19 (2017).</li><li>Casey, A. L., Karpanen, T. J., Nightingale, P., Elliott, T. S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+risk+of+microbial+contamination+associated+with+six+different+needle-free+connectors.">The risk of microbial contamination associated with six different needle-free connectors.</a> British Journal of Nursing (Mark Allen Publishing). 27 (2), 18-26 (2018).</li><li>Salgado, C. D., Chinnes, L., Paczesny, T. H., Cantey, J. R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Increased+rate+of+catheter-related+bloodstream+infection+associated+with+use+of+a+needleless+mechanical+valve+device+at+a+long-term+acute+care+hospital.">Increased rate of catheter-related bloodstream infection associated with use of a needleless mechanical valve device at a long-term acute care hospital.</a> Infection Control and Hospital Epidemiology. 28 (6), 684-688 (2007).</li><li>Jarvis, W. R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Health+care-associated+bloodstream+infections+associated+with+negative-+or+positive-pressure+or+displacement+mechanical+valve+needleless+connectors.">Health care-associated bloodstream infections associated with negative- or positive-pressure or displacement mechanical valve needleless connectors.</a> Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America. 49 (12), 1821-1827 (2009).</li><li>Btaiche, I. F., Kovacevich, D. S., Khalidi, N., Papke, L. 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Infusion Resource Library - BD Available from: <a target="_blank" href="https://www.bd.com/en-us/offerings/capabilities/infusion/infusion-resource-library?contenttype=22_productline=115">https://www.bd.com/en-us/offerings/capabilities/infusion/infusion-resource-library?contenttype=22_productline=115</a> (2019)</li><li>Kim, S. C., Klebach, C., Heinze, I., Hoeft, A., Baumgarten, G., Weber, S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+supraclavicular+fossa+ultrasound+view+for+central+venous+catheter+placement+and+catheter+change+over+guidewire.">The supraclavicular fossa ultrasound view for central venous catheter placement and catheter change over guidewire.</a> Journal of Visualized Experiments. (94), 52160 (2014).</li><li>Clavier, T., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Impact+of+MaxZeroTM+needle-free+connector+on+the+incidence+of+central+venous+catheter-related+infections+in+surgical+intensive+care+unit.">Impact of MaxZeroTM needle-free connector on the incidence of central venous catheter-related infections in surgical intensive care unit.</a> Australian Critical Care: Official Journal of the Confederation of Australian Critical Care Nurses. , (2018).</li><li>Lehn, R. A., Gross, J. B., McIsaac, J. H., Gipson, K. E. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Needleless+connectors+substantially+reduce+flow+of+crystalloid+and+red+blood+cells+during+rapid+infusion.">Needleless connectors substantially reduce flow of crystalloid and red blood cells during rapid infusion.</a> Anesthesia and Analgesia. 120 (4), 801-804 (2015).</li><li>Ferroni, A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Pulsative+flushing+as+a+strategy+to+prevent+bacterial+colonization+of+vascular+access+devices.">Pulsative flushing as a strategy to prevent bacterial colonization of vascular access devices.</a> Medical Devices (Auckland, N.Z). 7, 379-383 (2014).</li><li>Flynn, J. M., Keogh, S. J., Gavin, N. C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Sterile+v+aseptic+non-touch+technique+for+needle-less+connector+care+on+central+venous+access+devices+in+a+bone+marrow+transplant+population:+A+comparative+study.">Sterile v aseptic non-touch technique for needle-less connector care on central venous access devices in a bone marrow transplant population: A comparative study.</a> European Journal of Oncology Nursing: The Official Journal of European Oncology Nursing Society. 19 (6), 694-700 (2015).</li><li>Merrill, K. C., Sumner, S., Linford, L., Taylor, C., Macintosh, C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Impact+of+universal+disinfectant+cap+implementation+on+central+line-associated+bloodstream+infections.">Impact of universal disinfectant cap implementation on central line-associated bloodstream infections.</a> American Journal of Infection Control. 42 (12), 1274-1277 (2014).</li><li>Mermel, L. A., Bert, A., Chapin, K. C., LeBlanc, L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Intraoperative+stopcock+and+manifold+colonization+of+newly+inserted+peripheral+intravenous+catheters.">Intraoperative stopcock and manifold colonization of newly inserted peripheral intravenous catheters.</a> Infection Control and Hospital Epidemiology. 35 (9), 1187-1189 (2014).</li><li>Rosenthal, V. D., Maki, D. G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Prospective+study+of+the+impact+of+open+and+closed+infusion+systems+on+rates+of+central+venous+catheter-associated+bacteremia.">Prospective study of the impact of open and closed infusion systems on rates of central venous catheter-associated bacteremia.</a> American Journal of Infection Control. 32 (3), 135-141 (2004).</li><li>Bouza, E., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+needleless+closed+system+device+(CLAVE)+protects+from+intravascular+catheter+tip+and+hub+colonization:+a+prospective+randomized+study.">A needleless closed system device (CLAVE) protects from intravascular catheter tip and hub colonization: a prospective randomized study.</a> The Journal of Hospital Infection. 54 (4), 279-287 (2003).</li><li>Tabak, Y. P., Jarvis, W. R., Sun, X., Crosby, C. T., Johannes, R. S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Meta-analysis+on+central+line-associated+bloodstream+infections+associated+with+a+needleless+intravenous+connector+with+a+new+engineering+design.">Meta-analysis on central line-associated bloodstream infections associated with a needleless intravenous connector with a new engineering design.</a> American Journal of Infection Control. 42 (12), 1278-1284 (2014).</li><li>Wallace, M. C., Macy, D. L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Reduction+of+Central+Line-Associated+Bloodstream+Infection+Rates+in+Patients+in+the+Adult+Intensive+Care+Unit.">Reduction of Central Line-Associated Bloodstream Infection Rates in Patients in the Adult Intensive Care Unit.</a> Journal of Infusion Nursing: The Official Publication of the Infusion Nurses Society. 39 (1), 47-55 (2016).</li><li>Btaiche, I. F., Kovacevich, D. S., Khalidi, N., Papke, L. F. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+effects+of+needleless+connectors+on+catheter-related+thrombotic+occlusions.">The effects of needleless connectors on catheter-related thrombotic occlusions.</a> Journal of Infusion Nursing: The Official Publication of the Infusion Nurses Society. 34 (2), 89-96 (2011).</li><li>Williams, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Catheter+Occlusion+in+Home+Infusion:+The+Influence+of+Needleless+Connector+Design+on+Central+Catheter+Occlusion.">Catheter Occlusion in Home Infusion: The Influence of Needleless Connector Design on Central Catheter Occlusion.</a> Journal of Infusion Nursing: The Official Publication of the Infusion Nurses Society. 41 (1), 52-57 (2018).</li></ol>

设置连接器会稍微增加放置导管所需的总时间。然而,它们的使用有几个优点:无需为非注入线路保持连续盐水灌注,必要时快速停止输液线路(例如,在紧急转运患者的情况下),无需使用一次性盖数一天几次关闭输液线。连接器的使用简化了导管输液管的每日使用,没有任何特殊的并发症。需要注意的是,在我们四年的PPNC连接器经验中,快速流体管理没有出现并发症,而其他类型的连接器11</sup...

中央静脉导管相关感染 (CRI) 是重症监护病房 (ICU) 中静脉导管的严重并发症。CRI的下降仍然是一个始终存在的目标,最终目标是"零导管相关感染"1。无针连接器最初是为避免卫生保健工作者的血液接触而设计和推广的。连接器有两种主要设计:分离隔膜(无内部移动部件)和封闭阀系统(内部移动部件),但两种设计都可以组合在一个连接器2中。无针连接器根据雄性 Luer 阀断开后发生的流体位移类型进行分类:负(血液回流到导管中)、中性、正(用血从导管流明管中排出)2,3.
一些连接器被描述为与导管相关的感染的原因,特别是在重症监护病房(ICU)4,5,6。设计了新一代无针连接器,具有最小的内部复杂性,减少或消除间隙或死区,提供可见的流体路径,以帮助评估适当的冲洗技术,以及平坦的检修表面等,以降低风险感染。在体外,这些连接器已显示出低细菌殖民化7。制造这些连接器的实验室提出了全球建议;然而,没有实际的描述,如何将它们安装在导管8。因此,每个团队可能以不同的方式使用它们。因此,我们提出了一个正式的协议,用于在ICU的中央静脉线路上安装这些连接器。
我们在 ICU 中演示了带内部硅胶活塞的正压无针连接器 (PPNC),但此协议适用于任何正位移阀。此阀是带正位移的机械无针接头。

<table>
	<tbody>
		<tr>
			<td>BD MaxZero&#8482;&#160;needle-free connector</td>
			<td>Becton Dickinson</td>
			<td>MZ1000-07</td>
			<td>we present the installation of the connector with MaxZero but this protocol is applicable with any positive displacement valve.</td>
		</tr>
		<tr>
			<td>4-port mannifold with PE/PVC extension</td>
			<td>Cair-LGL</td>
			<td>RPB4310A</td>
			<td></td>
		</tr>
		<tr>
			<td>PE/PVC extension line with 3-way stopcock</td>
			<td>Cair-LGL</td>
			<td>PE3302M</td>
			<td></td>
		</tr>
		<tr>
			<td>NaCl 0.9% 250 ml</td>
			<td>Baxter</td>
			<td>2B1322</td>
			<td></td>
		</tr>
		<tr>
			<td>BD&#160;Plastipak&#8482; 50mL Luer-Lock Syringe</td>
			<td>BECTON DICKINSON MEDICAL</td>
			<td>613-3925</td>
			<td></td>
		</tr>
	</tbody>
</table>

a protocol to set up needle-free connector with positive displacement on central venous catheter in intensive care unit

无针连接器最初是为避免卫生保健工作者的血液接触而设计和推广的。最近的一些数据表明,最新一代的连接器(带正位移)可能有利于减少中央静脉线感染。我们在重症监护病房中使用无针连接器已有数年,在这里我们提出了在中央静脉导管上安装这些连接器的协议。插入导管并控制线路的渗透性后,在连接之前,必须用 0.9% NaCl 清除连接器。连接器取代了输液止液塞和歧管上使用的所有一次性盖。所有连接器均按制造商建议每 7 天更换一次(除非存在宏观污染,需要立即更换连接器)。每次注射前,必须用 70% 的等丙醇对接头进行至少 3 秒的消毒。不得断开接头(除非更改),因为喷射是通过设备完成的。设置连接器会稍微增加放置导管所需的总时间,并且没有正式证据表明这些连接器可降低传染性或血栓并发症的发生率。然而,这些设备简化了中央静脉线路的管理,防止导管电路在无菌安装后"打开"。

一旦所有元件都就位,导管在两条输液线之间的几乎所有结点上都有接头(图1)。因此,它每条线路都有近端连接器,在 3 路扩展的插座上有两个连接器(图2)。每个输液管有连接器的所有母插座 (图3)。组件到位后,任何注射或输注(连续或不连续)都必须在消毒后通过输注管或延长线或延长件的连接器之一进行(图4)。...

Watch this Scientific Journal Video about A Protocol to Set Up Needle-Free Connector with Positive Displacement on Central Venous Catheter in Intensive Care Unit at JoVE.com

A Protocol to Set Up Needle-Free Connector with Positive Displacement on Central Venous Catheter in Intensive Care Unit

我们提出了一个协议,以显示在中央静脉导管上安装带正位移的无针连接器。

在重症监护病房的中央静脉导管上设置无针接头,带正位移

Needle-free connectors were initially designed and promoted to avoid blood exposure for healthcare workers. Some recent data suggest that the latest ...

无针连接器最初设计和推广，以避免医护人员的血液暴露。最近的一些数据表明，最新一代的正位移连接器可能有兴趣减少中央静脉线感染。新一代正压连接器现已被广泛使用，许多报告在类似环境中使用ICU、肿瘤学或家长营养。目前，没有实际描述如何将这些连接器放在导管上。因此，每个团队可能以不同的方式使用它们。因此，我们提出了在ICU的中央静脉线路上安装这些连接器的正式协议。我们介绍我们在 ICU 中确实使用的连接器的安装，但该协议适用于任何正排量阀。我们将向您展示一个协议，在重症监护病房的中央静脉导管上设置带正位移的无针连接器。无菌检索连接器。将一个连接器拧入三路延长卡子的每个插座，将一个连接器拧入延长线的端。然后，用无菌盐水血清清除连接器。应清除每个连接器。然后，复制该过程三次。在过程结束时，应有三个带连接器的扩展。多拿五个连接器和一个四个端口歧管。从歧管上拧下每个使用盖。然后，将一个连接器拧入歧管的每个插座，以更换单个使用盖。通过按顺序转动每个止损器，通过每个接头清除输液管路。在此步骤结束时，有三个扩展，带三个带清除连接器的带的端口歧管，以及带清除连接器的四个端口歧管。按照单位或医院的常规做法，将中央静脉导管无菌放置。检查每条线的渗透性，然后重新注射盐水血清。此喷射后夹紧管路。将三路延长卡子的接头拧入导管管路。然后，拆下夹子。这三个连接器是近端连接器。将四个端口歧管的延伸拧入近端线三个路塞的连接器之一。现在，所有连接器都设置在导管上，可以使用导管。每次输液前，用无菌压缩消毒连接器的端端三秒钟，浸泡在70%异丙醇中。然后，等待 10 秒钟，让接头干燥。当接头干燥时，将注射器直接连接到接头，然后注射。注射或输液后，拧开设备，但请勿卸下接头。即使管路未充满，也保留近位阀。如果消毒后有微小污染，当接头干燥时，用盐水冲洗连接器。在先前发表的一项研究中，包括1，633名导管ICU患者，我们观察到，在协议实施后，导管相关感染减少，从每1000个导管日6.2例感染，到每1000个导管日2.7例感染。设置连接器会增加放置导管所需的总时间。但是，它们的使用有几个优点。无需为非注入线，如有必要快速停止输液管路，无需每天多次使用单用盖关闭输液管路。在您使用这些连接器期间或为了您的经验，我们没有任何问题。没有正式证据表明这些连接器可减少感染性或血栓性并发症的发生率，但鉴于大系列所述的优点和没有严重并发症，使用正位移连接器似乎是ICU中单用帽的一种很好的替代方案。

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科研

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锁骨上窝超声显示为中心静脉导管放置和导管改过来导丝

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中央静脉狭窄病的Murine模型,使用具有流出狭窄病的动脉静脉瘘管病

Central venous stenosis is an important entity contributing to arteriovenous fistula (AVF) failure. A murine AVF model was modified to create a partial ...

Clinical Practice Protocol of Creative Music Therapy for Preterm Infants and Their Parents in the Neonatal Intensive Care Unit

新生儿重症监护病房早产儿及其家长创造性音乐治疗的临床实践规程

Creative music therapy for preterm infants and their parents (CMT) has emerged as a promising family-integrated early intervention involving communicative ...

Halogenated Agent Delivery in Porcine Model of Acute Respiratory Distress Syndrome via an Intensive Care Unit Type Device

重症监护病房型装置在猪模型急性呼吸窘迫综合征中的卤化剂递送

Acute respiratory distress syndrome (ARDS) is a common cause of hypoxemic respiratory failure and death in critically ill patients, and there is an urgent ...