Читать книгу Emergency Management of the Hi-Tech Patient in Acute and Critical Care - Группа авторов - Страница 84

Catheter breakage can occur for a variety of reasons, including inadvertent cutting during a dressing change, a patient pulling away during an attempt to access the line, snagging of the externalized portion of a CVC during daily activities or play, or blunt‐force injury during contact sports or accident. Any fluid or blood reported by the patient or witnessed in the ED should be treated as a catheter break. Visualization of the catheter's Dacron cuff outside the chest wall should be treated similarly. To prevent infection, air embolus, or bleeding, broken externalized lines should be immediately clamped with nontoothed forceps proximal to the site of breakage and the damaged portion of the line should be cleaned with povidone‐iodine and covered with sterile dressing. While repair kits specific to each type of CVC are available in many centers, they should be deployed only by those with expertise in their use – usually in consultation with an institutional IV team or interventional radiology. Less commonly, externalized CVCs can fracture proximal to their point of exit in the chest. In these cases, it is critical to apply pressure to the catheter's entrance to the vein and not to the chest wall exit site itself. A chest radiograph should be performed to determine the location of the proximal line fragment. Rarely, fractured catheter fragments are discovered in the pulmonary circulation, from which they must be removed by interventional radiology – usually via a femoral approach. Trauma or patient manipulation may dislodge an implanted port from its subcutaneous pocket in the chest wall. For this reason, practitioners should always check the stability of the port reservoir before attempting to access it with a needle. If port dislodgement is suspected, obtain a chest radiograph to interrogate the integrity of the implanted system. If dislodgement is confirmed by an X‐ray, immediately discontinue any infusions running through the port and notify the interventional radiology or surgery department of the need for catheter replacement.