您的位置 > 6. 预防和护理措施
在中心静脉置管及护理过程中注意一些细节是避免感染的最重要一环，尤其是在重症监护室，因为那里的中心静脉使用最频繁，且病人的一般状况亦较差，是高发人群。整个预防和护理过程分为：导管本身要慎重考虑穿刺的必要性，选用不易形成血栓材料所制的导管，使用涂用抗菌或消毒物质的导管或皮下套囊，尽可能少的内腔及通道；导管置入过程，在可控制的环境下插管较急诊插管危险性低，部位选择皮肤表面细菌定居数目少的部位（股静脉 > 颈内静脉 / 锁骨下静脉 > 肘窝），消毒上采用洗手及完善的防护屏障（口罩，消毒衣，手套，无菌单），技术上要减少穿刺损伤，穿刺困难的人可能增加局部感染的发生率；插管部位护理，皮肤消毒剂推荐使用 2% 洗必泰，插管部位选择干燥薄纱或其它透气敷料，因密闭敷料造成局部温暖潮湿，微生物聚居；导管护理，减少使用频率，全静脉营养会增加感染的发生率，尽量减少在这一通道中加药，每 72 小时更换输液管等。尽管新的科学技术及制造工艺进步，如抗微生物材料所制的导管对减少导管相关性菌血症也是很有意义的，但最重要的仍然是穿刺及护理过程的严格无菌操作。了解病情、选择适当的穿刺部位尽可能的缩短操作时间，减少污染机会，尽量缩短留置时间，同时注意病人体温变化及其他感染征兆，若发现插管局部有渗出物和红肿，要进行细菌培养，必要时换药，以免引起全身感染。
作者简介：刘淑粉，女，护师。
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