问题 问答题

简述如何预防导管相关感染。

答案

参考答案:预防导管相关感染应注意:(1) 正确选用导管:正确选用导管是预防血管内插管感染的重要措施之一。不锈钢针头导管比塑料导管的感染机会少。聚四氟乙烯、四氟乙烯导管在各种塑料导管中发生感染率最低。(2) 加强局部穿刺或血管插管无菌技术:多数血管内感染是来自静脉穿刺点或导管插入部位的细菌逆行性感染。因此,要加强静脉输液及静脉切开的无菌技术。(3) 选择插管感染机会最少的部位:导管插入部位与感染发生率有关。皮肤穿刺法比皮肤切开导管插入法感染率低。在成人病员中,上肢、锁骨下及颈部血管插管时发生感染并发症要少于下肢,尤其是血栓性静脉炎。对于已在下肢血管插管者,要尽快更换到其他较好的部位。(4) 静脉切开放置导管的操作技术:选择导管粗细要与切开的血管口径大小相适应。插管时动作要轻,尽量减少血管内膜的损伤,放入的长度不宜太长,以缩小包裹其上的纤维蛋白鞘下的藏菌范围和菌量,从而减少导管败血症的发生率。(5) 导管要妥善固定:要保证导管不滑动,以防脱出或将静脉切口的细菌被松动的导管推向血管的深部。(6) 输液过程中,要注意有计划地调整输入液体的渗透压及pH,以增加输入静脉对液体的耐受性。周围静脉导管输入液体的渗透压不宜超过600 mOsm/kg水溶液,其液体pH要调整为6.8~7.4,可以减轻静脉壁内膜的损伤及血栓形成。即使通过大静脉输液,渗透压也尽量不要超过1 500 mOsm/kg。(7) 使用小剂量肝素可以推迟或预防导管血栓形成,但其作用仅限于导管尖端局部,而不是全身抗凝作用。(8) 外周静脉导管及中心静脉插管要定期更换。

判断题
单项选择题

(三)

Mr. Peter Johnson, aged twenty-three, battled for half an hour to escape from his trapped car yesterday when it landed upside down in three feet of water. Mr. Johnson took the only escape route-through the boot.

Mr. Johnson’s car had finished up in a ditch at Romney Marsin, Kent after skidding on ice and hitting a bank. "Fortunately, the water began to come in only slowly," Mr. Johnson said. "I couldn’t force the doors because they were jammed against the walls of the ditch and dared not open the windows because I knew water would come flooding in. "

Mr. Johnson, a sweet salesman of Sitting Home, Kent, first tried to attract the attention of other motorists by sounding the horn and hammering on the roof and boot. Then he began his struggle to escape.

Later he said, "It was really a half penny that saved my life. It was the only coin I had in my pocket and I used it to unscrew the back seat to get into the boot. I hammered desperately with a hammer trying to make someone hear, but no help came. "

It took ten minutes to unscrew the seat, and a further five minutes to clear the sweet samples from the boot. Then Mr. Johnson found a wrench and began to work on the boot lock. Fifteen minutes passed by. "It was the only chance I had. Finally it gave, but as soon as I moved the boot lid, the water and mud poured in. I forced the lid down into the mud and scrambled clear as the car filled up. "

His hands and arms cut and bruised, Mr. Johnson got to Beckett Farm nearby, where he was looked after by the farmer’s wife, Mrs. Lucy Bates. Huddled in a blanket, he said, "That thirty minutes seemed like hours. " Only the tips of the car wheels were visible, police said last night. The vehicle had sunk into two feet of mud at the bottom of the ditch.

It may be inferred from the passage that ().

A.the ditch was along a quiet country road

B.the accident happened on a clear warm day

C.the police helped Mr. Johnson get out of the ditch

D.Mr. Johnson had a tender wife and was well attended