Ka nānā ʻana i ke kaomi ʻaʻa

ʻO ka nānā ʻana i ke kaomi ʻana he ʻano o ka nānā ʻana i ke koko invasive a hana ʻia ma o ka cannulation o kahi aʻa peripheral. He mea koʻikoʻi ka nānā ʻana i ka hemodynamic i ka mālama ʻana i kekahi maʻi maʻi. ʻO ka nānā pinepine ʻana he mea koʻikoʻi loa ia i nā maʻi maʻi koʻikoʻi a me nā maʻi ʻokiʻoki me ka piʻi nui o ka maʻi a me ka make. Hiki ke hoʻokō ʻia kēia ma o ka nānā ʻana i ka manawa, ʻaʻole ia he invasive akā hāʻawi wale i nā kiʻi paʻi i ka manawa, a i ʻole ma ka nānā ʻana i ka invasive mau.

ʻO ke ala maʻamau e hana ai i kēia, ʻo ia ka nānā ʻana i ke kaomi arterial ma o ka cannulation o kahi aʻa peripheral. ʻO kēlā me kēia hoʻopaʻapaʻa puʻuwai e hoʻoikaika i ke kaomi, e hopena i ka neʻe mechanical o ke kahe i loko o ka catheter. Hoʻouna ʻia ka neʻe mechanical i kahi transducer ma o kahi paipu wai piha piha. Hoʻololi ka transducer i kēia ʻike i nā hōʻailona uila, i hoʻouna ʻia i ka monitor. Hōʻike ka mea nānā i ka beat-to-beat arterial waveform a me nā kaomi helu. Hāʻawi kēia i ka hui mālama me ka ʻike mau e pili ana i ka ʻōnaehana cardiovascular o ka mea maʻi a hiki ke hoʻohana ʻia no ka ʻike a me ka mālama ʻana.

ʻO ka wahi maʻamau o ka cannulation arterial ʻo ia ke aʻa radial ma muli o ka maʻalahi o ka hiki. ʻO nā wahi ʻē aʻe ʻo ka brachial, femoral, a me dorsalis pedis artery.

No nā hiʻohiʻona mālama mālama maʻi, e hōʻike ʻia kahi laina arterial:

① ʻO nā maʻi maʻi koʻikoʻi i loko o ka ICU e koi pono i ka nānā pono ʻana i ka hemodynamics. I loko o kēia mau maʻi, ʻaʻole palekana ke ana ʻana o ke koko i nā manawa i hoʻokaʻawale ʻia no ka mea hiki ke hoʻololi koke i ko lākou kūlana hemodynamic a makemake i ka manawa kūpono.

② ʻO nā maʻi e mālama ʻia me nā lāʻau vasoactive. Loaʻa kēia mau mea maʻi i ka nānā ʻana i ka arterial, e ʻae ana i ke kauka e hoʻokaʻawale i ka lāʻau i ka hopena koko i makemake ʻia me ka palekana.

③ ʻO nā poʻe maʻi ʻokiʻoki i piʻi aʻe ka pilikia o ka maʻi a i ʻole ka make, ma muli paha o nā maʻi maʻi maʻi (cardiac, pulmonary, anemia, etc.) a i ʻole ma muli o nā kaʻina hana paʻakikī. ʻO kēia mau mea akā ʻaʻole i kaupalena ʻia i nā kaʻina neurosurgical, nā kaʻina cardiopulmonary, a me nā kaʻina hana i manaʻo ʻia ai ka nui o ke kahe koko.

④ ʻO nā poʻe maʻi e koi ana i nā kiʻi kiʻi pinepine. Hoʻopili kēia i nā mea maʻi i ka hoʻolōʻihi ʻia o ka mechanical ventilation, kahi e pono ai ka nānā ʻana i ke kinoea koko arterial no ka titration o nā hoʻonohonoho ʻana. ʻAe ka ABG no ka nānā ʻana i ka hemoglobin a me ka hematocrit, ka mālama ʻana i nā imbalances electrolyte, a me ka loiloi ʻana i ka pane ʻana o ka mea maʻi i ka hoʻōla hou ʻana i ka wai a me ka lawelawe ʻana i nā huahana koko a me ka calcium. I loko o kēia mau maʻi, ʻo ka loaʻa ʻana o kahi laina arterial e hiki ai i ke kauka ke kiʻi maʻalahi i kahi laʻana o ke koko me ka ʻole e hoʻopili pinepine i ka mea maʻi. Hoʻemi kēia i ka hōʻoluʻolu o ka mea maʻi a hoʻemi i ka pilikia o ka maʻi ma muli o ka pono ʻole o ka pono o ka ʻili e uhaki ʻia me kēlā me kēia kiʻi kiʻi.

ʻOiai ʻo ka nānā ʻana i ke kahe koko arterial hiki ke hāʻawi i ka ʻike koʻikoʻi, ʻaʻole ʻo arterial cannulation ka mālama maʻi maʻamau. ʻAʻole koi ʻia no kēlā me kēia maʻi i loko o ka ICU a i ʻole kēlā me kēia maʻi e hana ʻia ana. No kekahi mau maʻi, ua contraindicated ka cannulation o ke aʻa. Hoʻopili kēia i ka maʻi ma ke kahua o ka hoʻokomo ʻana, kahi ʻano anatomic kahi i ʻike ʻole ʻia ai ke kahe ʻana o ka collateral, ka loaʻa ʻana o ka lawa ʻole ʻana o nā kīʻaha ʻaʻa peripheral, a me nā maʻi vascular arterial peripheral e like me ka arteritis moku liʻiliʻi. Eia kekahi, ʻoiai ʻaʻole ia he contraindications, pono e noʻonoʻo pono i nā mea maʻi me nā coagulopathies a i ʻole e lawe i nā lāʻau lapaʻau e pale ai i ka coagulation maʻamau..