Терапия этаноловым «замком»
Антибиотики могут быть неэффективны при лечении инфицированных ЦВК. Это происходит по причине формирования биопленки во внутреннем просвете катетера. Биопленка препятствует попаданию антибиотика во внутреннюю поверхность просвета катетера, несмотря на соответствующую антибиотикотерапию. Были доказаны эффективность этаноловых «замков» в лечении инфицированных катетеров и продлении срока функционирования ЦВК.
Решение о начале терапии этаноловым «замком» принимает консилиум - совместно бригадой по инфекционным заболеваниями с лечащим врачом.
Лечение этаноловым «замком» нельзя применять:
если пациент нестабилен;
если у пациента наблюдаются признаки туннельной инфекции или инфекции входного отверстия катетера;
у беременных или кормящих пациенток;
если у пациента бактериемия, связанная с наличием Staphylococcus aureus, известного мультирезистентного микроорганизма или грибковой инфекции.
Лечение этаноловым «замком» можно применять:
если пациент стабилен;
если у пациента КАИК;
если нет признаков туннельной инфекции или инфекции входного отверстия катетера;
если начата соответствующая антибиотикотерапия;
если инфекционисты и лечащий врач пришли к решению начать терапию.
Инструкции по назначению:
Объем вводимого и аспирируемого этанола, промывание 0.9% раствором натрия хлорида и частота введения «замков» должны быть прописаны в виде назначений лечащим врачом в карте пациента.
Срок действия этанолового «замка» составляет 4 часа. Этаноловый «замок» должен заменяться ежедневно в течение 4-5 дней.
Врач должен аспирировать введенный раствор этанола по завершению времени действия «замка» и оставить об этом запись в карте больного.
Объем вводимого этанола должен соответствовать объему просвета катетера плюс объем всех соединительных компонентов. Объем определяется в соответствие с типом ЦВК. Обратитесь к данным производителя для определения объема ЦВК.
Разведение:
Необходимо набрать до 3.5 мл 96% этанола и 1.5 мл стерильной воды для инъекций в 10 мл шприц (при этом получится 5 мл 70% раствора).
Лишний объем раствора необходимо удалить из шприца, оставив только объем необходимый для заполнения катетера.
Необходимо промыть ЦВК до введения «замка» и после его удаления 0.9% раствором хлорида натрия. Завершающее введение 0.9% раствора хлорида натрия проводится после аспирации из катетера введенного объема спирта по завершению 4-х часового лечебного периода.
См. разделы Промывка ЦВК и «Замки» для ЦВК.
Список сокращений
ИСМП – Инфекции, связанные с оказанием медицинской помощи
КАИК – Катетер-ассоциированные инфекции кровотока
ЛПУ – Лечебно-профилактическое учреждение
СанПиН – Санитарные правила и нормы
ЦВК – Центральный венозный катетер
ЭКГ – Электрокардиография
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