What Is a Chemotherapy Pump?

Percutaneous subclavian artery chemotherapy pump indwelling

Percutaneous subclavian artery chemotherapy pump indwelling

This entry lacks an overview , an information bar , and an overview map . Supplementing related content makes the entry more complete and can be upgraded quickly. Come on!

Percutaneous subclavian artery chemotherapy pump indwelling

Percutaneous subclavian arterial chemotherapy pump indwelling is suitable for advanced primary liver cancer, liver metastasis cancer, liver cancer resection, esophageal cancer, gastric cancer, small intestine tumor, colon cancer surgery, pancreatic cancer, extensive abdominal metastases, lung cancer chemotherapy.

People with iodine allergies, severe liver and kidney damage, severe arrhythmias, congestive heart failure, various bleeding disorders, and various acute infections (including skin infections at the puncture site).

1. Device chemotherapy pump, puncture needle, 5F catheter, 0.89mm (0.035 inch) super slip exchange guide wire.

2. Contrast agent imported or domestic non-ionic contrast agent.

3. Routine examination of liver, kidney, heart function, blood routine, time of coagulation and coagulation. Chest radiographs exclude lung infections. In all cases, the white blood cell count was above 3 × 109 / L, and the platelets were above 9 × 1012 / L. Liver, kidney, and heart functions, as well as time to coagulation, were within normal ranges.

4. The iodine allergy test should be done carefully to guide patients to eat easily digestible, low-fat foods, fast for 4 hours before surgery, and prepare skins. Check the patient's name, bed number, CT film, X-ray film, and take the medicine into the intervention room.

1. The puncture point is in the left subclavian fossa, which is about 2.5cm below the middle and outer 1/3 of the clavicle. The puncture needle punctures the left subclavian artery inward and upward. During puncture, if the brachial plexus nerve is punctured, the patient's upper extremity has a discharge or numbness, which indicates that the angle of the cross section is too large, and the angle should be adjusted to a small angle. , Should increase the angle appropriately. Several times unsuccessful, puncture at the midpoint of the outer edge of the left first rib under perspective. If the puncture is very difficult, the femoral artery cannula guide wire can be sent to the left subclavian artery, and the guide wire is punctured under the perspective.

2. After successful puncture, insert the guide wire. Immediately after the guidewire enters 10-20cm, follow the position of the guidewire under perspective to prevent the guidewire from entering the distal branch of the ipsilateral vertebral artery or subclavian artery.

3. Introduce the 5F Cobra catheter and twist the catheter so that its opening is toward the descending aorta. The guide wire was successfully delivered to the abdominal aorta, and the catheter was followed to the target vessel.

4. Send the exchange guide wire, replace the Cobra catheter with a silicone tube, and confirm that the position of the head of the silicone tube is correct.

5. Make a 2cm incision under local anesthesia on the left anterior chest wall. After blunt dissection, form a subcutaneous sac cavity that can accommodate the chemotherapy pump. Then introduce a silicone tube through the subcutaneous tunnel into the incision to connect with the chemotherapy pump. .

6. Chemopump angiography confirmed that the tube head was in the correct position, the silicone tube was unobstructed and the interface had no leakage, and the subcutaneous and skin were sutured. Partially pressurize the bandage and remove the thread 7d.

1. Precautions during operation The sterilization principle must be strictly followed before the injection of chemotherapeutic drugs to avoid secondary infection. First touch the round chemotherapy pump under the patient's skin with hands, then disinfect the skin with iodine, ethanol, and the operator's own fingers. Fix the edge of the chemotherapy pump with your left hand, and hold a 5ml syringe (7 or a special needle) in normal saline. There is a feeling of falling into the needle of the pump body. At this time, physiological saline can be injected to confirm that the puncture is accurate and the catheter is unobstructed. After chemotherapy, the catheter was flushed with heparin saline and the needle was pulled quickly with positive pressure to prevent the fluid in the tube from flowing back.

2. Prevention and treatment of complications

(1) Pneumothorax and hemothorax: due to improper puncture of the subclavian artery.

(2) Delayed healing of the incision: due to the weak constitution and poor nutrition of the patient, the implantation of the chemotherapy pump is too shallow, the tension of the skin is large, and the compatibility of the chemotherapy pump with the skin tissue is poor.

(3) Incision infection: It is related to the suppression of bone and the decline of body resistance. In order to prevent local skin and systemic infections, aseptic technique must be strictly applied during chemotherapy with the chemotherapy pump. The puncture site is disinfected with iodine and ethanol, and the puncture site is covered with sterile gauze.

(4) Hematoma: Strictly observe the skin around the pump for swelling and congestion. The patient felt local swelling and pain of the drug pump after the operation. It was found that the top of the drug pump was full, and hematoma may occur due to operation reasons or coagulation dysfunction of the tumor patient. Aspirate with a sterile empty needle, withdraw blood, apply appropriate pressure bandaging and perform hemostatic treatment.

(5) Catheter blockage: Although the chemotherapy pump is heparinized, it is also prone to blockage. Blockage is one of the reasons for the failure of chemotherapy. Therefore, it is important to keep the pump smooth. Routinely inject 4 heparin sodium 5 10ml chemotherapy pump after chemotherapy to prevent blood clots from blocking the lumen; do a good job of discharge guidance for patients and instruct them to inject heparin solution every 2 weeks during chemotherapy interval 1 time to ensure patency and facilitate chemotherapy again. Once the occlusion occurs, the skin is opened under sterile conditions to replace the catheter or the chemotherapy pump is removed.

(6) Target vessel occlusion: On the one hand, due to the excessive use of anti-tumor drugs, the concentration is too high, which stimulates intimal hyperplasia and vascular occlusion.