The initial fixation of the central venous catheter was done by the catheterist using silk suture to ligate and fix the catheter. Suture fixation did indeed play a role in preventing catheter detachment, but due to the large scope of trauma, inconvenience in maintenance, and susceptibility to catheter-related infections (CRI), adhesive tape fixation was later used, but the detachment rate significantly increased.

Using a catheter fixation device, this device uses a locking structure to clamp the catheter wings together with the catheter fixation device, which is very reliable. The other side is fixed to the skin around the catheter by pasting, which can effectively reduce the slipping of the catheter. In addition, this operation is non-invasive, and as a one-time use material, the catheter only needs to be discarded and replaced during maintenance. The operation is simple and convenient, and there is no inflammatory reaction at the fixation point, reducing patient pain, Improved patient satisfaction and is now the most commonly used fixation method for central venous catheters in clinical practice.

Sometimes, there may be bleeding or exudation in the local area of the patient's puncture site, or in special cases where the patient is allergic to transparent patches, nursing staff may cover the puncture site with sterile gauze dressing and fix it with adhesive strips externally. Due to the advantages of gauze's good adsorption and non allergenic properties, gauze still has certain disadvantages compared to transparent patches, such as difficulty in observing the local area of the puncture site, poor sealing, and unreliable fixation, Therefore, in view of this situation, there are many new clinical dressings, such as antibacterial gel dressings, low sensitization hydrocolloid dressings, and so on. In clinical practice, the patient's situation is complex and diverse, and suitable dressings should also be selected based on the specific situation.

Taking the catheter fixation device as an example

Assessment: Evaluate whether there is redness, swelling, dermatitis, skin lesions in the local skin, and whether there is fluid leakage at the puncture site.

Remove old dressings: Fix the catheter, from the distal end of the catheter to the direction of the puncture point, and fold back at a 180 ° angle to remove the old dressings.

Disinfection: Trained nursing staff, with a puncture point as the center and a diameter greater than 12 * 12cm, thoroughly disinfect the local skin with chlorhexidine

Fixation: Place the catheter fixing device in a sterile area in a sterile manner, wear sterile gloves, clip the catheter fixing wing into the slot of the catheter fixing device, and then attach the catheter fixing device to the skin; Cover the transparent dressing with a tensionfree adhesive around the puncture point, and ensure a tight fit by properly fixing the catheter and shaping it.

Remove gloves, record the time and operator name on the tape, and stick them on the edge of the film.

Finally, it should be emphasized that: (1) once the catheter is dislodged, do not reinsert the dislodged catheter into the blood vessel. Measures to be taken: if the catheter is dislodged less, determine the position of the catheter tip and evaluate its function. If it is determined that the catheter tip is still in the upper (lower) vena cava, re fixing it using non bacterial fixation methods can still be used as a central venous catheter. If the catheter is dislodged more and affects its use after evaluation, consider removing the catheter, Re puncture and catheterize in other areas. (2) Try to choose a catheter fixation device with adhesive and soft substrate that have good compatibility, reduce the incidence of skin allergies caused by adhesive, and avoid secondary operations.