{"id":2934,"date":"2020-08-18T14:53:05","date_gmt":"2020-08-18T06:53:05","guid":{"rendered":"https:\/\/www.cosmomed.com.tw\/?p=2934"},"modified":"2020-10-19T14:45:19","modified_gmt":"2020-10-19T06:45:19","slug":"catheter-size-matter","status":"publish","type":"post","link":"https:\/\/www.cosmomed.com.tw\/en\/catheter-size-matter\/","title":{"rendered":"The factors hindering you in rapid infusion"},"content":{"rendered":"\n
\"\"<\/figure><\/div>\n\n\n\n

\u8f38\u6db2\u3001\u8f38\u8840\u7684\u901f\u5ea6\u4e0d\u5920\u5feb\uff1f\u4f7f\u7528\u52a0\u58d3\u888b\u901f\u5ea6\u9084\u662f\u4e0a\u4e0d\u4f86\uff1f\u56db\u9ede\u5efa\u8b70\u5e6b\u4f60\u6d41\u901f\u7ffb\u500d\uff1a
1.\u4f7f\u7528\u6700\u5927\u53ef\u884c\u7684\u58d3\u529b\u9032\u884c\u8f38\u6ce8[8]\u3002<\/span>
2.\u4f7f\u7528\u7368\u7acb\u7684Large-Bore\uff0c\u6700\u597d\u662fRIC(Rapid Infusion Catheter)[1]\u3002<\/span>
3.\u4e0d\u8981\u4f7f\u7528\u591a\u7ba1\u8154\u7684\u4e2d\u592e\u975c\u8108\u5c0e\u7ba1\uff0c\u56e0\u70ba\u5373\u4fbf\u6700\u5927\u7684\u7ba1\u8154\u5176\u5b54\u5f91\u4e5f\u5f88\u5c0f[1]\u3002<\/span>
4.Packed RBC\u4f7f\u7528Normal Saline\u9069\u7576\u7a00\u91cb\u964d\u4f4e\u9ecf\u5ea6\u6709\u76ca\u65bc\u6539\u5584\u6d41\u901f[6]\u3002<\/span><\/p>\n\n\n\n

\u6db2\u9ad4\u5728\u5713\u7ba1\u5167\u7684\u6d41\u52d5\u60c5\u5f62\u53ef\u4ee5\u7528\u666e\u4fee\u8449\u5b9a\u5f8b(Poiseuille’s Law)<\/strong>\u8868\u9054\uff0c\u8a72\u5b9a\u5f8b\u8aaa\u660e\u7ba1\u8def\u58d3\u529b\u5dee\u3001\u7ba1\u8def\u534a\u5f91\u6703\u8207\u6d41\u901f\u6210\u6b63\u6bd4\uff0c\u9019\u8868\u793a\u58d3\u529b\u5dee\u8d8a\u5927\u3001\u7ba1\u8def\u5b54\u5f91\u8d8a\u5927\u6db2\u9ad4\u6d41\u901f\u4e5f\u8d8a\u5feb\uff1b\u76f8\u53cd\u7684\uff0c\u6db2\u9ad4\u9ecf\u5ea6\u3001\u5713\u7ba1\u9577\u5ea6\u6703\u8207\u6d41\u901f\u6210\u53cd\u6bd4\uff0c\u9019\u8868\u793a\u9ecf\u5ea6\u8d8a\u4f4e\u3001\u7ba1\u8def\u8d8a\u77ed\u6db2\u9ad4\u6d41\u901f\u8d8a\u5feb\u3002\u4e5f\u5c31\u662f\u8aaa\uff0c\u589e\u52a0\u8f38\u6ce8\u58d3\u529b\u3001\u589e\u52a0\u5c0e\u7ba1\u7ba1\u5f91\u3001\u7e2e\u77ed\u5c0e\u7ba1\u9577\u5ea6\u6216\u662f\u964d\u4f4e\u8f38\u6ce8\u6db2\u9ecf\u5ea6\u5728\u7406\u8ad6\u4e0a\u80fd\u63d0\u4f9b\u8f03\u9ad8\u7684\u6d41\u901f<\/strong>\u3002\u7136\u800c\u5728\u5be6\u52d9\u4e0a\uff0c\u7d05\u8840\u7403\u8f38\u6ce8\u58d3\u529b\u6709\u5176\u9650\u5236\u4e0d\u5b9c\u904e\u9ad8(<300 mmHg)\uff0c\u518d\u8005\u8f38\u6ce8\u6db2\u9ecf\u5ea6\u672a\u5fc5\u5141\u8a31\u8abf\u6574\uff0c\u56e0\u6b64\u6539\u8b8a\u91dd\u5177\u3001\u5c0e\u7ba1\u5c3a\u5bf8\u6703\u662f\u8f03\u53ef\u884c\u7684\u4f5c\u6cd5\u3002<\/p>\n\n\n\n

\"\"
\u666e\u4fee\u8449\u5b9a\u5f8b(Poiseuille’s Law)\u8868\u9054\u6db2\u9ad4\u5728\u5713\u7ba1\u5167\u7684\u6d41\u52d5\u72c0\u614b<\/figcaption><\/figure>\n\n\n\n

\u5982\u4f55\u6311\u9078\u91dd\u5177\u3001\u5c0e\u7ba1<\/strong>
\u5728\u91ab\u5b78\u4e0a\uff0c\u91dd\u5177\u53ca\u5c0e\u7ba1\u5c3a\u5bf8\u8861\u91cf\u65b9\u5f0f\u6709\u5169\u5957\u7cfb\u7d71\uff1aFrench(Fr)\u8207Gauge(G)\u3002French\u8861\u91cf\u7684\u662f\u5c0e\u7ba1\u7684\u5916\u5f91\uff0c\u8a08\u7b97\u65b9\u5f0f\u662f\u5916\u5f91(\u516c\u91d0)\u4e58\u4e09\u500d\uff1aFr = D(mm) x 3\uff0c\u56e0\u6b64Fr\u8d8a\u5927\u7ba1\u5f91\u8d8a\u5927<\/strong>\uff1bGauge\u5247\u6c92\u6709\u660e\u78ba\u8a08\u7b97\u516c\u5f0f\uff0c\u4e3b\u8981\u53c3\u8003ISO\u6240\u767c\u4f48\u7684\u5c0e\u7ba1\u76f8\u95dc\u5c3a\u5bf8\u898f\u7bc4\uff0c\u4f46\u8207Fr\u76f8\u53cd\u7684\u662fGuage\u8d8a\u5c0f\u4ee3\u8868\u7ba1\u5f91\u8d8a\u5927<\/strong>[4]\uff0c\u6211\u5011\u53ef\u4ee5\u5f9e\u4e0b\u8868\u53ef\u4ee5\u6982\u7565\u66b8\u89e3\u5230Gauge\u548cFrench\u4e4b\u9593\u7684\u5c0d\u61c9\u3002<\/p>\n\n\n\n

\"\"
Gauge\u3001French\u5c3a\u5bf8\u8f49\u63db\u8868<\/figcaption><\/figure>\n\n\n\n

\u4ee5\u8c9d\u723e\u66fc\u7279\u8f38\u6db2\u7ba1\u7406\u7cfb\u7d71RI-2<\/a>\u4f86\u8aaa\uff0c\u6700\u9ad8\u8f38\u6ce8\u901f\u7387\u662f750 mL\/min\uff08\u62161000 mL\/min)\uff0c\u642d\u914d12 Gauge\u91dd\u5177\u6642\u80fd\u5920\u767c\u63ee\u5230\u6975\u9650\u901f\u5ea6\uff1b\u7136\u800c\uff0c\u4f7f\u752816 Gauge\u91dd\u5177\u6642\u5247\u53ea\u80fd\u767c\u63ee400 mL\/min\u3002\u5982\u679c\u4f7f\u7528Packed RBC\u9084\u6703\u56e0\u9ecf\u5ea6\u66f4\u9ad8\uff0c\u8f38\u6ce8\u901f\u5ea6\u518d\u6298\u640d\uff0c\u4e0b\u8868\u70ba\u5b98\u65b9\u8c9d\u723e\u66fc\u7279\u8f38\u6db2\u7ba1\u7406\u7cfb\u7d71<\/a>\u4e0d\u540c\u5c3a\u5bf8\u5c0e\u7ba1\u7684\u53c3\u8003\u6d41\u901f\u503c\u3002<\/p>\n\n\n\n

\"\"
\u8c9d\u723e\u66fc\u7279\u8f38\u6db2\u7ba1\u7406\u7cfb\u7d71\u5b98\u65b9\u63d0\u4f9b\u6578\u64da<\/figcaption><\/figure>\n\n\n\n

\u9664\u4e86\u5b98\u65b9\u63d0\u4f9b\u7684\u6578\u64da\u5916\uff0c\u97d3\u570b\u4ec1\u6fdf\u5927\u5b78\u6d77\u96f2\u53f0\u767d\u91ab\u9662(Haeundae Paik Hospital, Inje University, Busan, Republic of Korea )\u91dd\u5c0d16\u7a2e\u5e02\u552e\u5c0e\u7ba1\u4ee5\u53ca\u4e09\u7a2e\u8f38\u6ce8\u6db2Normal Saline(NS)\u3001Ringer’s Lactate(RL)\u3001HES\u7814\u7a76\u5c0e\u7ba1\u4ee5\u53ca\u8f38\u6ce8\u6db2\u9ecf\u5ea6\u5c0d\u6700\u5927\u6d41\u901f\u7684\u5f71\u97ff[5]\u3002\u7814\u7a76\u4e2d\u4f7f\u7528\u8c9d\u723e\u66fc\u7279\u8f38\u6db2\u7ba1\u7406\u7cfb\u7d71<\/a>\u4e26\u5728\u8f38\u6ce8\u58d3\u529b\u4e0d\u8d85\u904e300 mmHg\u60c5\u6cc1\u4e0b\u6e2c\u5f97\u6a5f\u5668\u80fd\u5920\u5230\u9054\u7684\u6700\u5927\u901f\u7387\u6574\u7406\u5982\u4e0b\u8868\uff1a<\/p>\n\n\n\n

\"\"
\u5e02\u552e\u91dd\u5177\u3001\u5c0e\u7ba1\u8207\u8c9d\u723e\u66fc\u7279\u8f38\u6db2\u7ba1\u7406\u7cfb\u7d71\u901f\u7387\u6bd4\u8f03[5]<\/figcaption><\/figure><\/div>\n\n\n\n

\u5728\u9019\u4efd\u7814\u7a76\u4e2d\u6307\u51fa\uff1a
1.\u5982\u679c\u7ba1\u5f91\u76f8\u540c\uff0c\u9577\u5ea6\u8d8a\u77ed\u6d41\u901f\u8d8a\u5feb\uff1a<\/strong>\u7814\u7a76\u4e2d\u6bd4\u8f03\u5169\u7a2e20G\u5c0e\u7ba1\uff0c\u8f03\u9577\u7684\u5c0e\u7ba1\u6e2c\u5f97\u901f\u7387\u70ba160 mL\/min\uff1b\u8f03\u77ed\u7684\u5c0e\u7ba1\u6e2c\u5f97\u901f\u7387\u70ba176 mL\/min
2.\u5982\u679c\u9577\u5ea6\u76f8\u540c\uff0c\u7ba1\u5f91\u8d8a\u5927\u6d41\u901f\u8d8a\u5feb\uff1a<\/strong>\u7814\u7a76\u4e2d\u6bd4\u8f03\u540c\u70ba1.16\u82f1\u540b(30mm)\u768420G\u53ca18G\u5c0e\u7ba1\uff0c20G\u5c0e\u7ba1\u6e2c\u5f97\u901f\u7387\u70ba176 mL\/min\uff1b18G\u5c0e\u7ba1\u6e2c\u5f97\u901f\u7387\u70ba273 mL\/min
3.\u9ecf\u5ea6\u8d8a\u4f4e\u6d41\u901f\u8d8a\u5feb\uff1a<\/strong>HES\u6bd4\u8d77NS\u3001RL\u9ecf\u5ea6\u8f03\u9ad8\u5c0e\u81f4\u5728\u6240\u6709\u5be6\u9a57\u7d44\u4e2d\u8f38\u6ce8\u901f\u5ea6\u90fd\u6bd4\u8f03\u6162\uff1bNS\u3001RL\u5247\u9ecf\u5ea6\u76f8\u4f3c\uff0c\u6e2c\u5f97\u7684\u8f38\u6ce8\u901f\u7387\u76f8\u4f3c\u3002
\u9019\u6a23\u7684\u5be6\u9a57\u7d50\u8ad6\u57fa\u672c\u4e0a\u548c\u666e\u4fee\u8449\u5b9a\u5f8b(Poiseuille’s Law)<\/strong>\u4e0d\u8b00\u800c\u5408\u3002<\/p>\n\n\n\n

\u4e2d\u592e\u975c\u8108\u5c0e\u7ba1\u9069\u4e0d\u9069\u5408\u5feb\u901f\u8f38\u6db2\uff1f<\/strong>
\u5728\u9019\u4efd\u7814\u7a76\u4e2d\u503c\u5f97\u4e00\u63d0\u7684\u9084\u6709\u4e2d\u592e\u975c\u8108\u5c0e\u7ba1<\/strong>(Central Venous Catheter, CVC)\u6ff3\u85cf\u7684\u8f38\u6db2\u554f\u984c\u3002\u5e02\u9762\u4e0a\u5e38\u898b\u7684\u4e2d\u592e\u975c\u8108\u5c0e\u7ba1\u7ba1\u8154\u6578\u5206\u55ae\u8154\u3001\u96d9\u8154\u3001\u4e09\u8154\u751a\u81f3\u56db\u8154\uff0c\u6bcf\u500b\u7ba1\u8154\u5c3a\u5bf8\u662f\u4e0d\u4e00\u6a23\u7684\u3002\u4ee5\u7814\u7a76\u4e2d\u4f7f\u7528\u7684\u5169\u7d445Fr 150mm\u4e2d\u592e\u975c\u8108\u5c0e\u7ba1\u70ba\u4f8b\uff0c\u5728\u8f38\u6ce8NS\u6642\uff0c\u55ae\u8154\u5c0e\u7ba1\u901f\u5ea6\u53ef\u9054190 mL\/min\uff1b\u96d9\u8154\u5c0e\u7ba1\u662f\u7531\u4e00\u500b20G(\u767d\u8272)\u53ca\u4e00\u500b18G(\u68d5\u8272)\u5c0e\u7ba1\u69cb\u6210\uff0c\u5373\u4fbf\u8f03\u5927\u7684\u7ba1\u8154(18G)\u8f38\u6ce8\u901f\u5ea6\u53ef\u9054118 mL\/min\u8207\u55ae\u8154\u5c0e\u7ba1\u6709\u6240\u5dee\u8ddd\u3002\u56e0\u6b64\u5728\u4f7f\u7528\u4e2d\u592e\u975c\u8108\u5c0e\u7ba1<\/strong>\u9032\u884c\u5feb\u901f\u8f38\u6db2\u6642\u9700\u8981\u683c\u5916\u7559\u610f\u6bcf\u500b\u7ba1\u8154\u7684\u5be6\u969b\u7ba1\u5f91\u8207\u53ef\u9054\u901f\u5ea6\uff0c\u5efa\u8b70\u6700\u597d\u662f\u9078\u7528\u55ae\u8154\u5c0e\u7ba1\u3002<\/p>\n\n\n\n

\u4f7f\u7528\u5c08\u7528\u7684Large-Bore\u9032\u884c\u5feb\u901f\u8f38\u6db2\uff0c\u6700\u597d\u662f\u5feb\u901f\u8f38\u6ce8\u5c0e\u7ba1(RIC)\u3002\u5207\u52ff\u4f7f\u7528\u4e2d\u592e\u975c\u8108\u5c0e\u7ba1\uff0c\u56e0\u70ba\u5373\u4fbf\u6700\u5927\u7684\u7ba1\u8154\u5176\u7ba1\u5f91\u4e5f\u975e\u5e38\u5c0f\u3002
A dedicated, large bore catheter, preferably a RIC (rapid infusion catheter) line. Do NOT use with a central venous catheter, as the bores of even the largest catheter are excessively small.<\/p>\u6ce2\u58eb\u9813\u5152\u7ae5\u91ab\u9662\u5fc3\u81df\u91cd\u75c7\u52a0\u8b77\u75c5\u623f\u6e96\u5247[1]
Boston Children’s Hospital Cardiac ICU Handbook<\/cite><\/blockquote>\n\n\n\n

\u5b89\u5168\u81f3\u4e0a Think Safety First<\/strong>
\u5feb\u901f\u8f38\u6db2\u7cfb\u7d71\u7684\u4f7f\u7528\u8005\u5e38\u9047\u898b\u7684\u554f\u984c\u4e4b\u4e00\u5c31\u662f\u201c\u70ba\u4ec0\u9ebc\u6a5f\u5668\u901f\u5ea6\u4e0a\u4e0d\u4f86\uff1f\u70ba\u4ec0\u9ebc\u6a5f\u5668\u986f\u793a\u58d3\u529b\u904e\u9ad8\uff1f<\/strong>\u201d\u904e\u53bb\u7814\u7a76\u986f\u793a\u8840\u888b\u52a0\u58d3\u8d85\u904e300 mmHg\u5c31\u53ef\u80fd\u5c0e\u81f4\u6eb6\u8840\uff0c\u70ba\u4e86\u5728\u6027\u80fd\u8207\u5b89\u5168\u6027\u4e4b\u9593\u6b0a\u8861\u512a\u5148\u4fdd\u969c\u60a3\u8005\u5b89\u5168<\/strong>\uff0c\u8c9d\u723e\u66fc\u7279\u8f38\u6db2\u7ba1\u7406\u7cfb\u7d71<\/a>\u8a2d\u8a08\u4e0a\u6703\u5728\u8f38\u6ce8\u58d3\u529b\u903c\u8fd1300 mmHg\u6642\u4e3b\u52d5\u6e1b\u901f\u964d\u58d3\u6216\u662f\u66ab\u505c\u8f38\u6db2\u4e26\u5831\u8b66\u4f7f\u7528\u8005\u3002\u9019\u6a23\u7684\u63aa\u65bd\u662f\u57fa\u65bc\u8f38\u8840\u5b89\u5168\u8003\u91cf\u4f46\u4e5f\u662f\u9020\u6210\u6a5f\u5668\u63d0\u901f\u4e0d\u4e0a\u4f86\u7684\u539f\u56e0\u3002\u4f9d\u64da\u524d\u9762\u6240\u63d0\u4f9b\u7684\u76f8\u95dc\u7814\u7a76\u8cc7\u8a0a\uff0c\u6211\u5011\u6703\u5efa\u8b70\u4f7f\u7528\u8005\u5728\u9032\u884c\u5feb\u901f\u8f38\u6db2\u6642\uff0c\u5617\u8a66\u642d\u914d\u5b54\u5f91\u5927\u4e14\u9577\u5ea6\u77ed<\/strong>\u7684\u5c0e\u7ba1\u4e26\u4e14\u9069\u5ea6\u7a00\u91cb\u8f38\u6ce8\u6db2<\/strong>\u5c31\u80fd\u964d\u4f4e\u8f38\u6ce8\u6642\u7684\u7ba1\u5167\u58d3\u529b\uff0c\u7372\u5f97\u66f4\u9ad8\u7684\u6d41\u901f\u3002<\/p>\n\n\n\n

\"\"
\u9664\u4e86\u9ad8\u6027\u80fd\uff0c\u6211\u5011\u4e5f\u540c\u6a23\u91cd\u8996\u75c5\u60a3\u7684\u8f38\u6ce8\u5b89\u5168<\/figcaption><\/figure>\n\n\n\n
<\/div><\/div>\n\n\n

\u53c3\u8003\u8cc7\u6599\uff1a
<\/strong>1.Massive Transfusion Protocol and Rapid Infuser. <\/a>Boston Children’s Hospital Cardiac ICU Handbook.<\/a><\/a>
2.Tufts Medical Center. Pediatric Anesthesia Digital Handbook.<\/a>
3.Iserson, Kenneth & Reeter, Alan & Criss, Elizabeth. (1985). Comparison of Flow Rates for Standard and Large-Bore Blood Tubing. The Western journal of medicine. 143. 183-5.<\/a>
4.Ahn W, Bahk JH, Lim YJ. The “Gauge” system for the medical use. Anesth Analg<\/em>. 2002;95(4):1125. doi:10.1097\/00000539-200210000-00076<\/a>
5.Kim, Yong & Choi, Young & Bang, Sira & Lee, Sangeun & Park, jae Hong & Jeon, Sang & Shin, Jung & Kim, Ki Hoon & Kim, Jin. (2011). Comparison of maximal infusion rate of FMS 2000 fluid warmer on various catheters and fluids. Rawal Medical Journal. 36.<\/a>
6.Charles J. Cot\u00e9, Jerrold Lerman and Brian J. Anderson<\/span>. (2019). A Practice of Anesthesia for Infants and Children.<\/a>
7. Gauge Chart. Precision Tubes Europe.<\/a>
8.Poiseuille’s law: IV fluids. OpenAnesthesia.<\/a>
9.Goodbye, Large-Bore IV Access<\/a>
10.Large Bore IV Access Showdown: Do you know which IV cannula can deliver fluid to your patient the fastest?<\/a><\/p>","protected":false},"excerpt":{"rendered":"

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