Caabuqa dhiigga ee la xidhiidha tuumbada macmalka ah ee xididka dhexe: Central Line-Associated Bloodstream Infections

Caabuqa dhiigga oo dhowr magac ku leh afka qalaad sida  sepsemia, bacteremia, fungemia, iyo  bloodstreem infection, waa marka caabuq-keene galo habdhiska wareegga dhiigga oo uu dabadeed ku dhaliyo  caabuq habdhiska wareegga dhiigga.

Tuumbada macmalka ahi waa tuumbo dhuuban oo oo bukaanka laga geliyo mid ka mid ah xididada waaweyn ee dhiigga ee luqunta ama laabta xageeda sare mara, walow ay marmar dhacdo in laga geliyo gacanta ama xaga hoose ee kalagoyska bowdada iyo gumaarka.

Labada sababood ee ugu waaweyn ee tuumbada macmalka ah ee dhexe loo geliyo bukaanka waxa weeye: 1) in laga siiyo dawooyin sida kuwa lid-jeermiska antaybayootikada iyo kuwa kansarka; iyo 2) in bukaanka laga siiyo nafaqo aanu ka qaadan karin afka. 

Shuruuda ugu muhiimsan ee tuumbada macmalka loogu aqoonsan karo in ay tahay TMXD waa haddii tuumbada la geliyo mid ka mid ah xididada waaweyn ee hoos tu taxan:

  • Aorta
  • Pulmonary artery
  • Superior vena cava
  • Inferior vena cava
  •  Brachiocephalic veins
  • Internal jugular veins
  • Subclavian veins
  • External iliac veins
  • Common iliac veins
  • Femoral veins
  • The umbilical artery/vein, waa dhalaanka oo keliya

Marka la gelinayo TMXD waxaa tuumbada la xuliyaa mid ka mid ah xidida waaweyn dhexdiisa oo dacalkeeda la gaadhsiiyaa meel u dhow wadnaha ama lagu joojiyaa xididka weyn dhexdiisa. Afka kale ee TMXD oo ah dhinaca kale ee jidhka debeda uga baxsan waxaa lagu rakibaa fur dawooyinka ama nafaqada laga siiyo bukaanka. TMXD waxay kale oo muhiim u tahay in lagula socdo cadaadiska dhiigga iyo in dhiig sambal ah laga qaado TMXD marka la doonayo in la baadho dhiigga bukaanka. TMXD oo loogu talo galay in ay bukaanka ku jirto mudo dheer, waxaa xididada waaweyn loo geliyaa si looga maarmo in bukaanka marwalba la geliyo faleebada la geliyo xididada dusha sare (Periveral IV).

Tuumbooyinka macmalka ah ee xididka dhexe waxaa loo qaybiyaa laba nooc marka la eego mudada ay bukaanka ku jiraan: 

  1. TMXD ee weligeed ku jiraysa bukaanka (permanent catheter). Tuumbadan waxaa loo soo qaybiyaa laba nooc marka la eego sida jidhka loogu rakibo:
    • TMXD ee la xuliyo (tunneled) maqaarka hoostiisa dabadeedna (tunneled). Tusaale ahaan TMXD ee safaynta dhiiga (hemodialysis catheter)
    • TMXD ee afkeeda sare ee dawada iyo nafaqada lagaga shubaa uu ku aasan yahay maqaarka hoostiisa (implanted)
  2. TMXD ee mudada kooban (temporary catheter). Tuumbadan lama xuliyo (non-tunneled) maqaarka hoostiisa

Tuumbooyinka macmalka ah ee xididka dhexe waxaa loo qaybiyaa dhowr nooc marka la eego inta af (halka dawada iyo nafaqada lagaga shubo tuumbada)

Sadexdan TMXD, ta hoose waxa ay leeday hal af (single lumen). Ta dhexe waxa ay leedahay  laba af (double lumen). Ta sarena waxa ay leedahay sadex af (triple lumen).

Tuumbooyinka macmalka ah ee xididka dhexe waxaa loo qaybiyaa dhowr nooc marka la eego dhumucdooda

Bukaanjiifka  ku jira qaybta daryeelka culus (ICU) ee  badanaa la geliyo TMXD ayaa a kuwo halis badan ugu jira inuu ku dhaco caabuqa dhiigga ee la xidhiidha TMXD. Haseyeeshee, bukaanjiif kasta oo ay ku jirto TMXD oo jiifa cusbitaalka iyo kuwa u baahan daryeelka sifaynta dhiigga (Hemodialysis) waxay halis ugu jiraan inuu ku dhaco caabuqa dhiigga ee la xidhiidha TMXD. Intaas waxaa soo raaca inay jiraan khataro kale oo halis u geliya in uu caabuqa dhiigga ee la xidhiidha TMXD ku dhaco bukaanka. Khartarahaas waxaa ka mid ah:

  • Iyada oo  bukaanku uu mudo dheer jiifey cusbitaalka kahor inta aan la gelin TMXD
  • TMXD oo mudo dheer ku jirta bukaanka
  • Halka TMXD laga geliyey jidhka oo ay degaan caabuq-keeneyaal
  • Afka TMXD oo dawada iyo nafaqada laga siiyo bukaanka oo ay degaan caabuqkeeneyaal
  • TMXD oo la geliyo xididka weyn ee Internal Jugular
  • TMXD oo la geliyo xididka weyn ee Femoral, gaar ahaan dadka qaangaadhka ah
  • Bukaanka oo ay ku yar yihiin unugyada cad-cad ee loo yaqaan Neutrophils
  • Ilmaha oo dhasha isaga oo dhicis
  • Iyada oo ay yar yihiin tirada kalkaaliyeyaasha caafimaad ee daryeelaya bukaanjiifka ku jira qaybta daryeelka culus (ICU). Haddii si kale loo yidhaahdana, waa iyada oo uu hoos u dhaco saamiga u dhexeeya kalkaaliyeyaasha caafimaad iyo bukaan-jiifka ku jira qaybta daryeelka culus.
  • Iyada oo gebi ahaanba bukaanku uu nafaqada ku qaadanayo tuumbo la geliyey
  • Iyada oo si fiican loo dayac tiriwaayo TMXD.
  • Iyada oo bukaanka lagu shubo dhiig (blood transfussion)

Bacteeriyada ayaa ah caabuq-keeneyaasha ugu badan ee keena caabuqa dhiigga.  Gaar ahaan, bakteeriyada midabka togan ayaa dhaliya caabuqa dhiigga ee la xidhiidha TMXD, walow bakteeriyada midabka taban ay iyaguna dhaliyaan caabuqa dhiigga ee la xidhiidha TMXD. Taxa hoose wuxuu muujinayaa sida ay u kala sareeyaan bakteeriyada inta badan keena caabuqa dhiigga ee la xidhiidha TMD:

Caabuq-keenaha

Boqolkiia caabuqa 

Coagulase-negative staphylococci

34.1%

Enterococci

16%

Staphylococcus aureus

9.9%

Klebsiella

5.8%

Enterobacter

3.9%

Pseudomonas

3.1%

E.coli

2.7%

Acinetobacter

2.2%

Candida species

11.8%

Others

10.5%

Shanta siyaabood ee hoos ku taxan ayaa ah kuwa ugu mihiimsan  ee caabuq-keeneyaasha u fududeeya inay galaan wareega dhiigga oo dabadeedna ay dhaliyaan caabuqa dhiigga ee la dhidhiidh TMXD:

  • TMXD oo ay wasakheeyaan ama diqeeyaan caabuq-keeneyaashu ka hor inta aan la gelin bukaanka. Inta badan caabuq-keeneyaashu waxay wasakheeyaan oo diqeeyaan TMXD mudo yar kahor uun inta aan la gelin bukaanka.
  • Noolaha ili-maqabatayga ah ee sida caadiga ah ugu dul nool maqaarka ayaa u siqa oo gala halka jidhka laga dalooliyey ee TMXD jidhka laga geliyey. Noolaha ili-maqatayga ahi waxay raacaan TMXD xageeda sare ilaa ay ka gaadhaan oo degaan ka samaystaan TMXD caaradeeda ama afkeeda ku jira xididka weyn. Sidaas ayaa noolaha ili-maqabatayga ahi u galaan wareega dhiigga iyaga oo caabuq-keeneyaal ah oo ku dhaliyaan caabuqa dhiigga ee la xidhiidha TMD.
  • Furka sare ee dawada iyo dareeraha lagaga shubo TMXD oo ay wasakheeyaan oo diqeeyaan caabuq-keeneyaal kadib markii gacmo aan la nadiifin ama walax aan la nadiifin ay taabtaan furkaas. Caabuq-keeneyaashaasi waxay galaan gudaha TMXD oo ay sidaas ugu gudbaan wareeega dhiiga kuna dhaliyaan caabuqa dhiigga ee la xidhiidha TMXD.
  • Haddii bukaanku uu qabo caabuq kale, sida caabuqa kaadi-mareenka, oofwareen, boog caabuqaysan, iwm, caabuq-keene ka soo baxay caabuqaas kale ayaa soo raaca wareega dhiiga oo dabadeenda ku abuurma TMXD. Caabuq-keenahaas oo markaas u gudba wareega diiga oo dhaliya caabuqa dhiigga ee la xidhiidha TMXD. Habkan waxaa afka qalaad lagu yidhaahdaa “seeding”.
  • Dawo ama dareere wasakhaysan ama diqeysan oo lagu shubo TMXD. Sidaas ayay caabuq-keeneyaashu ku galaan wareega dhiigga ee ku dhaliyaan caabuqa dhiigga ee la xidhiidha TMXD. Laakiin ma badna in caabuqkeeneyaashu sidan ku dhaliyaan caabuqa dhiigga ee la xidhiidha TMXD.
red blood cell, vessel, hemoglobin-4807218.jpg

Mudada ay ku qaadato in calaamadaha cudurku soo ifbaxaan:

Mudadu waxay ku xidhan tahay nooca caabuq-keenaha. Inta badan bakteeriyada Staphylococcus ee keenta caabuqa dhiigga ee la xidhiidha TMXD, waxay ku qaadataa 4 ilaa 10 maalmood in calaamadaha caabuqu soo ifbaxaan. 

Xeelahdaha lagaga hortago caabuqa dhiigga ee la xidhiidha TMXD

Xeeladaha lagaga hortago caabuqa dhiigga ee la xidhiidha TMXD waxaa loo kala saaraa laba qaybood oo kala ah 1) xeeladaha aasaasiga ah oo loo baahan yahay in cusbitaal kasta oo daryeel deg deg ah bixiyaa uu dhaqan geliyo iyo 2) xeelado gaar ah oo loogu talo galay in la isticimaalo marka xeeladaha aasaasiga ahi ay wax ka qaban waayaan ka hortagga iyo hakinta caabuqyada dhiigga ee la xidhiidha TMD. Xeeladaha aasaasiga ahi waxay ka kooban yihiin talooyin raacitaankooku ay keeni karaan natiijooyin aan la jeclaysan oo khatartoodu ka dhib yihiin kuwa uu keeni karo caabuqa dhiigga ee la xidhiidha TMXD. Dhinaca kale, xeeladaha gaarka ahi waxay hakin karaan ama kahortegi karaan caabuqa dhiigga ee la xidhidha TMXD, haseyeeshee, isticimaalkooda waxaa ku lamaan ama ka dhasha maxsuul dhibaato ku noqon kara bukaanjiigka iyo cusbitaalkaba. Islamarkaana, xeeladah gaarka ahi waa xeelado xaqiiqaha cilmibaadhiseed ee ay ku salaysanyihiin ay noqon karaan kuwo daciif ah, ama xaqiiqahaas cilmibaadhiseed ay cadaynayaan in xeeladuhu ay dan u yihiin uun nooc ama qaybo ka mid ah bukaanjiifka oo keliya, ee aanay ahayn kuwo ku haboon qofkasa oo buka oo TMXD la geliyo.

  1. Si looga feejignaado in aan TMXD la gelin qof bukaan ah oo aan baahi caafimaad u qabin TMXD, waa in cusbitaalku leeyahay xeer si cad u qeexaya shuruudaha lagamamaarmaanka u ah in TMXD la geliyo qofka bukaanka ah.
  2. Waajib ka dhig in shaqaalaha caabimaadku ay soo mareen ama qaateen tabobar iyo waxbarasho ku saabsan sida loo geliyo loona dayactiro TMXD iyo sida looga hortaggo caabuqa dhiigga ee la xidhiidha TMXD.
    • Waa in shaqaalaha caafimaadku aqoon u leeyihiin xeeladaha lagaga hortago caabuqa dhiigga ee la xidhiidha TMXD iyo weliba xeeladaha lagaga hortago guud ahaan caabuqyada oo dhan.
    • Si loo hubiyo in shaqaaluhu aanay ilaawin aqoonta ku saabsan gelinta TMXD, dayactirka TMXD, iyo ka hortagga caabuqa dhiigga ee la xidhiidha TMXD, waa in marmar la imtixaamaa oo la hubiyaa tayada aqoontooda.
    • Waa in cusbitaalku leeyahay hab lagu hubin karo in shaqaalaha caafimaadka ee geliya TMD ay haystaan shahaadooyin cadaynaya inay soo mareen tababar waxbarasho oo jaamacadeed ama xirfadeed oo karti u siinaya inay si madaxbanaan u gelin karaan TMXD.
    • Markasta oo cusbitaalku bedelo nooca iyo sida loo isticimaalo TMXD, waa in shaqaalaha caafimaadka lala socodsiiyaa isbedelka oo la baraa sida loo gelinayo, isticimaalayo, loona gelinayo TMXD ee cusub.
    • Marka shaqaalaha caafimaadka la barayo sida loo geliyo, isticimaalo, loona dayactiro TMXD, waxaa wanaagsan oo dhib yar in ay ku tababartaan maaniken (walaxda caagga ka samaysan ee qofka u eg ee leh xididada macmalka ah ee dareeraaha dhiiga u egi ku jiro).
  3. Dhamaan bukaanjiifka da’doodu ka weyn tahay 2 bilood ee ku jira qaybta daryeelka bukaanjiifka halista ah waa in maalinwalaba loogu maydhaa ama qubeeyaa maadada “Chlorhexidine Glucunate). Waa in si taxadar leh loo raacaa tilmaameyaasha isticimaalka ee maadada Chlorhixidine Glucunate oo ah maado disha noolaha ili-maqabatayga ah.
  1. Waa in cusbitaalku leeyahay hab tayo-dhowr oo lagu hubiyo in shaqaalaha caafimaadka ee gelinaya TMXD ay isticimaalayaan ama raacayaabn xeeladaha lagaga hortago caabuqa dhiiga ee la xidhiidha TMXD.
    • Xeeladaha lagaga hortago caabuqa dhiigga ee la xidhiidha TMXD ee muhiimka ah marka la gelinayo TMD waa in loo sameeyaa tax la xigsiiyaa oo loo kala hormariyaa siday u kala horeeyaan.
    • Waa in qof (dhakhtar ama kalkaaliye caafimaad) aan ahayn qofka gelinaya TMXD uu daawadaa ama ilaaliyaa sida qofka TMXD gelinayaa u raacayo ama isticimaalayo xeeladaha. Waana in qofka ilaaliyaha ahi uu xeeladaha mid mid u diwaan geliyaa in la raacay iyo in aan la raacin.
    • Qofka ilaaliyaha ahi waa in uu awood loo siiyaa in uu sixi karo qofka gelinaya TMXD amaba uu kakin karo gelinta TMXD, ilaa inta laga saxayo khaladka laga galay raacitaanka iyo isticimaalka xeeladda ama xeeladaha.
  2. Nadiifi gacmaha kahor marka la gelinayo ama la dayactirayo TMXD.
    • Isticimaal gacme nadiifiyaha ay ku jirto maadahda aalkohooltu (alcohol based hand sanitizer) ama saabuunta disha caabuq-keeneyaasha iyo biyo.
  3. Haddii aanay xaaladu ahayn mid ded-deg ah, TMXD ha gelin xididka weyn ee mara bowdada ee “femoral”, gaar ahaan dadka aadka u buurbuuran.
  4. Tuumbada macmalka ah ee gelinteedda laga soo bilaabo xididada sare (peripherilyy inserted) ha u isticimaalin xeelad lagaga hortaggi karo caabuqa dhiigga ee la xidhiidha TMXD. Sababtu waxay tahay iyadoo ay siman yihiin khataraha sababa in uu dhasho caabuqa dhiiga ee la xidhiidha tuumbada macmalka ah ee gelintooda laga soo bilaabo xididada sare iyo khataraha sababa caabuqa dhiigga ee la xidhiidha TMXD.
  5. Qoondee sanduuq ama kartoon u gaar ah kaydinta TMXD iyo dhamaan qalabka iyo walxaha kale ee muhiimka u ah in si caabuq-keene la’aan ah loo geliyo TMXD. Waana in sanduuqaas ama kartoonkaasi si fudud looga heli karaa dhamaam qaybaha cusbitaalka ee lagu daryeelo bukaanjiifka.
  6. U isticimaal muuqaal-tusaha “ultrasound” inuu hago TMXD marka la gelinayo xididka weyn ee “jagular”. Isticimaalka muuqaal-tusaha ultrasound wuxuu taageeraa kahortagga caabuqa dhiigga ee la xidhiidha TMXD. Sidaas oo kale, isiticimaalka muuqaal-tusaha ultrasound uxuu taageeraa kahortagga dhibaatooyinka kale ee aan caabuqa ahayn ee bukaanjiifka ku dhici kara marka la gelinayo TMXD.
  7. Marka la gelinayo TMXD, waa in la isticimaalaa taxadarka nadaafadeed ee ugu heerka sareeya ee lagaga gaashaanto dhamaan noolaha ili-maqabatayga ah (maximum barrier sterile precautions).
    • Dhamaan shaqaalaha caafimaad ee ka qayb qaadanaya gelinta TMXD waa in ay afka iyo sanka ku dabooshaan maaskada qaliinka, waa inay madaxa iyo timaha ku dabooshaan koofiyada qaliinka, islamarkaana gashadaan gamco-gashi ka nadiifsan dhamaan noolaha ili-maqabatayga ah (sterile gloves).
    • Marka la gelinayo TMXD, waa in bukaanjiifka jidhkiisa oo dhan lagu dedaa daah’ baceed heerka nadaafadiisu yahay mid laga nadiifiyey dhamaan noolaha ili-maqabatayga ah (sterile drape).
    • Kahor marka la gelinayo TMXD, waa in milan (sida milan ay ku jiraan maadooyinka alcohol iyo Chlorhexidine Glucunate) dili kara noolaha ili-maqabayga ah lagu nadiifiyaa halka jidhka laga daloolinayo ee TMXD laga gelinay jidka. Marka milanka lagu nadiifiyo halka jidhka laga mudi doono waa in la sugaa ilaa inta milanku iskiis uga qalalayo jidhka, ka bacdina la bilaabaa in la mudo jidhka oo la bilaabo gelinta TMXD.
  1. Kor u qaad saamiga u dhexeeya kalkaaliyeyaasha caafimaad iyo bukaankajiifka ku jira qaybta daryeelka bukaankjiifka halista ah. Hoos u dhig tiradada kalkaaliyeyaasha caafimaad ee aan takhasuska u lahayn qaybta bukaanjiifka halista ah inay daryeelaan bukaanjiifka ku jira qaybta daryeelka bukaanjiifka halista ah, gaar ahaan kuwa ay ku jiraan TMD.
  2. Kahor marka la doonayo in la isticimaalo TMXD oo dawo ama nafaqo lagu shubayo ama dhiig laga qaadayo, waa in si dhamaystiran loo nadiifiyaa afka iyo furmeyaasha TMXD.
    • Waa in ugu yaraan 5 ilbidhiqsi la xoqaa oo la nadiifiyaa afka, furmeyaasha, ama halka irbada lagaga mudayo TMD iyada oo la isticimaalayo cudbi ama maro nadiif ah iyo milanka dila noolaha ili-maqabatayga ah sida 70% alcohol, alcohol chlorhexidine, ama povidone iodine.
    • Waa in si tayo-dhowr ahaan ah loola socdaa in sida shaqaalaha caafimaadku u nadiifinayaan ee u dayactirayaan TMXD ay tahay sida saxda ah ee xaqiiqooyin cilmibaadhiseed iyo xeerarka custibaalku ay waajibinayaan.
  3. Ka saar TMXD haddii bukaanjiifku aanu baahi caafimaad u qabin.
    • Koox shaqaale caafimaad oo iskudhaf ahi waa in ay maalinkasta qiimayn ku sameeyee dhamaan bukaanjiifka ay ku jiraan TMXD oo ka doodaan in la gaadhay xiligii laga saari lahaa TMXD iyo haddii kale sababta caafimaad ee ay TMD ugu sii jireyso bukaanka.
    • Waa in tayo-dhowr mar mar ah lagu xaqiijiyaa in si habsami ah oo aan raagitaan lahayn looga saaro TMXD bukaanjiifka marka ugu horeysa ee la ogaado inay dhamaatay baahidii caafimaad ee bukaanjiifku u qabey TMXD.
  4. Marka la dayactirayo TMXD ee aan ahayn mid la xuliyey maqaarka hoostiisa (non-tunneled), waa in 5tii ilaa 7dii maalmoodba hal mar la bedelaa faashada daahafuran (transparent dressing) ee ku xidhan halka TMXD ay kaga jirto jidhka. Inta aan lagu xidhin faashad daahfuran oo cusub, waa in halka ay TMXD kaga jirto jidha iyo agagaarkeeda lagu nadiifiyaa milan ka samaysan maadada “chlorhexidine”. Waa in si deg-deg ah loo bedelaa markasta oo faashada daahafurani ay wasakhowdo, qoydo, ama debecsanaan lagu arko sida ay jidhka ugu xidhan tahay. Faashada aan daahfurnayn waa in la bedelaa 2dii maalmoodba hal mar. Faashada aan daahfurnayn waa in la bedelaa markasta oo ay wasakhowdo, qoydo, ama debecsanaan laga dareemo sida ay ugu xidhan tahay jidhka.
    • Maadaama oo TMXD ay si fudud uga siiban karto oo uga bixi karto qaar ka mid ah dhalaanka ku jira qaybta daryeelka dhalaanka xaaladoodu culustahay (NICU), mudada ama kalka lagu bedelayo faashada daahfuran way ka dheeraan kartaa 5 ilaa 7 maalmood.
  5. Mari boomaatada lid-jeermiska (sida Polysporin iyo Povidone-iodine) halka TMXD ee safaynta dhiigu kaga jirto jidhka.  Waxaa jira welwel ah in isticimaalka boomaatada Mupirocin ay horseedi karto in caabuq-keeneyaasha qaarkood ay isu bedelaan kuwo aan u nugleyn Mupirocin, sidaas darteed waxaa lagu taliyey in aan la isticimaalin Mupirocin. Waxaa kale oo muhiim ah in maskaxda lagu hayo in nooca boomaatada ee la ist iyo noocaicimaalayaa aanay ahayn mid wax u dhimaysa tayada TMXD ee sifaynta dhiigga, sidaas darteed waa in si hufan loo akhriyaa tusaha isticmaalka TMXD.

Kahor inta aan la dhaqan gelin xeeladaha gaarka ah waa in khatar-qiimeyn lagu sameeyaa heerka uu marayo caabuqa dhiiga iyo inay jiraan arimo gaar ah oo sabab u ah in heerka caabuqu uu meel sare marayo. Marwalba waa in niyada lagu yahaa inay jiraan natiijooyin aan la jeclaysan doonin oo ka dhalankara dhaqan gelinta xeeladaha gaarka ah. Dhaqan gelinta xeelaaha gaarka ahi waxay ku haboon yihiin qaybta cusbitaalka iyo nooca bukaanjiifka ee heerka caabuqa dhiiggu uu weli sareeyo kabacdi marka si buuxda loo isticimaalay xeeladaha aasaasiga.  

  1. Isticimaal TMXD gudaheeda iyo korkeeda lagu dheehay maado ama curiye ah lid-jeerimis. TMXD ee lagu dheehay maadada “chlorhexidinesilver sulfadiazine” iyo TMXD ee lagu dheehay maadada “minocycline rifampin” ayaa ka mid ah kuwa waqtigan xaadirka ah laga isticimaalo dunida.
    • TMXD ee lagu dheehay maado ama curiye lid-jeermis ahi waxay u fiican tahay: a) bukaan-jiifka da’doodu ka weyntahay 18 sano; b) bukaan-jiifka uu ku soo noq-noqday caabuqa dhiiga ee la xidhiida TMXD; iyo c) bukaan-jiifka u nugul dhibaato caafimaad oo halisteedu darantahay oo ka dhalata caabuqa dhiiga ee la xidhiidha TMXD.
    • Si joogto ah ula soco dhibaatooyinka caafimaad ee ka dhalan kara isticimaalka TMD ee lagu dheehay maadooyinka lidka ku ah noolaha ili-maqabatayga ah. Dhibaatooyinkaas caafimaad waxaa ka mid ah bukaanjiifka oo ay ku dhacdo xasaasiyad daran (anaphylaxis).
  2. Faashad samaynteeda lagu daray maadada chlorhexidine ku xidh halka ay TMD kaga jirto jidhka bukaanjiifka da’doodu ka weyn tahay 2 bilood.
  3. Furar samayntooda lagu daray maadooyinka lidka ku ah noolaha ili-maqabatayga ah ku dabool afka iyo kalagoysyada TMD.
  4. Dhalaanka dhiciska ah ee TMD laga gelinayo xudunta waa in la geliyaa TMD oo samayteeda lagu daray maadada silver zeolite.
  5. Milanka ataybayootikada ee xidhaha (antibiotic locks) ka buuxi TMD marka aan afkeeda la isticimaalayn.
    • Xeeladan waxaa loogu talo galey oo ay ku haboontahay: a) bukaan-jiifka ay mudo dheer ku jirayso TMXD ee safaynta dhiiga (permenant hemodialysis catheter); b) bukaan-jiifka ay adag tahay in la helo xididadooda “venous” ee inta badan laga qaado dhiiga, islamarkaana uu hore dhowr jeer ugu dhacay caabuqa dhiiga ee la xidhiidha TMXD; iyo c) bukaan-jiifka halista u ah inay dhibaato caafimaad xumo aa daran ay kala kulmi karaan haddii uu ku dhaco caabuqa dhiiga ee la xidhiidha TMXD. Bukaanjiifkaas waxaa ka mid ah kuwa habdhiska wareega dhiigooda (xididadooda ama wadnahooda) si joogto ah loogu rakibay walax macmal ah, sida haniyaha wadnaha ee macmalka ah (prosthetic heart valve) iyo gadhka wadne ee macmalka ah (aortic graft).
    • Marka ay dhamaato mudada milanka antaybayootikada ee xidhaha ahi uu ku jirayo TMD, waa in la soo barobixiyaa iyada oo la isticimaalayo siliinge (syringe).
  6. Bukaanjiifka ay ku jirto TMD ee sifaynta dhiiga, todobaadkiiba hal mar (ka bacdi marka la dhameeyo sifaynta dhiiga) sii dawada ka hortagta xinjirta la wareegta dhiiga (thrombosis) ee loo yaqaan “Recombinant tissue plasminogen activating factor.
  1. Ha siin antaybayootikada lagaga hortago caaabuqyada (antibiotic prophylaxis) bukaanjiifka la gelinayo ama ay ku jirto TMXD.
  2. Ha iska bedelin TMXD (haka saarin TMXD ku jirta oo ha gelin TMXD kale oo cusub) haddii aanay jirin sabab TMXD loo bedelaa.

La socodka heerka caabuqyada dhiiga ee la xidhiidha TMXD

  • Si joogto ah u xisaabi heerka caabuqa dhiigga ee la xidhiidha TMXD ee guud ahaan cusbitaalka iyo gaar ahaan qaybta daryeelka culus (ICU). Isbarbardhig ku samee heerka guud ee caabuqa dhiigga ee la xidhiidha TMXD ee cusbitaalka iyo heerka celceliseed ee caabuqa dhiidha ee la xidhiidha TMXD ee dalka. Si joogto ah u wargeli shaqaalaha caafimaadka iyo hogaamiyeyaasha sarsare ee cusbitaalka oo la socodsii halka uu mar walba marayo heerka caabuqa dhiigga ee la xidhiidha TMXD.
  •  Isbarbardhig ku samee heerarka caabuqa dhiigga ee la xidhiidha TMXD ee xiliga la joogo iyo xiliyadii la soo dhaafay. 
NHSN
National Healthcare Safety Network waa hoyga xeerarka iyo hageyaasha sida loola socdo caabuqyada la xidhiidha daryeelka caafimaad.
Guji
La soco heerka caabuqa
Cusbitaal kasta oo bixiya daryeelka deg-dega ah (acute care hospital) waa in uu leeyahay qorshe lagula socdo heerka caabuqyada dhiigga ee la xidhiidha TMXD oo ku dhacaya bukaan-jiifka qaybta daryeelka bukaan-jiifka halista ah (ICU) iyo waadhadhka kale ee cusbitaalka.
Bil kasta xisaabi heerka caabuqa
Marka war la helo ayaa talo la helaa

Tixraac: References

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  8. Schoot R.A., van Ommen C.H., Stijnen T., Tissing W.J., Michiels E., Abbink F.C., et. al.: Prevention of central venous catheter-associated bloodstream infections in paediatric oncology patients using 70% ethanol locks: a randomised controlled multi-centre trial. Eur J Cancer 2015; 51: pp. 2031-2038.
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