Pediatric intravenous indwelling needle has been widely used in clinic as a new nursing technique. It not only avoids the pain and fear that repeated puncture brings to the children, but also reduces the anxiety and psychological pressure of the children's parents due to the difficulty of puncture. Intravenous needle, also known as cannula needle, as a replacement of scalp needle, is widely used in clinic for its simple operation, easy to use, soft cannula, long time of cannula in the vein and not suitable for breaking blood vessels, etc. [1]. Since the end of 2004, our hospital began to widely used pediatric intravenous needle, in clinical use has received good results, now the common problems and treatment methods are summarized below.
1 Clinical information
1.1 General information Since the end of 2004, our hospital has used intravenous needles in 401 cases, the age of 4 months to 8 years old, of which there are 298 male cases and 103 female cases. The indwelling time was from 1 to 7 d, of which 17 cases (4.24 %) were in 1 d, 31 cases (7.73 %) in 2 d, 89 cases (22.19 %) in 3 d, 133 cases (33.17 %) in 4 d, 71 cases (17.71 %) in 5 d, 43 cases (10.72 %) in 6 d, and 17 cases (4.24 %) in 7 d. The number of puncture failures was 21 cases (5.24 %); cannulae were dislodged in 44 cases (10.73 %); and cannulae were dislodged in 44 cases (10.73 %). 10.73 %); cannula blockage 16 cases (3.99 %); local leakage and swelling 59 cases (14.71 %); phlebitis 7 cases (1.75 %).
1.2 Methods of operation
1.2.1 Models and selection of pediatric intravenous needles Intravenous needles produced by the American BD company were used. According to the child's age, disease and vascular condition, the specification of 22?24GY type indwelling needle.
1.2.2 Selection of blood vessels Select relatively thick and straight, elastic, rich blood flow, avoiding the joints of the blood vessels. Such as the frontal vein, temporal vein, dorsal hand vein, dorsal foot vein and so on.
1.2.3 Puncture method Remove the 10 cm hair around the puncture needle, and routinely disinfect the skin area of the needle. Remove the intravenous indwelling needle and exhaust the air in the dermal cannula. Remove the needle sleeve, loosen the outer cannula, adjust the bevel of the needle, tense the skin, keep the needle tip upward, and enter the needle at 15-30 degrees from the needle tip to the skin on the blood vessel, and after seeing the return of blood, lower the angle of penetration by 5-10 degrees and enter the needle again for 0.2 cm. With the left hand, withdraw the needle core for about 0.5 cm, and then use the core as a support to advance the outer plastic cannula with the right hand along with the direction of the penetrating blood vessel until it enters into the vein completely. Hold down the needle handle, withdraw the needle core, release the tourniquet, confirm the smooth infusion and then connect the heparin cap and cover with 3M sticker. Record the date and time of cannulation and the name of the person who performed the puncture.
1.2.4 Retention time The International Society of Intravenous Fluid Nursing (INS) retention standard is 3 d. There is no uniform regulation in China, generally 3-5 d. If redness, swelling and phlebitis are found in the retention site during the period, the intravenous needle should be pulled out immediately and the puncture site should be replaced.
2 Tube sealing
2.1 Methods Use a syringe to seal the tube directly. At the end of infusion, close the regulator of the infusion set and separate the needle from the heparin cap. Sterilize the heparin cap, extract 5 mL of sealing solution with a syringe, stab the syringe directly into the heparin cap, slowly push 3 mL of sealing solution, and then push the remaining solution while retreating the needle to the point of needle removal. Push the injection speed should be slow, in order to reduce the impact on the blood vessels, and at the same time make the lumen full of sealing fluid, close the needle.
2.2 Selection and dosage of sealing solution The concentration of sealing solution is 50 U/mL heparin saline (prepared by adding 1 heparin to 250 mL of 0.9 % sodium chloride solution), and the dosage of sealing solution is 5 mL of heparin saline.
3 Problems of intravenous indwelling needles
3.1 Failure of puncture The main reasons are: 1) the selected vessel is too thin or curved. The main reasons are: ① the selection of blood vessels is too thin or curved, resulting in the delivery of the cannula to penetrate the blood vessels, this group **** 4 cases. The main reasons are: ① choose the blood vessel is too thin or curved, resulting in the delivery of the cannula to penetrate the blood vessel, this group *** 4 cases. ③Stop the needle immediately after seeing the return of blood, at this time, the outer casing is still outside the blood vessel, at this time, pull out the steel needle to send the outer casing, the outer casing is curled outside the blood vessel and can not enter the blood vessel, resulting in failure, ****9 cases. ④Seeing the return of blood after the needle is too deep to puncture the blood vessel, ***5 cases.
3.2 Tubing dislodgement 44 cases of dislodgement analysis: 21 cases due to sweating and excessive secretion of grease, so that the 3M adhesive stickers lose adhesion, the child's activities to fall off; 7 cases due to the crying of improper care, the child grasping off, the above two cases to 4 months ~ 1 year old children are mostly, and most often in the scalp venous catheterization. 16 cases due to the frequent movement of the children, gradually fall off to limb venous catheterization. The number of cases was higher than that of the other cases.
3.3 Tubing blockage 16 cases in this group, the reasons are: ① the child's own blood is in a state of concentration or hypercoagulability, such as brain flu or toxic bacillary dysentery children. ② The heparin sealing solution was not injected enough because of the fear of pushing too much heparin to the disadvantage of the children, and the cannula was blocked by the returning blood. ③ sealing method is not accurate enough to ensure that the catheter is full of sealing solution, blood back to block the cannula.
3.4 Local leakage and swelling 59 children, all in the use of indwelling needle 3 d after the local leakage and swelling, the children mostly have injection local pain, accompanied by infusion rate slowdown. It is hypothesized that this is mainly related to the decrease in elasticity and brittleness of the vascular wall, as well as the increase in permeability of the vascular wall caused by certain drugs, and the partial detachment of the cannula.
3.5 Phlebitis is characterized by redness, swelling, pain, and fever along the direction of the child's veins. The causes are related to irritation from drugs and catheters, lax asepsis, repeated punctures, temperature of the fluid, and many other factors.
4 Nursing measures
Should choose thicker and straighter, elastic, lying down is not easy to pressure of the blood vessels, such as superficial temporal vein, frontal median vein, to avoid the choice of the veins behind the ear, the posterior occipital vein and close to the venous valves and the veins with scars. Since the incidence of phlebitis is significantly higher in the lower limbs than in the upper limbs, lower limb veins are not selected as much as possible. Strictly aseptic technical operation to prevent the occurrence of phlebitis, especially scalp indwelling needle should be strictly sterilized, to achieve three enough: that is, enough disinfection time, disinfectant and disinfection range. The indwelling needle should be firmly fixed. After successful puncture, first use sterile infusion patch to cover the needle eye, then use transparent dressing to fix the indwelling needle, and then use 4-6 ordinary adhesive tape to fix the needle wings and heparin cap to prevent reflexion. Tell the parents to take good care of the child to avoid the catheter falling off due to the child's touching and scratching or excessive limb movement. Regular replacement of transparent dressing and puncture site, such as transparent dressing breakage, shedding, should be replaced immediately, or depending on the contamination of the transparent dressing (ooze, blood seepage, sweating, air, etc.) at any time to replace; infusion process, the nurse should strengthen the patrol, control the infusion speed, observation of the skin of the site of the needle, such as the discovery of localized redness, swelling, or hard nodules, the infusion should be halted, immediately remove the trocars, and use 50% magnesium sulfate wet compresses for inflammation and inflammation of the needle. If you find local redness, swelling or hardness, you should stop the infusion, remove the cannula needle immediately, and use 50% magnesium sulfate to apply wet compresses to the inflammation. If the liquid drip is not smooth, do not force to squeeze the infusion tube, in order to prevent the occurrence of embolism; intravenous infusion of medicinal fluids to avoid excessive force, so that the local pressure in the blood vessels increased suddenly, the permeability of the tube wall increases, fluid extravasation. If half blocked, the thrombus should be withdrawn first, and then connected to the infusion device; if already blocked, the cannula needle should be withdrawn for other puncture, and the application of liquid with high drug concentration and strong irritation can shorten the retention time. Infusion is completed, timely and correct positive pressure tube sealing, to ensure adequate dosage of heparin, to ensure that 12 ~ 24 h recanalization of the use of the tube. When re-infusion, aseptic operation should also be strictly implemented.
5 Discussion
In recent years, intravenous needles have been widely used in clinical practice, and have been recognized by both doctors and patients for their ability to alleviate the pain of repeated puncture, reduce the workload of nurses, and improve work efficiency. However, some problems have arisen after it has been carried out in our hospital, resulting in some short retention time and not really reflecting its advantages. Therefore, we have to summarize and improve continuously in our work, so as to further improve the success rate of trocar retention and reduce the occurrence of complications.
References
[1] Chen Xianchun, Feng Yue. Intravenous indwelling
Keywords Rubella; Nursing; Children
Rubella is an acute infectious disease caused by the rubella virus, characterized by a red maculopapular rash, enlarged lymph nodes in the posterior occipital region, neck, and back of the ear, accompanied by low-grade fever and other mild systemic symptoms [1]. It is characterized by a red maculopapular rash, swelling of the lymph nodes behind the occiput and neck, and mild systemic symptoms such as low-grade fever [1]. It mostly infects children, and is characterized by disseminated and focal outbreaks. The 213 cases of rubella admitted to our hospital from January to May 2007 are reported as follows.
1 Clinical data
1.1 General data 213 cases of rubella children were admitted to our hospital from January to May 2007***, including 126 males and 87 females, aged 3 to 13 years old. The shortest duration of treatment was 4 d, the longest was 12 d, and the average duration was 8 d.
1.2 Clinical manifestations All 213 cases had fever, cough, tearing and runny nose, and enlarged lymph nodes in the neck. The rash was red congestive maculopapular, mostly on the face and trunk, and the skin between the rashes was normal. Blood counts were normal or slightly decreased, with 83 children having varying degrees of elevation of glutamate aminotransferase.
1.3 Treatment The children were treated with symptomatic treatment, including intravenous infusion of Andrographolide injection, vitamin C, energy synthesizer, potassium magnesium mentholatum, oral bicarbonate, antipyretic and cough suppressant as appropriate for fever and cough.213 children were cured within 3-7 d of the consultation and treatment, and those with fever were generally relieved to normal within 24 h of the treatment. The rash subsided within 3-5 d, and there was no hyperpigmentation in any of the cases.
2 Clinical care
2.1 Psychological care Health care personnel should be kind, take the initiative to care for the children, and eliminate the children's fear. Explain the necessity and importance of isolation to prevent the disease from becoming epidemic.
2.2 General nursing care Respiratory isolation, isolation until 5 d after the rash. sick room should be ventilated frequently, maintain the appropriate temperature and humidity, air spray disinfection, the use of disinfectant or boiling disinfection of the items used, quilt clothing by sunlight exposure and so on. After caring for the child, it should be rinsed clean with soapy water. The child should rest in bed, avoid direct wind, prevent cold aggravate the condition.
2.3 Skin care Keep children's eyes, nose, mouth and skin clean and hygienic. Do not let the wind blow directly or sunlight irradiation of the child's eyes, available salt water gargle, not too much clothing, change and wash, cut short nails to prevent scratching the skin caused by infection. Itchy skin can be scrubbed with lukewarm water, and localized glycerine lotion or raw oil can be applied. Conjunctivitis with 0.2 % chloramphenicol eye drops or 10 % sulfanilamide acetate eye drops for several days. After cleaning nasal secretions, paraffin oil or gentamycin ointment can be applied to protect the nasal mucosa. If necessary, appropriate anti-allergic drugs can be used, and at the same time, keep the skin clean and dry, and when there is high fever and sweating, wipe the body in time and change clean and soft clothes.
2.4 Symptomatic care Most of the children with rubella have low-grade fever, and most of them do not need special cooling treatment. For those with fever, warm water can be used to cool down the temperature. For children with high fever, close observation is needed. For those with eye congestion, avoid light stimulation and use eye drops. Pay attention to oral hygiene, and use saline solution for mouthwash. Coughing people to be cough medicine.
2.5 Diet Drink plenty of water during the fever period, and choose nutritious, light and easy-to-digest fluids or semi-fluids, such as milk, gruel, egg custard, etc., and don't eat fried and greasy food.
3 Discussion
Rubella is a common rash infectious disease in children, and it is a lifelong immunization. During the epidemic period of rubella, you should minimize the number of public **** places to reduce the chance of infection and transmission. Infection of pregnant women can cause fetal infection, which can result in developmental delay and malformation of the fetus. Therefore, combined immunization with rubella and measles vaccines is of practical value. The safety of rubella vaccine is very good, and the antibody positive rate of the new vaccine can be up to 98%, except for a few people who have joint pain and other side effects after injection [2]. There was no complication in this group of cases, and all of them achieved good nursing effect, which shows that careful nursing is extremely important.
References
[1] Yang Guoliang, Wang Chansheng. Modern Dermatology [M]. 1st ed. Shanghai: Shanghai Medical University Press, 1996, 312.