How to ensure one needle to return blood when intravenous infusion needle is inserted? What about those who can't see blood vessels?

Choose blood vessels from the distal end to the proximal end, and try to choose straight blood vessels with good elasticity and good fixed position. The needle insertion angle should not be too large or too small, too small to puncture blood vessels, and too large to puncture blood vessels. After blood transfusion, the needle horizontally penetrates two-thirds to three-quarters of the needle tip and then is fixed. If it is a indwelling needle, slowly pull out the needle core after puncture, tighten the skin, and slowly push the hose into the blood vessel. Practice more at ordinary times, and personal feeling is also very important. Intravenous infusion is one of the most basic clinical nursing techniques and plays a very important role in nursing work. In order to improve the success rate of puncture, relieve the pain of patients and ensure the quality of infusion, many skills have been summarized through clinical practice and research, which are introduced as follows. 1. During needle-holding manual venipuncture, the thumb and forefinger of the right hand hold the upper and lower surfaces of the needle handle, and the thumb and forefinger hold the front and rear surfaces of the needle handle after skin puncture, which has a high puncture success rate and mild pain for patients. Because in the initial stage of needle insertion, the contact area between the upper and lower surfaces of the hand-held needle handle is large, the force is uniform, the needle insertion is stable, the needle insertion speed is fast, the pain action time is short, and the patient's pain is light. After the needle pierces the skin, the thumb and forefinger hold the front and back of the needle handle, exposing the tail of the needle bar, which is convenient for observing venous blood return and avoiding puncturing blood vessels. 2. For patients with thick blood vessels and obvious easy fixation, the needle should be inserted from the front or side at an angle of 20; For those who have few subcutaneous fat veins and are easy to slide, it is easy to succeed to tighten the skin with the left hand to fix the blood vessels and quickly enter the skin from the right side of the blood vessels at a 30 angle. For patients with dehydration or insufficient blood vessel filling, first use hot compress to dilate blood vessels, and the needle quickly enters the skin at an angle of 25 from the front, and then gently stir the skin. When the needle is inserted 1/4, the needle inclines slightly downwards, and then the vein is picked up to slowly put the needle in place, so that the upper and lower blood vessel walls are separated to avoid puncturing the blood vessel. For patients with edema, the thicker blood vessels should be selected, and the thumb should be pressed along the blood vessels to expose them, and the needle should be inserted quickly after disinfection; The patients with scalp venipuncture used a 5-angle straight puncture, and after entering the skin, they slowly sneaked in the direction of blood vessels, and succeeded after seeing blood return. 3. Easy-to-return blood method: conventional infusion and exhaust clamp regulator. The front end of the infusion tube at the lower part of the regulator is folded back, and 0.2 ml or 0.5 ml of liquid at the extrusion front end is fixed and folded back. After the puncture needle enters under the skin, loosen and fold back, and puncture the blood vessel according to the conventional method. Once it penetrates the blood vessel, you can see a rapid blood return. If there is no blood return in the blood vessel, you can squeeze the plastic tube of the scalp needle distally by hand to increase the negative pressure in the scalp and see obvious blood return. 4. If you don't make a fist to tie a tourniquet, the back of the patient's hand naturally stretches horizontally upward, the nurse's palm is facing down, and the patient's finger roots and fingers are gripped, and the thumb and forefinger are on both sides of the patient's back. The skin on the back of the hand will tighten and blood vessels will be selected for puncture. The puncture angle is 5 ~ 15. This method exposes blood vessels obviously and is easy to puncture successfully. 5. The needle eye in the skin and the needle eye in the blood vessel are often not at the same point after the needle is pulled out during venipuncture, and the distance between them is related to the angle of needle insertion and the thickness of subcutaneous fat. Therefore, when the needle is pulled out after infusion, the cotton swab is directly pressed on the blood vessel in parallel, and the tip of the cotton swab exceeds the proximal end of the skin needle eye 1 ~ 2 cm, so that the skin needle eye and the blood vessel needle eye are simultaneously pressed. Don't pull out the needle when pressing the blood vessel hard, because the pressing force and the acute angle of the needle tip will produce shear force when pulling out the needle quickly, which will lead to mechanical damage of cutting off the blood vessel. Instead, gently press the skin, quickly pull out the needle and then press it slightly for 2 ~ 3 minutes to reduce the occurrence of subcutaneous bleeding. After venipuncture in the elbow, let the patient straighten his forearm and press the cotton swab parallel to the blood vessel for 3 ~ 5 minutes. Don't bend his elbow to stop the bleeding. So as not to form subcutaneous congestion. 6. The damage of different needle lengths to blood vessel wall Through clinical observation, venipuncture was carried out in the same part of the same body and with the same drug. If the needle enters the blood vessel for a short time, the damage to the blood vessel is small, the service life of the blood vessel is long, and the patient's pain response is small, and vice versa. This is mainly due to the local mechanical damage to the blood vessel wall caused by injection. The longer the needle enters the blood vessel, the larger the area of mechanical stimulation and damage to the blood vessel wall, the more serious the damage to the blood vessel wall, the more red blood cells and their plasma components exude, and the more obvious the blood vessel congestion is. Because a large number of vascular endothelial cells are damaged and collagen is exposed, it is easy to stimulate thrombosis and thrombosis polarization and block the lumen. It is suggested that the length of the needle entering the vein should be reduced as much as possible on the premise that the needle can be firmly fixed after blood transfusion. Especially for patients with critical diseases, chronic diseases and tumors, long-term infusion chemotherapy has important clinical use value for prolonging the service life of patients' veins, relieving patients' pain and preventing phlebitis. 7. "S" fixation method Scalp vein puncture can adopt "S" fixation method, that is, after the puncture shows blood return, it is fixed with 4 tapes (0.8×7cm). The first adhesive tape is attached horizontally to fix the needle handle, and the second adhesive tape is fixed after passing through the needle handle downwards. One end of the third adhesive tape is horizontally attached to the needle eye of the skin, and the other end is horizontally attached to the scalp needle plastic pipe, so that the scalp needle plastic pipe is fixed on the left or right side of the needle handle. One end of the fourth adhesive tape is horizontally attached to the third adhesive tape to overlap and fix the scalp acupuncture plastic pipe, and the other end is horizontally attached to the downward bent plastic pipe of the scalp acupuncture and skin to fix the scalp acupuncture plastic pipe into an S-shape. Its characteristics are: (1) forms two bends, with large buffering force; (2) the curvature of bending is small, and the lateral force of the needle is small; (3) Two fixed points are added to the needle, and the needle with more fixed points has good stability. This method conforms to the mechanical principle, is simple to operate, easy to fix and has a good effect. It is an ideal scalp vein puncture and fixation method. To sum up, these skills can make venipuncture as painless and slightly painful as possible, improve the success rate of hitting the nail on the head, avoid mechanical and chemical damage to blood vessels, and make infusion technology develop in a fast, accurate and safe direction, which is worth popularizing and applying. Blood vessels 2. 1 Hand-foot vein infusion method for the elderly and infirm The elderly and infirm with various chronic diseases have small hand-foot veins, shallow body surface, less subcutaneous fat, poor elasticity, lack of tissue support, large mobility and difficult puncture. Therefore, let the patient's arm droop first and tie a tourniquet to make the superficial vein filling degree of the back of the hand the best [2]. Before puncture, you should carefully understand the characteristics of blood vessels, see the direction clearly, and find out the depth and thickness. Compare the length of needle body and blood vessel before needle insertion to determine the length of needle insertion; You don't have to make a fist when stabbing, so you can relax naturally. The operator holds the patient's hand or foot with the thumb of his left hand, and tightens the skin with the thumb to fix the lower end of the blood vessel to reduce the blood vessel sliding. If the blood vessel is bifurcated, it is necessary to insert the needle 0.5cm below the blood vessel, and then quickly pierce the subcutaneous at an angle of 35, and then lay the needle slightly flat. When the needle tip is pressed against the blood vessel, the angle of the needle should be slightly raised by 25 to penetrate the blood vessel quickly and stably, and then the needle should be leveled and then slowly entered into a point and fixed with four belts. 2.2 Retrograde transfusion of scalp vein in children The scalp vein in children is a reticular shunt with no venous valve, so the speed of retrograde transfusion will not slow down. Pediatric scalp infusion generally adopts puncture to the heart end. If blood vessels are damaged for a long time, they cannot be recovered in a short time. If the punctured blood vessel is reused, the liquid can penetrate into the tissue space through the original needle eye, causing local swelling and even tissue necrosis. Therefore, for children with long-term infusion, retrograde infusion can be used without local swelling and other adverse reactions.