Basic principles:
1. The puncture blood vessel is thick and straight, with rich blood flow and no venous valve;
2. Select the smallest model and shortest indwelling needle for puncture;
3. Select the safest product for puncture;
4. Choose the puncture product that is most suitable for the patient's condition and course of treatment. Understand the patient's skin and blood vessels.
Patients of different ages have different skin and blood vessels.
Children: tender skin, good elasticity of blood vessel wall and few puncture points.
Old people: dry and inelastic skin, fragile blood vessel wall and poor elasticity. Www.med66.com Medical Education Network
Second, the choice of puncture point
The lateral forearm vein is selected, and the cephalic vein is the first choice. (Because cephalic vein is a special vein in human peripheral vein. Special vein: there is a layer of annular longitudinal smooth muscle in the intima of vein. Tip: The vein wall has good elasticity. ) Try not to puncture the joints. Try not to puncture the incomplete skin.
Third, the correct disinfection method
Abroad: Wash the skin with alcohol first, and then disinfect it with iodophor. The continuous disinfection effect of iodophor can reach 5 ~ 6 hours.
Domestic: Disinfect with iodine first, and then deiodify with alcohol. The continuous disinfection effect of iodine is only about 8 minutes. Iodine is not dry, so it can't be completely disinfected. Remember: don't take out the iodine until it dries.
Four, scalp indwelling needle operation procedures
Steps:
1. Wash your hands;
2. Wear a mask;
3. Preparation of articles: scalp indwelling needle, transparent dressing and intravenous infusion;
4. check it;
5. Distribution of medicines;
6. Explain to patients;
7. Three checks and seven pairs;
8. Exhaust;
9. Choose blood vessels;
10. Sterilized with iodine, about 8 cm in diameter;
1 1. Needle selection model: transfusion for children, 24G, 22G；; Adult infusion 22G, 20G；; Adult blood transfusion 20G,18g; ;
12. After the scalp needle is connected to the infusion set, insert the scalp needle into the heparin lock, and the heparin lock is connected to the scalp indwelling needle;
13. exhaust and prepare transparent dressing;
14. Tie a tourniquet;
15. Deiodination with alcohol;
16. Loosen the outer sleeve;
17. Selection of needle insertion point: the needle should be inserted in the upper and middle 2/3 of the disinfection range, above the blood vessel;
18. Needle insertion angle: 15 ~ 30 degrees;
19. Needle feeding speed: slow. Because the needle tip is electronically polished, it is easy to puncture the blood vessel wall if the needle is inserted too quickly;
20. Observe whether there is blood return. After seeing the blood returning, reduce the angle (about 5 ~ 15 degrees) and then insert the needle 0.2cm to ensure that the hose is in the blood vessel;
2 1. Loosen the wings and fix the wings (forefinger and middle finger). Be careful not to cross the sterile area;
22. Pull out the needle core 0. 5 ~ 1 cm, give all the hoses to the blood vessels; Www.med66.com Medical Education Network
23. Loosen the tourniquet;
24. Open the governor;
25. Pull out all the needle cores (pull out the needle cores after successful puncture);
26. Fix with transparent dressing. Secure the trident joint with old tape. Note that one end of the straight line is parallel to the blood vessel, and the other end is biased to the outside of the blood vessel. (avoid the interface pressing the blood vessel to hinder the blood return);
27. Adjust the infusion speed;
28. Fill in the infusion card;
29. Bed-making unit.
Verb (short for verb) seals the pipe.
First, pull out the scalp needle from the remaining needle tip, inject 2 ~ 5ml, and push the remaining 0.5ML of tube sealing liquid while pulling out the needle tip to ensure positive pressure tube sealing.
Type and dosage of sealing fluid
1. physiological saline: 5 ~ 10 ml, once every 8 hours.
2. Dilute heparin solution: 2 ~ 5ml, and its anticoagulant effect is above 12h.
Preparation of pipeline sealing fluid
Each milliliter of physiological saline contains 10 ~ 100 units of heparin. (1 heparin can be added 125 ~ 1250 ml normal saline) After routine disinfection, heparin lock can be inserted into scalp needle for infusion.
Sixth, nursing.
1. Have a high sense of responsibility and mission, think of patients, and strive to improve the quality of nursing.
2. Strict aseptic operation procedures.
3. Seal the pipeline correctly. Pay attention to filling the lumen with tube sealing liquid to prevent tube plugging or thrombophlebitis.
4. Strictly observe the puncture site and find the early signs of complications in time.
5. Intima can be kept for 3-5 days, not more than one week. Www.med66.com Medical Education Network
6. Keep the puncture site clean and dry, and replace the transparent dressing once every 3 to 7 days and once every two days in summer. If the dressing is not sticky or dirty, it should be replaced in time.
7. Strengthen the education of patients and do a good job of explanation.
8. Record the puncture date, time, location, catheter model, operator name, etc. Follow the doctor's advice and record the indwelling situation of catheter every day, whether there is redness or patient's complaint.
9. Replace the puncture point, and the opposite arm or different vein is preferred.