Intravenous infusion is an important way of administration in clinic. Many patients need to retain trocar again because of transfusion extravasation, which not only increases the workload of nurses, but also brings pain to patients. What are the factors that cause transfusion extravasation?
Nurse factor
Improper selection of puncture site leads to drug extravasation or repeated puncture of the same vein. Repeated puncture of the same vein will lead to the injury and hardening of the intima of blood vessels, increase the fragility of blood vessels, and thus increase the incidence of drug extravasation.
Patient factors
The age span is large, there are newborns and old people. Newborns can see fewer blood vessels and cry incongruously, which makes it difficult to puncture and fix. The behavior control ability of the elderly is decreased, which makes the needle move and the perception ability poor.
Adjoint factor
The care of patients is not in place, and the consequences caused by drug extravasation are not understood and not paid enough attention.
Drug factor
The corrosiveness of drugs is closely related to the occurrence of extravasation of intravenous infusion. The pH value of normal blood is 7.35 ~ 7.45, and the osmotic pressure is 280 ~ 310 mosm/L. Infusion of drugs with strong acidity (pH ≤ 4. 1), strong alkalinity (pH≥9) or hypertonic (osmotic pressure ≥600mOsm/L) can affect the water absorption of epithelial cells, and affect the water absorption of epithelial cells.
Disease factors
In the case of repeated chemotherapy, the venous condition of cancer patients becomes worse, which increases the difficulty of venipuncture. Peripheral vascular diseases, such as arteriosclerosis, are easy to extravasate. Diabetes mellitus is affected by abnormal metabolism of sugar and fat, which gradually hardens the blood vessels of patients and easily leads to extravasation of intravenous infusion.
What should nurses do to solve these problems?
Nurses, as operators of indwelling needles, should strictly abide by the guidelines. The puncture point should start from the distal end, and the left and right limbs should alternate; When injecting drugs with strong irritation, flexible and straight blood vessels should be selected, and central venous catheterization can be selected for administration if necessary. Improve the professional quality of nurses, understand the local anatomy and choose the appropriate blood vessel, and do not choose the similar part of the same blood vessel when indwelling trocar again, so as to avoid repeated puncture of the same vein. In addition, if the activity intensity is high, try to choose forearm blood vessels. According to the age of the patient, the type of drugs injected, the amount of drugs injected and the physical condition, choose the appropriate infusion method.
For special patients such as the elderly or children, it is necessary to focus on and strengthen inspection. For patients with good behavior ability, if they often go to the toilet, they need to ask their families to help them look after them. Don't adjust the descending speed at will to avoid large-scale activities.
Medical staff should carry out detailed health education for patients and their families, inform their families about matters needing attention in intravenous infusion, increase the degree of attention, teach the observation method of liquid medicine extravasation, and instruct them to inform medical staff in time if they find any abnormality.
When importing drugs with strong acidity, strong alkalinity or high osmotic pressure, they should be diluted as much as possible and slowly dripped; During the continuous infusion of dopamine, m-hydroxylamine and other irritating drugs, two intravenous channels should be established, which should be used alternately every 2 ~ 3 hours 1 time; When importing irritating drugs, you should first make sure that the needle is in the blood vessel before importing drugs; Alternately input non-irritating drugs and irritating drugs to reduce the stimulation of drugs on blood vessels. Indwelling the central vein with the consent of the patient to avoid extravasation of infusion caused by peripheral infusion.