Keywords intravenous indwelling needle; nurse
Recently, V-shaped indwelling needle has been used in critically ill patients, patients with poor vascular conditions and difficult puncture. Advantages: protecting blood vessels, reducing liquid extravasation and ensuring reasonable medication time. Improper operation and nursing of V-shaped indwelling needle leads to V-shaped inflammation and blockage, which affects V-shaped indwelling time and reduces the success rate of puncture [1]. The clinical application and nursing experience are introduced as follows:
1 data and methods
1. 1 General information: From September 2007 to September 20 10, V-shaped indwelling needle technique was implemented in the hospital where the author worked, and 50 cases were punctured/kloc-0, including 90 males and 60 females. Age 10 ~ 80 years old.
1.2 method: do a good job of patient education before operation, especially for patients who are conscious, explain the purpose of operation, matters needing attention and cooperation methods to eliminate patients' anxiety, nervousness and fear and make them cooperate with the treatment. Those who are unconscious should also explain clearly to the accompanying staff.
1.3 Selection of appropriate blood vessels: generally, blood vessels with thick and straight blood flow and appropriate length of indwelling needle are selected for puncture, and superficial veins of limbs, such as dorsum of foot, great saphenous V, median elbow V and forearm V, are usually selected. Try not to use back V, so as not to affect the daily activities of patients and avoid the injured parts of joints, V valves and limbs. Paralysis patients should choose blood vessels of healthy limbs, such as skin infection or dermatosis.
Operation method of 1.4: tie a tourniquet at 10cm above the puncture point, dry it after routine disinfection, fasten the skin at the far end of the puncture point, fix it with V, and insert the needle at 15-30, with the inclined plane of the needle facing upward, and reduce the needle insertion angle to 10, and push the needle to stay around in the V direction. The indwelling needle we use is a product directly connected to heparin cap.
If necessary, connect Kelaifu device (built-in negative pressure device, which can replace heparin to seal the tube for a short time) and fix it on the puncture site with transparent plastic film, and record the time.
2 nursing methods
2. 1 Skillful operation technology, improve the success rate of one puncture, improve the aseptic technical operation, and strictly check the packaging and expiration date of indwelling needles [2].
2.2 Avoid excessive limb movement when placing the tube, and pay attention to keep the puncture site dry and clean when placing the tube. If the puncture site is red, swollen and painful, indicating V inflammation, the catheter should be removed immediately. After extubation, press it with a dry cotton swab for 5 minutes without bleeding, wet and hot compress it with 50% magnesium sulfate, and apply antibiotic ointment locally [3]. Change the transparent plastic film every 2-3 days, and disinfect the surrounding skin. Continuous infusion, change the infusion set every day 1 time. When the indwelling needle after sealing the tube is activated, the syringe should be used to draw blood before receiving liquid. It is not advisable to forcibly push blood clots into blood vessels to avoid embolism, and the indwelling needle should not be too long, 5 days. Long-term infusion of drugs with high concentration and strong irritation should be fully diluted, and the injection site should be changed in a planned way to protect blood vessels. In the process of infusion, we should closely observe the dripping speed to prevent excessive circulation load or adverse drug reactions caused by too fast infusion, and prevent the liquid from dripping empty quickly.
2.4 At work, nursing staff should seriously study techniques, do a good job in patient health education, further familiarize themselves with and master nursing operation techniques, and carefully observe and care for indwelling needles. Improving the success rate of indwelling needle and reducing the occurrence of complications are conducive to promoting patients' recovery as soon as possible.
3 sealed pipeline
3. 1 preparation: add 100ml sodium chloride injection to 0.2ml heparin sodium stock solution (heparin sodium is contraindicated by gastrointestinal bleeding and DIC). Hemorrhage caused by hypertension, liver and renal insufficiency, etc. ) can also be used directly with sodium chloride injection, and it is not necessary to prepare normal saline when sealing the tube, thus avoiding the pollution caused by liquid preparation and reducing the nursing workload.
3.2 Tube sealing method: After infusion, use a syringe to extract 5ml of tube sealing solution, and continuously and slowly pull out the needle while pumping. Sealing method: rinse with normal saline every 6 hours, and heparin sodium will continue anticoagulation12 hours.
4 discussion
Intravenous indwelling operation is convenient and quick, with high success rate and few complications, which can meet the needs of multiple transfusion, blood transfusion and nutrient solution input; It is the most effective and important measure to rescue patients and surgical patients. The rapid establishment of V channel facilitates the input of drugs and provides sufficient time for medical staff. V indwelling needle also protects 3V, reducing the chance of infection and bleeding, and connecting the three-way connector can input multiple channels at the same time. In the process of applying V-shaped indwelling needle, we should first pay attention to patients' health education, and nurses should have a high sense of responsibility and professional quality, improve infusion system and improve nursing quality.
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[1] Wan Lingyun, Wang Furong. Nursing experience of intravenous indwelling needle [J]. Journal of Clinical and Experimental Medicine, June 2007 (1): 204.
[2] Wang. New nursing knowledge 1000 questions [M]. Hefei: China University of Science and Technology Press, 2006:36.
Pang Xinna, Zhao Jing. Prevention of phlebitis caused by venous indwelling needle [J]. Journal of Qiqihar Medical College, 2006, 26: 2.