1. 1 patient factors

1. 1. 1 Newborns have fetal mass all over their bodies, and some of them have pale and blue skin, so they can only puncture the scalp. It can be seen that there are few blood vessels, so it is difficult to puncture, and it is easy to fall off and extravasate after fixation.

1. 1.2 Infants are crying and uncooperative, their blood vessels are short and not straight, and their parents are nervous, which makes venipuncture difficult.

1.2 drug cause: highly irritating drugs, such as chemotherapy, extravasation and other high-risk drugs, which will cause serious consequences once extravasated.

The reason of 1.3 technique (1) is inexperience, ignorance of blood vessels and unclear local anatomical position. (2) No regular inspection; (3) Nurses lack relevant knowledge; (4) Puncture at the same site for many times.

Clinical manifestations and consequences of extravasation of intravenous infusion

Generally manifested as swelling and pain. Moderate or severe pain is generally burning, tingling, local redness and swelling, and there is no blood return after stopping the drug. In severe cases, local blisters may appear, the skin turns black and hard, and even ulcers may form. At this time, children will experience mental pain and physical trauma, prolong the treatment time of children, cause stress and worry to their families and medical staff, and lead to medical disputes.

3 Prevention of extravasation of intravenous infusion

3. 1 create a warm environment and actively cooperate with the treatment of children. After admission, due to the fear caused by physiology and disease, as well as the anxiety and depression caused by unfamiliar environment, they often cannot actively cooperate with the treatment. As a nursing staff, we should first master superb professional skills, accumulate and cultivate good comprehensive quality, get close to children, and let children establish trust and close relationship with nursing staff.

3.2 Improve the primary success rate of venipuncture, strengthen the basic skills training, operate rigorously and meticulously, improve the primary success rate of venipuncture, avoid joints during puncture, and properly fix the needle after successful puncture.

3.3 Choosing the right vein Both scalp vein and superficial vein in children are suitable for venipuncture, but the choice of puncture site varies with age, disease and treatment purpose. Generally, newborns -3-year-old children choose scalp veins, and 3- 12-year-old children choose limbs veins. If necessary, hot compress can be used to dilate its blood vessels, which is easy to expose and facilitate puncture. 3.4 Selection of needle size The principle of needle size selection is based on the size and depth of vein. Generally, the median scalp vein, frontotemporal vein, posterior auricular vein and superficial digital vein are commonly used, and 4, 5, 5 1/2 needles can be used for infusion and 5-7 straight needles can be used for elbow vein injection.

3.5 Auxiliary Fixator during Puncture Because children, especially infants, have no self-awareness, their heads, hands and feet often swing during puncture, which leads to poor fixation and easy puncture failure. In practice, it is best for the staff to cooperate and fix the child, which is conducive to improving the success rate of puncture.

3.6 Master the performance, characteristics and precautions of the drug, and pay attention to the concentration and speed of the drug, such as: using mannitol to increase local hot compress or increase the temperature of the drug when increasing vascular patency; When using irritating drugs, it is necessary to ensure that the needle is in the blood vessel before dropping the drug.

4 nursing countermeasures

4. 1 extravasation liquid has little irritation to tissues and is easy to be absorbed. For example, ordinary solution can be applied with wet hot compress or 95% alcohol, and the swelling will soon subside.

4.2 The imported liquid medicine is a vasoactive drug, and the local swelling is not obvious, but it is red, pale and painful. The injection site should be replaced immediately, and 95% alcohol can be used to wet compress the local area continuously, and the swelling will soon disappear.

5 abstract

Pediatric venous transfusion extravasation room is a common clinical nursing problem, but if it happens at the joint, it will cause serious consequences to patients. In short, children of different ages have different reactions in various treatments, especially when injected. As a pediatric nursing worker, we should be familiar with the distribution and anatomical parts of blood vessels, master the basic operations and techniques, and maintain a stable mood and delicate movements in the operation.

Cause analysis and preventive measures of extravasation of intravenous infusion [Part II]

Cause analysis of extravasation of 1 intravenous infusion

1. 1 patient factors

1. 1. 1 The newborn is covered with fetal fat, and the skin that needs intravenous infusion is pale and blue, which can only puncture the scalp. It can be seen that there are few blood vessels, which are not easy to puncture, easy to fall off after fixation, and easy to extravasate due to breastfeeding or feeding.

1. 1.2 The baby's blood vessels are short and not straight because of crying and uncoordinated, and parents are very nervous, which invisibly increases the pressure on nursing staff and makes venipuncture more difficult; In the process of infusion, children are naturally active, difficult to fix and easy to extravasate. Once extravasation occurs, it is difficult to express the feeling of pain, so children extravasate more than adults, and severe extravasation is also more than adults.

1. 1.3 elderly people are prone to out-of-control needle displacement due to the decline of physiological, psychological and behavioral functions; Pain relief, unresponsiveness, flabby skin and venous weakness.

1. 1.4 The patient cannot communicate. These patients mainly include patients receiving anesthesia, patients using sedatives or comatose patients.

Such patients are prone to extravasation due to irritability, sensory and perceptual disorders.

1. 1.5 Severe patients with shock, severe dehydration, and critical patients are prone to extravasation due to impaired microcirculation and increased vascular permeability.

1.2 Drugs with strong drug factors, such as chemotherapy drugs, mannitol, calcium, vasoconstrictors, such as dopamine, m-hydroxylamine, norepinephrine and other high-risk drugs, will cause serious consequences once these drugs are extravasated.

1.3 disease factors (1) cancer is a risk factor for extravasation, because the veins of cancer patients are fragile and it is difficult to puncture after repeated chemotherapy. (2) Peripheral vascular diseases such as arteriosclerosis are easy to extravasate. (3) Diabetic patients are prone to extravasation due to disorder of glucose and lipid metabolism and arteriosclerosis. (4) Patients with increased venous pressure, such as patients with right heart failure, are prone to extravasation due to systemic venous congestion and blocked blood return.

1.4 technical factors extravasation caused by nursing technical defects: (1) inexperience, ignorance of blood vessels and unclear local anatomical position. (2) venous access is not checked regularly. (3) Nurses lack knowledge and understanding of the characteristics and usage of drugs. (4) use a steel needle. According to the related literature, the extravasation of steel needle is twice that of indwelling needle. (5) Cover the puncture hole with dressing.

Position, affect the observation of extravasation. (6) Push the drug into the distal vein. (7) Use an infusion pump for long-term infusion in one place. (8) Puncture the same part for many times.

1.5 The peripheral veins in the anatomical site are easier to extravasate than the central veins. The blood vessels with phlebitis are prone to extravasation due to the increase of intravascular pressure caused by vasoconstriction; Parts with few joints and subcutaneous tissues are easy to extravasate because of their great fluidity.

2 Mechanism of extravasation of intravenous infusion

(1) Blood vessels are chemically stimulated by drugs, on the one hand, the blood components change, on the other hand, the direct stimulation of drugs causes the release of inflammatory mediators, which increases the permeability of the inner wall of blood vessels, thus causing inflammatory reactions. (2) colloid osmotic pressure decreased with the continuous infusion of drugs. (3) The hydrostatic pressure increases. (4) Secondary infection, due to the action of bacteria and their toxins, inflammatory cells gather and inflammatory mediators are released, leading to increased vascular permeability and tissue edema.

Clinical manifestations of extravasation of intravenous infusion

Generally manifested as swelling and pain. Moderate or severe pain is generally burning sensation, tingling, local redness and swelling, no blood return after stopping taking medicine, or local blisters, and the skin turns black and hard, forming ulcers.

4 Consequences of extravasation of intravenous infusion

Patients will experience mental pain and physical trauma, prolong their hospitalization time, increase their financial burden, cause pressure and worry to patients, their families and medical staff, and even cause serious disability and medical disputes.