As a new nursing technique, intravenous indwelling needle for children has been widely used in clinic. It can not only avoid the pain and fear caused by repeated puncture, but also alleviate the anxiety and psychological pressure caused by the difficulty of puncture for parents of children. Intravenous indwelling needle, also known as trocar, as an alternative product of scalp needle, has been widely used in clinic because of its advantages of simple operation, convenient use, soft intubation, long indwelling time in vein and unsuitable for puncturing blood vessels. Children's intravenous indwelling needle has been widely used in our hospital since the end of 2004, and good results have been achieved in clinical use. Common problems and solutions are summarized as follows.
Clinical data of 1
1. 1 General data Since the end of 2004, 40 cases of intravenous indwelling needles have been used in our hospital, ranging in age from 4 months to 8 years, including 298 males and 0/03 females. Retention time 1 ~ 7 d, of which 1 d 17 cases (4.24%), 2 d 3 1 case (7.73%), 3 d 89 cases (22. 19%), 4. 5 d 7 1 case (17.7 1%), 6 d 43 cases (10.72%) and 7 d 17 cases (4.24%); Puncture failure was 2 1 case (5.24%); Casing fell off in 44 cases (10.73%); There were 65438 06 cases of casing blockage, accounting for 3.99%; 59 cases had local leakage and swelling (14.438+0%); Phlebitis occurred in 7 cases (65438 0.75%).
1.2 operation method
1.2. 1 Model and selection of intravenous indwelling needle for children; Venous indwelling needle produced by American BD company. According to the child's age, disease type and vascular condition, the specification is 22? 24GY indwelling needle.
1.2.2 The choice of blood vessels is thick and straight, elastic and rich in blood flow, avoiding the blood vessels of joints. Such as frontal vein, temporal vein, dorsal vein of hand and dorsal vein of foot.
1.2.3 remove the hair around the needle 10 cm by puncture, and disinfect the skin area of acupuncture routinely. Take out the venous indwelling needle and exhaust the air in the skin cannula at the end. Take off the needle sleeve, loosen the jacket, adjust the inclined plane of the needle, tighten the skin, keep the needle tip upward, and insert the needle at 15 ~ 30 degrees above the blood vessel. After blood transfusion, the puncture angle was reduced by 5 ~ 10 degrees and then the needle was inserted by 0.2 cm. The left hand pulls out the needle core about 0.5 cm, and then with the needle core as the support, the right hand slowly pushes the plastic outer tube in the direction of puncturing blood vessels until it completely enters the vein. Press and hold the needle handle, pull out the needle core, loosen the tourniquet, connect the heparin cap after the infusion is clear, and cover the 3M patch. Record the date and time of catheter insertion and the name of the puncturer.
1.2.4 indwelling time The indwelling standard of International Intravenous Infusion Nursing Association (INS) is 3 days, but there is no uniform regulation in China, generally it is 3 ~ 5 days. In the meantime, if the indwelling site is found to be red, swollen and phlebitis, the venous indwelling needle should be pulled out immediately and the puncture site should be replaced.
2 sealed tube
2. 1 Methods The tube was sealed directly with a syringe. At the end of infusion, close the regulator of infusion set and separate the needle from heparin cap. Disinfect heparin cap, extract 5 mL of tube sealing liquid with a syringe, directly pierce the syringe into heparin cap, slowly and statically push 3 mL of tube sealing liquid first, and then pull out the needle while pushing the residual liquid until the needle is pulled out. The injection speed should be slow to reduce the influence on blood vessels, and the lumen should be filled with sealing liquid, and the indwelling needle should be closed.
2.2 Selection and dosage of sealing liquid The concentration of sealing liquid is 50 U/mL heparin saline (prepared by adding 1 heparin into 250mL 0.9% sodium chloride solution), and the dosage of sealing liquid is 5 mL heparin saline.
Three problems of intravenous indwelling needle
3. 1 The failure of puncture is mainly due to: ① The selected blood vessel is too thin or bent, which leads to the puncture of blood vessel during cannula delivery. There were 4 cases in this group. ② The outer sleeve was not loosened before puncture, and the outer sleeve was taken out together when the steel needle was pulled out. There are 3 cases in this group. (3) Stop the needle insertion immediately after seeing the blood returning, and the outer sleeve is still outside the blood vessel. At this time, the steel needle was pulled out and sent to the outer sleeve, which curled outside the blood vessel and could not enter the blood vessel, leading to failure. ***9 cases. ④ After the blood returned, the needle penetrated into the blood vessel too deeply, with 5 cases.
3.2 Analysis of 44 cases of casing shedding: 2 1 case is sweating and excessive oil secretion, which makes 3M glue lose its viscosity and children fall off; 7 cases were scratched due to improper nursing during crying. The above two cases are mostly children from 4 months to 1 year old, and most of them are scalp vein catheterization. 16 cases, due to frequent movements of children, gradually fell off, especially during venous catheterization of limbs.
3.3 There were 16 cases of casing blockage in this group. The reasons are as follows: ① Children's own blood is concentrated or hypercoagulable, such as meningitis or toxic bacillary dysentery. ② Because of the worry that pushing too much heparin is not good for children, the injection amount of heparin sealing solution is insufficient, and the blood returns to block the intubation. (3) The sealing method is not accurate enough to ensure that the catheter is filled with sealing fluid, and the return blood blocks the casing.
3.4 Local leakage and swelling 59 children had local leakage and swelling after using indwelling needle for 3 days, and most of them had local pain during injection, accompanied by slow infusion speed. It is speculated that it is mainly related to the decrease of elasticity and brittleness of blood vessel wall, the increase of permeability of blood vessel wall caused by some drugs and the partial shedding of cannula.
3.5 Phlebitis is characterized by redness, swelling, pain and heat along the vein direction of children. The reason is related to the stimulation of drugs and catheters, lax aseptic operation, repeated puncture, liquid temperature and many other factors.
4 nursing measures
We should choose thick and straight blood vessels, such as superficial temporal vein and median frontal vein, which are not easy to be compressed in lying position, and avoid choosing posterior auricular vein, posterior occipital vein and veins close to venous valves and scars. Because the incidence of phlebitis in lower limbs is significantly higher than that in upper limbs, lower limb veins should not be chosen as far as possible. Strict aseptic technique should be adopted to prevent phlebitis, especially the scalp indwelling needle should be strictly disinfected to achieve three goals: sufficient disinfection time, disinfectant and disinfection scope. The indwelling needle should be fixed firmly. After successful puncture, first cover the needle eye with sterile infusion, then fix the indwelling needle with transparent paste, and then fix the needle wing and heparin cap with 4 ~ 6 ordinary tapes to prevent the needle wing from folding back. Tell parents to take good care of their children and avoid the catheter falling off due to touch or excessive physical activity. Replace transparent application and puncture site regularly. If the transparent application is damaged or falls off, it should be replaced immediately, or it should be replaced at any time according to the pollution of the transparent application (including seepage, seepage, sweating, air, etc.). ); During infusion, nurses should strengthen patrol, control infusion speed and observe the skin condition of indwelling needle. If local swelling or induration occurs, they should stop infusion, immediately pull out the trocar and wet compress the inflamed area with 50% magnesium sulfate. If the drip is not smooth, don't squeeze the infusion tube hard to prevent embolism; Don't use too much force when injecting liquid medicine intravenously, which will cause the local pressure in the blood vessel to increase suddenly, the permeability of the tube wall to increase and the liquid to extravasate. If it is semi-blocked, the thrombus should be pulled out first, and then the infusion set should be connected; If it is blocked, the trocar should be pulled out for puncture, and the indwelling time can be shortened when the liquid with high drug concentration and strong irritation is used. Seal the tube with positive pressure in time and correctly after infusion, and ensure enough heparin dosage to ensure that the tube can be used again after 12 ~ 24 h, and the aseptic operation should also be strictly carried out when infusing again.
5 discussion
In recent years, intravenous indwelling needle has been widely used in clinic, because it can alleviate the pain of repeated puncture of children, reduce the workload of nurses and improve work efficiency, which has been recognized by both doctors and patients. However, there are some problems after the development of our hospital, which leads to a short retention time and does not really reflect its advantages. Therefore, we should constantly summarize and improve our work to further improve the success rate of trocar indwelling and reduce the occurrence of complications.
refer to
Xianchun Chen, Yue Feng. Venous indwelling
Rubella; Nursing; children
Rubella is an acute infectious disease caused by rubella virus, which is characterized by red maculopapular rash, swollen lymph nodes behind pillow, neck and ear, accompanied by mild systemic symptoms such as low fever [1]. Many infected children are sporadic, local outbreaks, generally no specificity, but nursing is particularly important. 2 13 cases of rubella admitted to our hospital from June to May in 2007 are reported as follows.
Clinical data of 1
1. 1 General data From June to May 2007, 2 13 children with rubella were treated in our hospital, including 26 males and 87 females, aged 3- 13 years. The shortest course of treatment is 4 days, the longest is 12 days, with an average of 8 days.
1.2 clinical manifestations 2 13 cases all had fever, cough, tears and runny nose, and cervical lymph node enlargement. The rash is a red congestive maculopapular rash, which is more common on the face and trunk, and the skin between rashes is normal. The hemogram was normal or slightly decreased, and aspartate aminotransferase increased in 83 children.
1.3 heat-clearing and detoxification treatment, symptomatic treatment. Andrographolide injection, vitamin C, energy mixture, potassium magnesium aspartate were injected intravenously, and Shuanggen mixture was taken orally. Fever and cough should be given as appropriate. 2 13 children recovered within 3 ~ 7 days after diagnosis and treatment, and fever patients generally recovered within 24 hours after treatment. The rash subsided within 3 ~ 5 days without pigmentation.
2 Clinical nursing
2. 1 Psychological nurses should be kind, take the initiative to care for children and eliminate their fears. Explain the necessity and importance of isolation to prevent the epidemic of diseases.
2.2 General nursing should isolate respiratory tract until 5 days after eruption. Ward should be ventilated frequently, maintain proper temperature and humidity, spray air for disinfection, use disinfectant or boil disinfection, and expose clothes to the sun. Rinse the baby with soapy water after feeding. Children should stay in bed and avoid direct blowing to prevent illness from catching cold.
2.3 Skin Care Keep children's eyes, nose, mouth and skin clean and hygienic. Don't let the wind blow directly or the sun shine directly on your child's eyes, rinse your mouth with light salt water, don't have too many clothes and quilts, change clothes frequently, and cut your nails to prevent scratching your skin from causing infection. Skin itching can be scrubbed with warm water and locally coated with calamine lotion or crude oil. Conjunctivitis was treated with 0.2% chloramphenicol eye drops or 10% sulfacetamide eye drops for several days. After cleaning nasal secretions, paraffin oil or chlortetracycline ointment can be applied to protect nasal mucosa. Appropriate anti-allergic drugs can be used when necessary, while keeping the skin clean and dry. When you have a high fever and sweat, you should wipe your body in time and put on clean and soft clothes.
2.4 Symptomatic nursing Most children with rubella have low fever, and most children do not need special cooling treatment. For people with fever, you can use warm water to cool down. Patients with persistent high fever should closely observe the changes of their condition. If the eyes are bloodshot, eye drops can be used to avoid light stimulation. Pay attention to oral hygiene and often rinse your mouth with light salt water. Give cough medicine to people who cough.
2.5 Drink plenty of water during the fever period, and choose liquid or semi-liquid foods that are nutritious, light and digestible, such as milk, gruel, custard, etc., and do not eat fried or greasy foods.
3 discussion
Rubella is a common eruptive infectious disease in childhood, and can be immunized for life after suffering from rubella. During rubella epidemic, go to public places as little as possible to reduce the chance of infection and transmission. Pregnant women's infection can cause fetal infection, which can cause fetal growth retardation and deformity. Therefore, the combined immunization of rubella vaccine and measles vaccine has practical value. Except for a few side effects such as joint pain after injection, rubella vaccine is very safe, and the antibody positive conversion rate of the new vaccine can reach 98% [2]. There is no 1 complication in this group, and all of them have achieved good nursing effect, which shows that careful nursing is extremely important.
refer to
Yang Guoliang, Wang Xiasheng. Modern dermatology [M]. Version 1. Shanghai: Shanghai Medical University Press,1996,312.