The Method of Intravenous Treatment Using Infusion Sets

The use of an infusion set for intravenous infusion is one of the most basic clinical nursing technical operations, and it occupies a very important position in nursing work. In order to improve the success rate of puncture, reduce the suffering of patients, and ensure the quality of infusion, clinical practice and research have concluded many techniques, which are now introduced as follows.

During venipuncture, the right thumb and index finger hold the top and bottom of the needle handle. After piercing the skin, the thumb and index finger hold the front and back of the needle handle. The puncture success rate is high and the patient suffers less pain.

Because at the beginning of needle insertion, holding the upper and lower parts of the needle handle, the contact area is large, the force is uniform, the needle is stable, the needle is inserted into the skin fast, the pain action time is short, and the patient has light pain.

After the needle is pierced into the skin, it is changed to hold the front and back of the needle handle with the thumb and index finger to expose the tail of the needle stem and facilitate the observation of venous blood return to avoid puncturing the blood vessel.

(1) For those with thick blood vessels that are obvious and easy to fix, the needle should be inserted from the front or side at an angle of 20°; for those with less subcutaneous fat and easy to slip veins, the left hand pull tightly on the skin to fix the blood vessels, and from the right side of the blood vessel at a 30° angle Quickly penetrate the skin and penetrate the blood vessel easily.

For patients with dehydration or insufficient blood vessel filling, heat compresses are used to dilate the blood vessels. The needle is quickly inserted into the skin at a 25° angle from the front, and then the skin is gently lifted. When the needle enters 1/4, the needle is slightly tilted down, and then Pick up the vein and slowly insert the needle into place, so that the upper and lower blood vessel walls are separated, so as not to puncture the blood vessel.

For patients with edema, choose a thick blood vessel, walk along the blood vessel with the thumb to expose it, and quickly insert the needle after disinfection.

For patients with scalp vein puncture, use a straight puncture at an angle of 5°, and then slowly descend along the direction of the blood vessel after the skin is inserted. After seeing the blood return, proceed a little to succeed.

(2) Pediatric scalp intravenous infusion

Usually, the two temporal parts and the forehead are used, especially the hairline edge of the forehead for easy fixation and needle retention. One finger can press one end of the vein and the other finger can be used to push forward. If it is filled immediately, it can be used as a puncture site. If it is filled slowly, it means that the blood vessel flows backward.

Needle retention should be easy to operate and fix. The angle of needle insertion is generally 5°～10°. If the angle is too large, it is easy to insert the needle too deeply into the fat layer, and the needle runs or punctures under the blood vessel. If it is too shallow, the needle is caused in the skin. The puncture resistance causes the puncture to fail and increases the pain of the child. Smaller children or wasting children have obvious blood vessels, and approximately zero-angle needle insertion can achieve satisfactory results.

The drip rate during the infusion process can change spontaneously for different reasons. According to clinical practice, the following reasons have been found:

(1) Since the bevel of the needle was attached to the blood vessel wall at the beginning of the puncture, the dripping speed was not fast at that time. During the infusion, the bevel of the needle would leave the blood vessel wall due to the patient's position change, and the result would become faster by itself.

(2) At present, when using disposable infusion sets, the drip rate regulator is often out of control. Generally, the drip rate is adjusted according to the physical and chemical properties of the drug and the treatment requirements.

The drug should be slowed down appropriately when the drug is injected with strong vascular stimulation to keep the drip rate suitable for the treatment requirements and minimize the damage to the blood vessels caused by the drug stimulation so that the patient does not affect the treatment. Under the circumstances and relatively comfortable feeling in infusion.

Most patients hope to finish the drip as soon as possible during the infusion, especially when they are in a more urgent mood when they are eating or needing to urinate. At this time, patients often adjust the drip rate by themselves or ask the nurse to adjust the drip-rate.

In order to avoid accidents, the nurse must make regular inspections and explain to patients and their families that the accelerated drip rate will rapidly increase the circulating blood volume in a short period of time, increase the burden on the heart and lungs, and easily lead to heart failure and pulmonary edema.

When replacing the liquid, if other medicines are added to the liquid bottle whose pressure is close to or greater than the atmospheric pressure, the mouth of the bottle should be upwards, and the infusion set should be inserted, and then the air should be discharged for a while before being hung upside down on the infusion stand. This can prevent liquid from flowing out of the ventilation tube, reducing the amount of medication and affecting the treatment.

Adjust the liquid regulator to the bottom of the infusion tube and close the liquid, extend the index finger of your left hand, wind the infusion tube clockwise around the index finger, use a certain amount of force when winding, so that the next circle is pressed against the previous circle to achieve the purpose of driving out the gas in the infusion tube.

In order not to make the upper part of the infusion tube discount, it can be rotated 90° each time it is wound. When the liquid reaches Murphy's dropper, the right hand squeezes Murphy's dropper forcefully, and 1/3 of the gas is discharged and the right hand is released, and the exhaust ends.

Close the infusion tube, and squeeze Murphy's dropper to remove 1/3 of the gas. Hold the bottom of the infusion tube with your left hand, and use your middle finger to vigorously flick the infusion tube with your right hand to make the liquid drop and the gas rise. Make sure that there is liquid in Murphy's dropped during operation.

(1) Pay attention to the dripping speed first. When the infusion is too slow, the infusion time will be too long, which will affect the effect of drug effect and the patient's rest. Therefore, when rehydration is required for common diseases or the infusion of generic drugs, the drip rate can be controlled at 60-80 drops per minute. However, the drip rate should not be too fast blindly. If the patient has high blood pressure or heart disease, the drip rate should be 40-50 drops per minute.

For patients with heart failure, the drip rate should be controlled at 15-30 drops per minute to avoid increasing the burden on the heart and causing accidents. In addition, some drugs should not be instilled too quickly due to their nature, such as aminophylline, potassium chloride, etc., should not be instilled too quickly, otherwise, it will be life-threatening.

(2) If the drip occurs, check whether the liquid level in the drip tube is too high. In addition, check whether the infusion needle is swollen. If it is swollen, it means that the liquid has been transferred outside the blood vessel. Please clamp it immediately infusion tube and re-inject.

(3)Observe the infusion reaction. During the infusion, family members should pay attention to the changes in the condition at any time, and call in time if special circumstances occur.

Many drugs can cause allergic reactions and pyrogen reactions. In mild cases, itchy skin, and in severe cases, dizziness, nausea, cold sweats, difficulty breathing, palpitation, and anaphylactic shock may occur. Therefore, close observation should be made to prevent accidents.

(4) Pay attention to the liquid medicine. When the infusion is almost finished, call the nurse in time to change the liquid medicine or remove the needle. If the bottle is empty for too long, blood return is likely to occur, and the needle may even be blocked.

The best time to withdraw the needle is when the liquid in Murphy's dropper has been dripped, and the liquid level in the infusion tube has significantly slowed down or stopped.

During venipuncture, the eye of the skin and the eye of the blood vessel are often not at the same point. The distance between the two is related to the angle of needle insertion and the thickness of subcutaneous fat. Therefore, we should pay attention to the following two points.

(1) When the needle is removed after the infusion, the cotton swab is directly pressed on the blood vessel parallel to the blood vessel, and the tip of the cotton swab is 1 to 2 cm beyond the proximal end of the skin needle eye so that the skin needle eye and the blood vessel needle eye are compressed at the same time.

Do not pull out the needle when pressing the blood vessel hard, because the pressing force and the sharp angle of the needle tip when pulling the needle quickly will produce cutting force, which will cause mechanical damage to the cut blood vessel. Instead, lightly press the skin and quickly pull out the needle before pressing with a little force of 2～3min, this can reduce the occurrence of subcutaneous bleeding.

Do not knead the needle while pressing. Repeated kneading can make the blood clotted blood vessel bleed again: After the elbow vein puncture, let the patient straighten the forearm and press the cotton swab to parallel to the blood vessel for 3 to 5 minutes. Do not press the elbow to stop the bleeding to avoid bleeding Formation of subcutaneous congestion.

(2)When removing the needle, first separate the tape and leave only the needle eye cotton swab. This tape does not separate. After quickly removing the needle, press the two-needle eyes with the thumb in the direction of the blood vessel.

The continuous pressing time is 2 to 3 minutes for those with a good coagulation mechanism, and the best pressing time is 3-6 minutes; for those with poor coagulation mechanism and anticoagulant drugs, they need to be pressed for more than 15 minutes.

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