A-C-L导管维护最佳实践标准5月18日(NXPowerLite)讲课.pptVIP

A-C-L导管程序化维护最佳实践标准 A-C-L导管维护最佳实践标准 A- Assess the function of the catheter 导管功能评估（抽回血） 导管穿刺期间 导管留置期间 C- Clear 冲管 L – Lock 封管 Blood Return is Mandatory!通过抽回血判断导管通畅是必须的! All catheters should yield a brisk blood return prior to infusion of each dose of medication. 所有的导管在输液前都会有一些回血 Lack of blood return means a non-functioning catheter 无回血意味着导管功能下降 Related to how or where the catheter was placed 与导管留置的过程和部位等因素相关 Catheter Lumen Occlusion导管腔内堵塞 Causes原因 Thrombotic 血栓性 Drug precipitate 药物沉淀 Mechanical 机械性 Proper flushing and locking catheters will either prevent or identify these problems正确冲封管能预防此类问题 Precipitate Causes药物沉淀因素 Contact between two or more incompatible drugs or fluids 两种或多种不相容药物/液体 Alteration in drug pH 药物PH值变化 Precipitate forms inside catheter lumen 管内沉淀形成 Lipid sludge from fat emulsion 脂肪乳沉积 Waxy coating on internal catheter walls 管壁内蜡状沉淀 Catheter Flushing导管冲封管 Standards and Guidelines标准和指南 INS Standard #56 INS标准第56条 If resistance is met or an absent blood aspirate noted, the nurse should take further steps to assess patency of the catheter prior to administration of medications and solutions. The catheter should not be forcibly flushed.给药和输液前，如果遇到阻力或者抽吸无回血，护士应进一步确认导管的通畅性。不应强行冲洗导管。 The nurse should aspirate the catheter for positive blood return to confirm patency prior to administration of medications and solutions. 给药和输液前，护士应抽回血以确认导管是否通畅。 A-C-L导管维护最佳实践标准 A- Assess导管功能评估 C- Clear 冲管：将导管内残留的药液和血液冲入血管 L– Lock 封管 Purposes of Catheter Flushing导管冲管的目的 Infusion Nursing Standards of Practice, Infusion Nurses Society 美国INS指南 To promote and maintain catheter patency 维持通畅 To prevent contact between incompatible medications and solutions 避免药物间反应 Many medications are incompatible 很多药物间都有配伍禁忌 Contact in the catheter lumen causes drug precipitate that occludes the lumen 药物沉淀在导管内形成堵塞 没有足够冲管会造成： 并发症 管腔阻塞 血液凝结 药物沉积 Flush Solution Containers冲管液容器的选择 Single dose containers are preferred Single dose vials, e.g. 10 mL vial of preservative-free normal saline 独立包