新生儿液体外渗的处理-1.pptVIP

Staging of extravasation injuries according to Flemmer.15 *The presence of any one of these characteristics constitutes a stage IV infiltrate 法国南希中央医院麻醉与重症监护科的Steinmann报道了他们的预防措施[11]续。 6 Fix the cannula in place using a transparent, non-occlusive dressing so as to facilitate observation of the overlying skin. 7 When utilizing continuous infusions, change the i.v. line every 48 h, whilst trying to avoid repeated puncture of the same venous network. Endeavour to change all i.v. lines that have been inserted under urgent circumstances. 8 Preceding the injection of noxious substances, clarify the patency of the line, the presence of venous return through it and the absence of any obvious local s.c. infiltration. 9 Instruct the patient to report any pain that he/she may experience at the cannula site . (2)、美国加州大学儿童医院的预防措施[12] a. Frequent (at least every hour) assessment of peripheral IV site. b. clear,visible insertion site c. Secure tape,not too tight at site d. Limit osmolarity of solutions infusing 参考文献 [21].Lehr V, Lulic-Botica M, Lindblad W, Kazzi N, Aranda J.Management of infiltration injury in neonates using DuoDerm Hydroactive Gel. Am J Perinatol. 2004;21:409- 414.210 Robin Clifton-Koeppel [22]. Sawatzky-Dickson D, Bodnaryk K. Neonatal intravenous extravasation injuries: evaluation of a wound care protocol. Neonatal Netw.2006;25:13- 19. [23]. Cisler-Cahill L. A protocol for the use of amorphous hydrogel to support wound healing in neonatal patients: an adjunct to nursing skin care. Neonatal Netw. 2006;25:267 - 273. ? 我院制定的预防液体外渗措施 a.穿刺者应经过静脉穿刺培训、考核合格后方能进行静脉 穿刺。提高一次穿刺成功率。 b.要严格遵守无菌技术操作原则。如穿刺前应使用适当的 皮肤消毒剂，如：驯碘消毒液；保证消毒液未被污染及 在有效范围内。 c.避免选择感染、创伤的血管及近期内发生过渗液部位的 血管，尽量选择较粗大、弹性佳且皮下脂肪较多的血 管。避开关节部位穿刺。 d.选择柔韧性好的留置针，避免使用钢针。 e.操作过程中如送管有阻力，不要强行操作，否则会造成 导管打折、弯曲；避免反复退针造成血管壁损伤，引起 液体外渗。 f.输液结束后应用1-10u/ml的肝素盐水正压脉冲法封管， 在管腔内形成涡流，防止回血堵管，进行再次穿刺破坏 血管。 g.使用敷料应无菌，如出现潮湿、松动或污染时应按无菌 操作进行更换，稳定固定导管和输液管，减少移动，必 要时可使用手臂固定托或其他固定辅助工具。敷料包扎 不宜太紧，以免影响血液循环，引起渗液。 i.一般外周静