6方法预防留置针静脉炎

2022-08-01 中卫护研院 中卫护研院

预防静脉炎,你需要知道这些!

静脉输液是将大量无菌溶液或药物直接输入静脉的治疗方法。据统计,我国住院患者的平均输液率为 73.35%,在二级医院甚至可达到95%以上。但静脉输液治疗存在着一定安全隐患,特别是儿童、老人、意识不清、烦躁等患者。其中,静脉炎(Phlebitis)的发生,也是隐患之一。

静脉炎(Phlebitis)是由于输液导致的静脉壁内膜的炎症反应,是一种常见的静脉输液并发症。其临床表现为:首先出现穿刺局部不适或轻微疼痛,进而局部组织发红、肿胀、灼热,并沿静脉走向出现条索状红线,可触及条索状硬结。其对患者影响较大,可能带来疼痛、甚至导致血管及周围组织永久性损害,增加治疗费用和临床护理工作量。因此,预防输液性静脉炎是静脉治疗的重要任务。

归纳相关文献,对静脉炎的预防综合了以下6个方面的措施:

1 评估患者,掌握技巧与流程

1.1要对患者进行评估,予以静脉炎防护知识宣教,进行心理疏导,增强患者的配合。血管条件差者,由专业性强、经验足的护理人员护理,以提高穿刺率。

1.2 定期进行培训并考核,熟练掌握穿刺技术,减少对血管壁的摩擦。确保穿刺整个过程在无菌条件下进行。穿刺前保证穿刺部位皮肤干燥等。穿刺后:按时检查穿刺部位是否固定牢固,保持敷料处干燥。

2 重视穿刺部位和导管的选择

意大利Cicolini等发表的多中心前瞻性队列研究显示,在手背进行外周静脉导管穿刺比肘窝和前臂更易发生静脉炎(均p<0.05)。

美国静脉输液护理学会(Infusion Nursing Society,INS)制定的《输液治疗实践标准》指出,在前臂留置静脉短导管可增加留置时间,减少并发症。

对于儿童患者穿刺部位的选择,推荐选用最可能在规定的全程治疗中都保留的静脉位置,考虑手部、前臂以及腋窝以下的上臂部位的静脉,避免失败率较高的肘前区域;对于婴幼儿还可考虑头皮的静脉,如果尚未学会走路,也可用脚部的静脉;避免手或手指,或吮吸的拇指/手指;婴幼儿进行先天性心脏缺陷的治疗过程后,可能会减少锁骨下动脉的血流,应该避免使用右臂上的静脉。

INS指出,输液治疗时间少于6天建议适用外周静脉短导管,针对大多数治疗应考虑 20G~24G 的导管,新生儿、儿童及老人应考虑使用22~24G 的导管,需要快速输血时考虑更大规格的导管。

3 注意留置时间的控制

静脉炎是留置针最常见的并发症, 多发生于置管后 5~7d 内。

我国2014版《静脉治疗护理技术操作规范》规定成人外周静脉留置针留置时间72h-96h,对于化疗药物引起的静脉炎,应每天更换留置针和血管。INS指南也指出,在急诊科置入的留置针宜在48h内更换,以减少静脉炎的发生。

4 新封管方式的采用

随着护理研究的发展,也有新的方式方法可预防静脉炎等并发症。

姜正二等通过研究得出,静脉输注甘露醇后用加温盐水先冲管再封管,可降低静脉炎的发生。王清等使用导管预冲式冲洗器对104例脑卒中病人静脉留置针进行封管,结果表明,其疗效优于5U/ml稀释肝素生理盐水,降低了静脉炎的发生率。

5 应用新型敷料

研究显示:水胶体敷料比普通的透明敷料能更好地预防静脉炎的发生。

在穿刺点部位向上沿静脉走行方向敷贴,康惠尔水胶体敷料下缘距穿刺点2cm-3cm ,再次消毒后用3M 透明贴固定,在普通透明敷料的基础上,加用水凝胶敷料也能明显降低静脉炎的发生率。水胶体或水凝胶敷料预防静脉炎的确切效果,值得进一步探讨。

6 其它预防方式

静脉炎的发生与药物的酸碱度、渗透压、浓度、药物本身的毒性有关。可引发静脉炎的药物有:抗微生物类药物、化疗类药物、循环系统类药物等。在不可避免使用一些易致静脉炎的药物时,可尽量做好其他的防护。

研究表明,云南白药气雾剂、喜疗妥软膏、金黄散加蜂蜜、芦荟和土豆片等外敷,对静脉炎的预防均有积极作用。

版权声明:
本网站所有内容来源注明为“梅斯医学”或“MedSci原创”的文字、图片和音视频资料,版权均属于梅斯医学所有。非经授权,任何媒体、网站或个人不得转载,授权转载时须注明来源为“梅斯医学”。其它来源的文章系转载文章,或“梅斯号”自媒体发布的文章,仅系出于传递更多信息之目的,本站仅负责审核内容合规,其内容不代表本站立场,本站不负责内容的准确性和版权。如果存在侵权、或不希望被转载的媒体或个人可与我们联系,我们将立即进行删除处理。
在此留言
评论区 (5)
#插入话题
  1. [GetPortalCommentsPageByObjectIdResponse(id=1698405, encodeId=9d1316984053f, content=<a href='/topic/show?id=f2399910109' target=_blank style='color:#2F92EE;'>#静脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=89, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99101, encryptionId=f2399910109, topicName=静脉)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=0bc129907796, createdName=fusion, createdTime=Thu Oct 27 15:28:15 CST 2022, time=2022-10-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1670104, encodeId=f0a716e01044f, content=<a href='/topic/show?id=809ce0322c0' target=_blank style='color:#2F92EE;'>#留置#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=45, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=70322, encryptionId=809ce0322c0, topicName=留置)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a12645, createdName=智慧医人, createdTime=Thu Sep 15 10:28:15 CST 2022, time=2022-09-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1423594, encodeId=fd5214235944c, content=<a href='/topic/show?id=e88d991535b' target=_blank style='color:#2F92EE;'>#静脉炎#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99153, encryptionId=e88d991535b, topicName=静脉炎)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a12645, createdName=智智灵药, createdTime=Wed Aug 03 02:28:15 CST 2022, time=2022-08-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1540656, encodeId=e3e7154065689, content=<a href='/topic/show?id=6019e03279f' target=_blank style='color:#2F92EE;'>#留置针#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=70327, encryptionId=6019e03279f, topicName=留置针)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=cafc13278755, createdName=chshh81, createdTime=Wed Aug 03 02:28:15 CST 2022, time=2022-08-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1235960, encodeId=9d461235960e5, content=赞👍🏻, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1f352444317, createdName=chiaki777, createdTime=Mon Aug 01 15:12:54 CST 2022, time=2022-08-01, status=1, ipAttribution=)]
    2022-10-27 fusion
  2. [GetPortalCommentsPageByObjectIdResponse(id=1698405, encodeId=9d1316984053f, content=<a href='/topic/show?id=f2399910109' target=_blank style='color:#2F92EE;'>#静脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=89, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99101, encryptionId=f2399910109, topicName=静脉)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=0bc129907796, createdName=fusion, createdTime=Thu Oct 27 15:28:15 CST 2022, time=2022-10-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1670104, encodeId=f0a716e01044f, content=<a href='/topic/show?id=809ce0322c0' target=_blank style='color:#2F92EE;'>#留置#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=45, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=70322, encryptionId=809ce0322c0, topicName=留置)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a12645, createdName=智慧医人, createdTime=Thu Sep 15 10:28:15 CST 2022, time=2022-09-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1423594, encodeId=fd5214235944c, content=<a href='/topic/show?id=e88d991535b' target=_blank style='color:#2F92EE;'>#静脉炎#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99153, encryptionId=e88d991535b, topicName=静脉炎)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a12645, createdName=智智灵药, createdTime=Wed Aug 03 02:28:15 CST 2022, time=2022-08-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1540656, encodeId=e3e7154065689, content=<a href='/topic/show?id=6019e03279f' target=_blank style='color:#2F92EE;'>#留置针#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=70327, encryptionId=6019e03279f, topicName=留置针)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=cafc13278755, createdName=chshh81, createdTime=Wed Aug 03 02:28:15 CST 2022, time=2022-08-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1235960, encodeId=9d461235960e5, content=赞👍🏻, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1f352444317, createdName=chiaki777, createdTime=Mon Aug 01 15:12:54 CST 2022, time=2022-08-01, status=1, ipAttribution=)]
  3. [GetPortalCommentsPageByObjectIdResponse(id=1698405, encodeId=9d1316984053f, content=<a href='/topic/show?id=f2399910109' target=_blank style='color:#2F92EE;'>#静脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=89, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99101, encryptionId=f2399910109, topicName=静脉)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=0bc129907796, createdName=fusion, createdTime=Thu Oct 27 15:28:15 CST 2022, time=2022-10-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1670104, encodeId=f0a716e01044f, content=<a href='/topic/show?id=809ce0322c0' target=_blank style='color:#2F92EE;'>#留置#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=45, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=70322, encryptionId=809ce0322c0, topicName=留置)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a12645, createdName=智慧医人, createdTime=Thu Sep 15 10:28:15 CST 2022, time=2022-09-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1423594, encodeId=fd5214235944c, content=<a href='/topic/show?id=e88d991535b' target=_blank style='color:#2F92EE;'>#静脉炎#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99153, encryptionId=e88d991535b, topicName=静脉炎)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a12645, createdName=智智灵药, createdTime=Wed Aug 03 02:28:15 CST 2022, time=2022-08-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1540656, encodeId=e3e7154065689, content=<a href='/topic/show?id=6019e03279f' target=_blank style='color:#2F92EE;'>#留置针#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=70327, encryptionId=6019e03279f, topicName=留置针)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=cafc13278755, createdName=chshh81, createdTime=Wed Aug 03 02:28:15 CST 2022, time=2022-08-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1235960, encodeId=9d461235960e5, content=赞👍🏻, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1f352444317, createdName=chiaki777, createdTime=Mon Aug 01 15:12:54 CST 2022, time=2022-08-01, status=1, ipAttribution=)]
  4. [GetPortalCommentsPageByObjectIdResponse(id=1698405, encodeId=9d1316984053f, content=<a href='/topic/show?id=f2399910109' target=_blank style='color:#2F92EE;'>#静脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=89, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99101, encryptionId=f2399910109, topicName=静脉)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=0bc129907796, createdName=fusion, createdTime=Thu Oct 27 15:28:15 CST 2022, time=2022-10-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1670104, encodeId=f0a716e01044f, content=<a href='/topic/show?id=809ce0322c0' target=_blank style='color:#2F92EE;'>#留置#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=45, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=70322, encryptionId=809ce0322c0, topicName=留置)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a12645, createdName=智慧医人, createdTime=Thu Sep 15 10:28:15 CST 2022, time=2022-09-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1423594, encodeId=fd5214235944c, content=<a href='/topic/show?id=e88d991535b' target=_blank style='color:#2F92EE;'>#静脉炎#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99153, encryptionId=e88d991535b, topicName=静脉炎)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a12645, createdName=智智灵药, createdTime=Wed Aug 03 02:28:15 CST 2022, time=2022-08-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1540656, encodeId=e3e7154065689, content=<a href='/topic/show?id=6019e03279f' target=_blank style='color:#2F92EE;'>#留置针#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=70327, encryptionId=6019e03279f, topicName=留置针)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=cafc13278755, createdName=chshh81, createdTime=Wed Aug 03 02:28:15 CST 2022, time=2022-08-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1235960, encodeId=9d461235960e5, content=赞👍🏻, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1f352444317, createdName=chiaki777, createdTime=Mon Aug 01 15:12:54 CST 2022, time=2022-08-01, status=1, ipAttribution=)]
    2022-08-03 chshh81
  5. [GetPortalCommentsPageByObjectIdResponse(id=1698405, encodeId=9d1316984053f, content=<a href='/topic/show?id=f2399910109' target=_blank style='color:#2F92EE;'>#静脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=89, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99101, encryptionId=f2399910109, topicName=静脉)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=0bc129907796, createdName=fusion, createdTime=Thu Oct 27 15:28:15 CST 2022, time=2022-10-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1670104, encodeId=f0a716e01044f, content=<a href='/topic/show?id=809ce0322c0' target=_blank style='color:#2F92EE;'>#留置#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=45, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=70322, encryptionId=809ce0322c0, topicName=留置)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a12645, createdName=智慧医人, createdTime=Thu Sep 15 10:28:15 CST 2022, time=2022-09-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1423594, encodeId=fd5214235944c, content=<a href='/topic/show?id=e88d991535b' target=_blank style='color:#2F92EE;'>#静脉炎#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99153, encryptionId=e88d991535b, topicName=静脉炎)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a12645, createdName=智智灵药, createdTime=Wed Aug 03 02:28:15 CST 2022, time=2022-08-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1540656, encodeId=e3e7154065689, content=<a href='/topic/show?id=6019e03279f' target=_blank style='color:#2F92EE;'>#留置针#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=70327, encryptionId=6019e03279f, topicName=留置针)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=cafc13278755, createdName=chshh81, createdTime=Wed Aug 03 02:28:15 CST 2022, time=2022-08-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1235960, encodeId=9d461235960e5, content=赞👍🏻, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1f352444317, createdName=chiaki777, createdTime=Mon Aug 01 15:12:54 CST 2022, time=2022-08-01, status=1, ipAttribution=)]
    2022-08-01 chiaki777

    赞👍🏻

    0