Name: peripheral iv care: site checks and flushes
Uploaded: 2023-04-30T06:49:37.000Z
Duration: 7 min 8 s
Channel: JoVE

1. 一般操作注意事项（在房间内与患者一同回顾）。
<ol>
	<li>与患者接触前，始终先用肥皂和温水彻底洗手。若双手无明显污物，可使用手部消毒剂，并充分揉搓。</li>
	<li>在床旁计算机上，查阅患者的病史，并确认患者是否仍需保留静脉通路。</li>
	<li>查阅医嘱执行记录（MAR）中的维持性静脉输液医嘱。
	<ol>
		<li>若患者当前正通过静脉通路输注维持性液体，需确认其是否仍需继续接受静脉输液治疗。可通过评估患者的出入量平衡、生命体征、皮肤弹性及黏膜状况，并结合血清实验室检查结果进行判断。</li>
	</ol>
	</li>
	<li>离开患者病房时，按上述方法（步骤 1.1）再次洗手。</li>
</ol>
2. 在药物准备区域，取10 mL生理盐水冲洗液和酒精棉片。
3. 评估并冲洗患者的静脉输液管路。首次进入患者病房时，按照步骤1.1所述，将物品放在台面上并洗手。
<ol>
	<li>评估外周静脉留置针穿刺部位。
	<ol>
		<li>检查静脉导管穿刺部位是否存在发红、肿胀或瘀伤。发红可能提示刺激、炎症、感染或血栓形成。瘀伤可能提示已形成血肿，并可能对周围组织造成损伤。</li>
		<li>评估透明导管敷料的状况。敷料应保持清洁、干燥，并牢固粘附于静脉导管穿刺部位周围的皮肤。若敷料松动、潮湿或污染，应采用无菌技术更换。</li>
		<li>评估是否存在压痛和肿胀。
		<ol>
			<li>轻柔触诊静脉导管穿刺部位周围区域，并询问患者该区域是否有压痛或疼痛。压痛可能提示穿刺部位已发生炎症或感染。</li>
			<li>用一只手轻柔触诊静脉导管穿刺部位周围区域，同时用另一只手同步触诊对侧肢体相同区域，进行双侧比较。</li>
			<li>触诊时，评估局部温度（i.e., 升高或降低）、皮肤质地（i.e., 柔软、松软或紧绷）以及肿胀情况（i.e., 两侧肢体大小是否存在差异）。温度升高可能提示炎症或感染，而温度降低和组织松软可能提示液体外渗。上述任一情况均表明该外周静脉留置针必须停止使用。</li>
		</ol>
		</li>
	</ol>
	</li>
	<li>冲洗外周静脉留置针。
	<ol>
		<li>在进行下一步操作前，按照步骤1.1所述方法洗手，并戴上清洁手套。</li>
		<li>准备0.9%氯化钠注射液冲洗液。
		<ol>
			<li>打开一支0.9%氯化钠注射器的包装。用惯用手握住注射器，非惯用手拧下并取下注射器帽。将帽口朝上放置于桌面/台面，注意避免污染帽端。轻轻旋转活塞以打破密封。</li>
			<li>用非惯用手竖直握住注射器，惯用手轻推活塞排出空气。用惯用手拾起注射器帽，注意避免污染帽端，然后轻轻将帽拧回0.9%氯化钠注射器上。将0.9%氯化钠注射器放置于桌面。</li>
		</ol>
		</li>
		<li>清洁外周静脉留置针无针接头部位。
		<ol>
			<li>打开一个酒精棉片包装，并用惯用手持握。</li>
			<li>用非惯用手固定外周静脉留置针无针接头部位，将酒精棉片包裹其上，用力摩擦擦拭至少15秒（i.e., 如同挤压橙子般施加力度）。继续用非惯用手持握该部位，待无针接头自然干燥，注意避免触碰已消毒区域。</li>
		</ol>
		</li>
	</ol>
	</li>
	<li>用生理盐水冲洗导管。
	<ol>
		<li>继续用非惯用手拇指和食指夹持外周静脉留置针无针接头部位，用另一只手取0.9%氯化钠注射器，将注射器帽夹于非惯用手的中指与无名指之间，然后拧下帽盖。</li>
		<li>将注射器轻轻推入无针接头端口中心部位，并顺时针旋转拧紧。</li>
		<li>轻轻推动塑料夹片将其打开，以松开外周静脉留置针夹。用惯用手的中指与食指夹持0.9%氯化钠注射器，以惯用手拇指轻推活塞，冲洗静脉通路。</li>
		<li>在推动活塞的同时，观察静脉穿刺部位是否有渗漏、穿刺部位是否肿胀以及推注是否顺畅。询问患者在推注0.9%氯化钠注射液过程中是否感到疼痛。若出现上述任一情况，或推注困难，则表明该静脉通路已不再适用，应予以更换。</li>
		<li>继续用非惯用手食指和拇指夹持无针接头部位，轻柔逆时针拧下0.9%氯化钠注射器。 
		将使用过的酒精棉片和0.9%氯化钠注射器丢弃至垃圾桶中。</li>
	</ol>
	</li>
</ol>
4. 在患者的电子健康记录中记录外周静脉置管部位的评估情况。
<ol>
	<li>在患者的电子健康记录中，记录外周静脉留置针穿刺部位评估的日期、时间及部位。记录评估结果。
	<ol>
		<li>若穿刺部位无并发症，应记录外周静脉留置针穿刺部位无红肿、肿胀及刺激症状。记录敷料清洁、干燥且完整，外周静脉通路通畅，冲管顺畅。</li>
		<li>若穿刺部位出现并发症，应记录具体发现及患者反应。应停止使用并更换外周静脉留置针。应通知患者的初级保健提供者，并采取适当措施以防止进一步并发症。</li>
	</ol>
	</li>
</ol>
5. 离开病房后立即洗手。

常规评估和导管维护可确保静脉输液治疗的持续进行，同时预防可避免的并发症和患者损伤。在评估注射部位时，若发现并发症，应立即停止静脉输液，联系主管医疗人员，并采取措施防止进一步损伤。若怀疑发生静脉炎或液体渗漏，应立即拔除外周静脉导管，并在患者的电子健康记录中记录该情况。若穿刺部位已发生渗漏，应抬高患者肢体，并根据所输注液体的类型以及医生和/或药剂师的指示，应用冰敷或热敷。在某些情况下，应在穿刺部位周围皮下注射中和性药物。最后，应定期评估血液循环、脉搏及毛细血管再充盈情况，以确保组织灌注维持正常。若怀疑静脉炎，应在穿刺部位使用热敷包。最后，若怀疑发生药物外渗或血栓性静脉炎，应立即停止静脉输液，并遵循所在机构的相关政策处理。在获得明确指示前，不得拔除静脉导管，因为在某些化疗药物外渗的情况下，可能需要通过导管给予解毒剂。

评估与冲洗外周静脉导管

Assessing and Flushing a Peripheral Intravenous Line

来源：Madeline Lassche，MSNEd，注册护士，Katie Baraki，MSN，注册护士，犹他大学护理学院，犹他州
在外周静脉（IV）通路建立后，根据机构政策和护理实践标准对静脉导管进行评估和维护至关重要。必须定期检查穿刺部位及周围区域是否出现并发症征象，以预防静脉导管相关并发症，包括渗漏、静脉炎、感染、外渗或导管脱出。常规静脉通路维护同样重要，旨在保持导管通畅，降低阻塞、血栓形成和血栓性静脉炎的风险。根据美国疾病控制与预防中心（CDC）的建议，外周静脉导管（PIV）在妥善护理和维护的前提下，可留置长达96小时。此外，根据输液护士学会（INS）的指南，儿科患者的静脉导管可保留至静脉通路不再通畅或出现并发症为止。由于反复穿刺会增加患儿焦虑，因此不建议对儿科患者常规每96小时更换一次导管。
本视频演示了外周静脉留置导管的评估与维护，包括操作前的一般注意事项、评估注射部位是否出现相关并发症，以及通过生理盐水溶液冲洗导管以维持导管通畅性。

来源：马德琳·拉舍（Madeline Lassche），护理学硕士教育方向（MSNEd），注册护士（RN）；凯蒂·巴拉基（Katie Baraki），护理学硕士（MSN），注册护士（RN），犹他大学护理学院，犹他州

外周静脉导管的评估、维护和冲管至关重要，必须依据医疗机构的政策和护理实践标准，在建立静脉通路后立即进行。若护理和维护得当，成人外周静脉导管可留置长达96小时，儿童则可更久，前提是导管保持通畅且无并发症迹象。定期评估可预防渗漏、静脉炎、感染、外渗或导管移位等并发症。此外，静脉通路的维护和冲管有助于保持导管通畅，降低阻塞和血栓形成的风险。本视频将演示正确评估、维护和冲洗外周静脉留置针管路的步骤，并讨论静脉输液并发症的管理。首先，如同每次进入患者病房时一样，若双手无明显污物，应使用肥皂和水彻底洗手，或使用手部消毒剂并充分揉搓。 然后，在床旁计算机上查看患者的病史，确认是否仍需保留静脉通路，并查阅药物管理记录（Medication Administration Record，简称 MAR）中的静脉输液医嘱。如果患者正在接受维持性静脉输液，需通过评估患者的出入量、生命体征、皮肤弹性、黏膜状况以及血清实验室检查结果，确认继续输液是否仍然必要。接下来，离开患者病房，按照前述方法洗手，并从药品准备区取一支10 mL生理盐水冲管注射器和酒精棉片。然后返回患者病房，将物品放在台面上，并再次洗手。评估静脉导管穿刺部位的第一步是检查是否存在发红或肿胀，这些可能是刺激、炎症、感染或血栓形成的征象。同时观察是否有瘀斑，这可能提示血肿，而血肿可损伤周围组织。此外，评估透明导管敷料的状况，敷料应清洁、干燥，并牢固地粘附在穿刺部位周围的皮肤上。如果敷料松动、潮湿或污染，应采用无菌技术更换敷料。接下来，通过触诊穿刺部位周围区域评估有无触痛，并询问患者是否感到疼痛。疼痛或触痛可能提示存在炎症或感染。随后，用一只手轻轻触诊穿刺部位，同时用另一只手触诊对侧手臂的相同区域，评估局部温度、皮肤质地及有无肿胀。温度升高和肿胀可能提示炎症或感染，而温度降低和组织松软可能提示液体渗漏。出现这些情况时应停止使用导管。在准备生理盐水冲洗液之前，应如前所述再次洗手。接下来，打开生理盐水冲洗注射器的包装。然后，用惯用手握住注射器，用非惯用手取下注射器帽，并将帽口朝上小心放置在台面上，避免污染帽的末端。此时，旋转注射器的推杆以打破密封。接着，保持注射器垂直向上，轻推推杆以排出空气。随后，用惯用手拿起针帽——注意保持其无菌状态——并将针帽重新旋回注射器上。然后将注射器放置在台面上。下一步是清洁外周静脉留置针的无针接头注射部位。首先，打开一个酒精棉片包装，并用你的优势手握住。然后，用非优势手握住外周静脉留置针的无针接头部位，将酒精棉片包裹其上，用力摩擦并彻底擦拭该部位，如同挤橙汁一般，持续15秒。在酒精自然干燥过程中，继续用手握住无针接头部位，避免污染。现在，你已准备好冲洗导管。用你的惯用手拿起生理盐水注射器，用非惯用手的无名指和中指拧下注射器的帽盖。接着，将注射器连接到无针接头处：轻轻推动注射器，使其尖端插入无针注射部位的中心位置，然后顺时针旋转拧紧。同时打开外周静脉留置针（PIV）管夹。将生理盐水注射器夹在惯用手的食指与中指之间，用拇指轻轻推动推杆，冲洗 PIV 管路。推注活塞的同时，观察外周静脉留置针穿刺部位是否有渗漏或肿胀，并询问患者是否感到疼痛。若出现上述任何情况，或液体推注困难，则表明该静脉穿刺部位已不再适合使用。冲管操作完成后，继续用非优势手的拇指和食指捏住无针接头部位，用优势手将注射器从接头处旋下。最后，妥善丢弃注射器和酒精棉片。最后一步是将操作过程记录在患者的电子健康档案（EHR）中，记录外周静脉导管评估的日期、时间、部位及检查结果。若穿刺部位无并发症，应记录无红肿、无肿胀、无刺激症状；敷料清洁、干燥且完整；导管通畅且冲管顺利。若存在任何并发症，应记录具体情况并通知主要诊疗医生。最后，再次洗手并离开患者病房。“常规进行PIV评估和冲管是确保静脉输液治疗无并发症持续进行的重要步骤。若在评估过程中发现任何问题，应立即停止输注，并通知患者的主管医师。”您刚刚观看了一段 JoVE 护理技能视频，内容是关于外周静脉导管的评估与冲洗。您应了解该操作所用的物品准备及操作技术。同时，您还应掌握如何识别并处理可能出现的并发症。一如既往，感谢您的观看！

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peripheral iv care: site checks and flushes

Peripheral IV care includes regular site checks and normal saline flushes to keep the catheter working properly. After peripheral intravenous access is started, the line should be assessed and maintained according to institutional policies and nursing standards of practice. Careful maintenance helps preserve patency, which means the IV remains open and usable.

The insertion site and the tissue around it must be checked often for signs of complications. These can include infiltration, phlebitis, infection, extravasation, or catheter dislodgement. Routine assessment helps reduce the risk of occlusion, thrombosis, and thrombophlebitis.

Peripheral IV catheters may remain in place for up to 96 hours when they are properly cared for and maintained, according to the CDC. In pediatric patients, the Infusion Nurses Society states that the catheter may stay in place until it is no longer patent or shows complications. Routine rotation every 96 hours is not recommended for children because repeated needle sticks can increase anxiety.

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assessing and flushing a peripheral intravenous line

Peripheral IV care includes regular site checks and normal saline flushes to keep the catheter working properly. After peripheral intravenous access is started, the line should be assessed and maintained according to institutional policies and nursing standards of practice. Careful maintenance helps preserve patency, which means the IV remains open and usable. The insertion site and the tissue around it must be checked often for signs of complications. These can include infiltration,...

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Maintenance IV fluids help keep a patient's fluid and electrolyte balance steady during hospital care. Patients who cannot drink by mouth may need IV fluids with or without electrolytes to help prevent hypovolemia, dehydration, and electrolyte imbalance. Patients who are NPO, or nil per os, before surgery or a procedure with anesthesia also need hydration while they are not eating or drinking. After surgery or other procedures, IV fluids may be used to restore intravascular volume after blood...

preparing and administering iv push medications

preparing-and-administering-iv-push-medications

IV Push Medication Safety and Dosing

IV push medication safety and dosing are shown in this nursing demonstration. An intravenous, or IV, push is the rapid delivery of a small amount of medicine into a vein through a previously placed IV catheter. These medications often come in vials or ampules, which are used to draw the drug into a syringe before it is given. This method is chosen when a fast response is needed or when a medication cannot be taken by mouth. The transcript gives moderate or severe pain treatment as one common...

preparing and administering intermittent intravenous medications with an infusion pump

preparing-administering-intermittent-intravenous-medications-with-an

Infusion Pump Steps for Intermittent IV Meds

Intermittent IV medications are given by infusion pump to deliver a set volume over a specific time. These infusions may be primary, meaning they run alone, or secondary, meaning they run with another IV fluid such as maintenance fluids. Medications like IV antibiotics are common examples of this type of treatment. Infusion pumps help control the fluid rate and keep medication effects more predictable. They also help reduce nurse medication errors. High-volume IV medications, often in the 50-...

preparing and administering secondary intermittent intravenous medications

preparing-administering-secondary-intermittent-intravenous

Secondary IV Piggyback Medication Setup

Secondary IV piggyback medication setup is used to give small, controlled amounts of IV solution, usually 25 to 250 mL. These infusions run longer than IV push medications. That slower delivery can lower the risk of problems linked to rapid infusion, such as phlebitis and infiltration. In secondary IV therapy, the medication tubing connects to the primary macrobore IV tubing, so the secondary line is tied to the main infusion. The secondary bag is usually hung higher than the primary bag. This...

discontinuing intravenous fluids and a peripheral intravenous line

discontinuing-intravenous-fluids-and-a-peripheral-intravenous-line

When IV Fluids Can Be Stopped

Intravenous (IV) fluids and peripheral IV catheters can be stopped when they are no longer needed. A patient may no longer need IV fluid therapy after returning to euvolemia, which means normal body fluid volume. IV fluids may also be stopped when the patient can drink enough fluids by mouth or is being discharged from the hospital. Peripheral IV catheters, or PIVs, also need regular checks for safety. In adults, the Centers for Disease Control and Prevention recommends replacing a PIV every...

central venous access device dressing change

central-venous-access-device-dressing-change

Sterile Care for Central Line Dressings

Central line dressings must be changed with sterile care to help protect the line from infection. Central venous access devices, or CVADs, are large IV catheters that go into the central circulation. They are also called central lines or central catheters. These devices usually end in the superior vena cava, just outside the right atrium of the heart. Some may end in other large veins, including the aorta, inferior vena cava, brachiocephalic vein, pulmonary artery, internal iliac vein, or...

nursing skills

该收集显示药物准备和管理, 与视频突出重要的安全检查, 考虑因素, 剂量计算, 和常见的错误与用药管理不当有关。

Learn how peripheral IV lines are checked and maintained with site assessments and normal saline flushes to help prevent complications and keep the line patent.

Peripheral IV Care: Site Checks and Flushes

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