Name: when iv fluids can be stopped
Uploaded: 2023-04-30T06:50:30.000Z
Duration: 7 min 22 s
Channel: JoVE

1.一般 IV 输液中止和 PIV 删除注意事项 （在房间里，与患者的审查）。
<ol>
	<li>首先进入病人的房间，清洁你的双手用洗手液或用肥皂和温水，应用剧烈摩擦为至少 20 s。</li>
	<li>审查流体卷状态的病人的电子健康记录。这包括摄入量和输出总量、 血清化验结果、 生命体征评估，区周围皮肤肿胀，粘液膜和病人的能力，以保持口腔摄入足够的液体。此外，查看当前的药物订单，以确定是否继续需要四访问和静脉注射药物治疗。注意: 如果病人的历史表明，增加出血后外围线去除，包括出血疾病、 抗凝治疗和低血小板计数的危险。</li>
	<li>确认病人的身份使用两个独立的标识符，不包括病人的房间号码或床数。这些可能包括病人的姓名和记录编号。</li>
	<li>与病人，回答任何问题，和讨论问题审查的 PIV 去除过程。与病人讨论他/她偏好为使用与非胶粘剂自粘裹 PIV 切除后的磁带。病人过敏的磁带胶粘剂将需要使用非胶粘剂自粘裹。</li>
	<li>检查四、 导管插入网站的发红，肿胀，或瘀伤。红肿可以表明刺激、 炎症、 感染、 或血栓的形成。瘀伤时插入站点可能是血肿，可能会导致对周围组织损伤的标志。</li>
	<li>轻轻地触诊周围四导管插入网站，评估的柔情和肿胀的区域。问病人是否地区感觉投标或痛苦。柔情可能表明炎症或感染在插入网站。</li>
	<li>重复四导管插入站点周围同时触诊同一地区的其他肢体与另一只手触诊。在触诊，注意温度 （即，增加或减少），皮肤纹理 （即，软，沼泽，或紧），和肿胀 （即，任何大小在两个肢体之间的差异）。温度升高可能表明炎症或感染，而降低温度和骨质增生可以建议渗透。</li>
	<li>注意到任何异常的调查结果，以确定是否需要进一步的干预以及 PIV 切除后的文档。</li>
	<li>离开病人的房间，洗你的手，（步骤 1.1） 上文所述。</li>
</ol>
2.收集 PIV 删除，包括两个不育 2 x 2 纱布包、 吸水垫和磁带或非胶粘剂自粘包所需的用品。
3.返回到病人的床边，在柜台上，放下用品，洗手步骤 1.1 中所述。
<ol>
	<li>床边站或过度床表定位作为外围插入网站的同一边，放在桌上用品。</li>
</ol>
4.停止 IV 输液。
<ol>
	<li>在你的非惯用手举行四、 油管、 用另一只手去滑窄钳年底将咬合油管辊子箝位。夹紧延长油管将防止血液回流到延长油管后中止的 IV 输液。<ol>
		<li>如果使用 IV 泵，则按和坚持 IV 泵通道到渠道权力停止静脉输注到"通道关闭"按钮，然后向夹紧延长油管。</li>
	</ol>
	</li>
	<li>处理液袋和油管设施政策进入适当处置容器。</li>
</ol>
5.请将病人和用品准备 PIV 去除。
<ol>
	<li>周边四插入网站下吸水垫的地方。</li>
	<li>打开两个 2 × 2 无菌纱布包，使他们对其无菌包装，和把它们放在床边的支架或过度床上桌近在咫尺。小心不要污染无菌纱布。</li>
</ol>
6.删除 PIV。
<ol>
	<li>洗手，如所述步骤 1.1 和唐清洁、 非无菌手套。</li>
	<li>删除覆盖 PIV 透明敷料。<ol>
		<li>与你的惯用手，轻轻剥去了近端一角按住皮肤绷紧附近敷料去除站点与你的非惯用手的透明敷料。持有的皮肤绷紧减少疼痛和有助于防止皮肤损伤中的透明敷料去除。</li>
		<li>皮回透明敷料，你占主导地位的手走向导管，远离病人，同时继续保持皮肤教敷料去除地点附近。剥皮敷料对导管和远离病人防止无意拆卸 piv 技术的之前你准备这样做。</li>
	</ol>
	</li>
	<li>脱去手套;洗手，详见步骤 1.1;和应用清洁、 非无菌手套。</li>
	<li>把握 PIV 附近导管枢纽优势拇指和食指之间。</li>
	<li>一个纱布对折。在外围的四插入网站与你的非惯用手轻轻按住纱布。</li>
	<li>与您惯用的手，通过导管拔线远离病人静脉及删除 PIV。</li>
	<li>用非优势手，不适用于公司压力纱布在插入站点 1-3 分钟或直到出血停止。</li>
	<li>与您的惯用手，对折剩余干净的 2 x 2 纱布;除去脏的纱布;并将折叠，干净的纱布放在外围导管插入网站。</li>
	<li>安全干净的纱布缠满胶带或非胶粘剂自粘敷料周边导管插入网站。被铭记的施加足够的压力，但没有那么多关于咬合末梢循环。</li>
	<li>监视器周边导管插入网站伤口出血和指导病人到网站施加压力，并通知你如果网站开始流血。</li>
	<li>评估已移除的 PIV 确定导管是否完好。导管不应缩短，并应该对其尖端有一个干净的优势。缩短或锯齿状导管尖端位置显示导管部分已分离和可能仍留在病人。初级保健提供者，应立即通知。</li>
	<li>取出并丢弃手套、 脏的纱布和垃圾流入的适当处置容器和设施政策。</li>
	<li>洗手，步 1.1 中所述</li>
</ol>
7.文件停止输液和 PIV 去除病人的电子健康记录中。
<ol>
	<li>文件应该包括病人对 PIV 去除反应和发现任何异常。</li>
</ol>

虽然停止输液脱 PIV 似乎是一个简单的过程，护士应确保充分的准备和评估程序之前，应密切监测病人之后。之前停止输液和移除 PIV，护士必须验证病人不再需要四、 治疗和教育病人以确保其了解他/她的职责，维持充分水化。护士和病人需要继续监视插入站点伤口出血、 青肿、 疼痛和感染。插入的出血可能需要额外的压力和干预，以防止出血。渐进式瘀伤时插入网站可能表明出血进入组织。这可能会导致受损的外周循环和组织，可能会导致筋膜室综合征中的压力增加。常见的错误时停止外围的四包括不获取适当的用品，忽略停止输液前过程，并不能监视插入站点的并发症导管去除。

停止静脉补液和外周静脉行

资料来源: 马德琳 Lassche、 MSNEd，RN 和凯蒂 · 巴拉基，MSN，RN，护理学院，犹他大学，UT
可能有好几个原因停止流体静脉注射 (IV) 和外周静脉导管 （物件）。停止输液的最常见原因是病人已经回到正常体液量 (euvolemia) 和能够保持口腔摄入足够的液体或者从医院出院。此外，中心的 Prevention of Intravascular Catheter-Related 感染 （2011 年） 的疾病控制指南都建议更换物件每 72-96 h 成人以防止感染或静脉炎的风险。如果 PIV 会脱落或插入现场演示的迹象和症状的感染、 浸润、 外渗或静脉炎，PIV 应停止使用并更换。儿科病人，输液护士社会建议更换 PIV 只有当 IV 输液网站已不再是专利或它演示的症状和体征的并发症。
此视频介绍停止 IV 输液和物件的方法。

来源：马德琳·拉舍（Madeline Lassche），护理学硕士教育方向，注册护士，及凯蒂·巴拉基（Katie Baraki），护理学硕士，注册护士，犹他大学护理学院，犹他州  
静脉输液（IV）给药及……

外周静脉导管可根据多种原因随时停止使用。停止输液的常见原因包括：患者的液体量已恢复至基线水平；患者即将出院；静脉导管需要更换；或静脉穿刺部位因感染、渗出、外渗或静脉炎而出现异常情况。本视频将演示如何停止静脉输液以及外周静脉导管的拔除方法。进入患者病房后的第一步是进行正确的手部卫生。在床旁计算机上登录并查看患者的电子病历。务必了解患者的体液容量状况，包括出入量的总体积、血清实验室检查结果、生命体征评估、皮肤弹性及黏膜情况，以及患者维持足够口服液体摄入的能力。此外，应查阅用药记录单（MAR），了解当前的药物医嘱，并判断是否仍需保留静脉通路及继续给药。同时，务必回顾患者是否有出血并发症的风险，例如出血性疾病、抗凝治疗以及血小板计数偏低等情况。接下来，务必与患者共同回顾取出操作流程，并解答患者可能提出的任何问题。此外，必须使用两个独立的身份识别信息来确认患者身份，例如患者的姓名和病历号。请注意，切勿使用患者的房间号或床位号作为识别信息。评估患者的静脉注射部位是否存在红肿或瘀伤，因为这些表现可能提示刺激、炎症、感染或血栓形成。接下来，轻柔触诊静脉注射部位周围区域，以评估有无压痛和肿胀。此外，用另一只手触诊对侧肢体的相应部位，比较皮肤温度、质地或肿胀情况是否存在差异：局部温度升高可能提示炎症或感染，而温度降低且组织松软则可能提示液体外渗。接下来，在床边计算机上记录患者电子病历（EMR）中的所有操作和评估结果，以及任何异常发现。离开患者病房以准备拆除静脉导管所需的物品，并在离开时按前述方法洗手。进入清洁准备间，收集拆除静脉导管所需的物品。根据患者的偏好，取两个无菌的 2 × 2 纱布包，以及胶带或非粘性自粘绷带。返回患者病房，将物品放在与患者静脉输液同侧的床头柜上，并进行手部卫生。现在，用你的惯用手握住输液管，另一只手将夹子向输液管的狭窄端滑动，以阻断管路并防止回流。如果使用输液泵，需按住输液泵上的“关闭通道”按钮，使设备停止运行。接下来，将输液管从患者身上断开，并根据医疗机构的规定，将输液袋和输液管丢弃至指定的医疗废弃物容器中。现在，打开两包 2 英寸 × 2 英寸的无菌纱布，将其保留在床头柜上的无菌包装内，以确保不被污染。洗手并戴上清洁手套。用非惯用手固定敷料移除部位附近的皮肤使其绷紧，用另一只手轻轻掀开透明敷料的一角，朝向导管方向并远离患者身体。接下来，脱去并丢弃手套，洗手，然后戴上一副新手套再继续操作。现在，用你的惯用手握住静脉导管靠近其接口的部分，将一块纱布对折，用非惯用手轻轻按压在静脉穿刺部位。接着，沿静脉走向将导管平稳拔出，远离患者身体。用非惯用手对穿刺部位上的纱布施加牢固压力，持续 1 至 3 分钟，或直至出血停止。然后，用惯用手将剩余的清洁纱布对折，取下污染的纱布，再将清洁纱布覆盖于穿刺部位。随后，使用胶带或非粘性自粘敷料将清洁纱布固定在穿刺部位。密切观察静脉输液部位是否出血，并指导患者若部位再次出血，应立即对穿刺部位施加压力。检查拔除的导管以确定其是否完整。导管不应变短，导管尖端应具有整齐的边缘。接下来，将导管和污染的纱布丢弃至适当的医疗废弃物容器中，脱去并丢弃手套，彻底洗手。最后，在患者的电子健康记录（EHR）中记录静脉输液的停止以及导管的移除情况。必须记录患者对留置外周静脉导管拔除的反应及任何异常发现。“尽管停止静脉输液并拔除外周静脉导管看似是一个简单直接的过程，护士在操作前应确保充分的准备和评估，并在操作后密切监测患者情况。”若患者病史提示外周导管拔除后出血风险增加，包括有出血性疾病、抗凝治疗或血小板计数偏低等情况，需特别注意。发红可能提示刺激、炎症、感染或血栓形成。穿刺部位出现瘀斑可能是血肿的征象，可能对周围组织造成损伤。“移除静脉导管时，不应剪短导管，导管尖端应保持整齐的切口边缘。”“在拔除外周静脉留置针时常见的错误包括未准备适当的用品、未在操作前停止液体输注，以及拔管后未对穿刺部位进行并发症的监测。”您刚刚观看了 JoVE 关于停止静脉输液及外周静脉留置针操作的视频。现在，您应该了解终止静脉输液以及从患者身上移除静脉留置针所需的用品和操作流程。一如既往，感谢观看！

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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 72 to 96 hours to lower the risk of infection or phlebitis, which is inflammation of the vein. A PIV should also be discontinued if it becomes dislodged or if the insertion site shows signs of infection, infiltration, extravasation, or phlebitis.

Pediatric patients follow a different rule. The Infusion Nurses Society recommends replacing a pediatric PIV only when the IV site is no longer patent, meaning it is no longer open for fluid flow, or when it shows signs of complications. This procedure explains how to discontinue IV fluid administration and remove a peripheral IV line.

When IV Fluids Can Be Stopped

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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

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 when IV fluids and peripheral IV lines are discontinued, including discharge, euvolemia, adult replacement timing, and signs of IV complications.

When IV Fluids Can Be Stopped

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