外周静脉导管插入

JoVE Science Education
Nursing Skills
A subscription to JoVE is required to view this content.  Sign in or start your free trial.
JoVE Science Education Nursing Skills
Peripheral Intravenous Catheter Insertion

62,933 Views

11:39 min
April 30, 2023

Overview

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

外周静脉留置针 (PIV) 插入旨在注入药物、 执行静脉注射 (IV) 液体治疗,或注射放射性示踪剂特别审批程序。放置的 PIV 是一种侵入和需要使用的无菌、 无接触的技术。

常见的四、 静脉穿刺部位是武器和成人双手和双脚的孩子们。根据静脉护士社会 (INS) 中,脚应避免在成人人口因为血栓性静脉炎的风险。静脉穿刺网站应仔细评估禁忌症,如疼痛、 伤口、 血液循环降低,以前脑血管意外 (CVA)、 透析瘘管或在同一侧乳房切除术。当可能时,应避免肘正中静脉、 头静脉在手腕部位。头静脉一直伴有神经损伤时用于四安置。手或手臂上可用的最远端站点是首选,这样未来静脉穿刺网站可能使用如果渗或外渗的发生。

这个视频将展示 piv 技术,包括编制和附件 IV 可拓集的插入。虽然 PIV 的固定设备,在这里就用以稳定静脉留置针,根据插件的建议,一些设施可能不选择购买这些设备和备用雪佛龙或 U 形编带方法也可以。

Procedure

外周静脉留置针的位置是经常执行的护理程序。外周静脉通路是必要的病人护理,包括输液、 药物、 染料、 和放射性示踪剂的许多方面。

在本视频中,我们将演示插入的外周静脉补液或 PIV,导管,与附件四可拓集的无菌性”无接触”技术。

最常见的部位为 PIV 导尿管的安置是武器和在成人中,双手和双脚的孩子们。脚应避免在成年人因为血栓性静脉炎的风险。此外时可能的因为神经损伤的风险应避免肘正中静脉、 头静脉在手腕上。总是使用最远端站点可能,这样更近端网站是在入渗或外渗的情况下仍然可用。当选择一个站点的其他考虑因素包括疼痛的伤口,血液循环降低,以前的脑血管意外、 透析瘘或乳房切除术的存在。

第一步,进入病人的房间,是为 20 秒,用肥皂和温水洗手或使用洗手液与激烈的摩擦,如果不脏手。

接下来,在床边的电脑,检查病人的电子健康记录和 PIV 插入的顺序。此外审查的出血并发症,如出血疾病、 抗凝治疗和血小板计数低风险的病人的历史。然后,对于患者来说,强调只有软、 柔性导管将留在他们的静脉后静脉穿刺,允许他们自由移动肢体和取得其同意的程序解释的程序。

它是,请务必确认病人的身份使用两个独立的标识符,如病人的姓名和医疗记录号码。作为标识符,则无法利用病人的床或房间号码。接下来,将病人放在一个舒适的位置,并调整床层高度维持人体工学护理立场,减少背部拉伤。另外,请确保照明是足够和床边站或在床上桌是清晰的使用。

供应准备退出病人的房间和洗你的手,如上文所述。现在收集所需的耗材,可作为四插入工具包。列表中所需用品包括止血带、 吸水垫、 洗必泰拭子、 2 对无乳胶手套、 适当大小超过针导管、 四无针式连接器、 预生理盐水冲洗注射器、 四扩展油管、 屏障解决方案、 四胶固定装置、 透明敷料、 transpore 磁带,2 x 2 无菌纱布和创可贴。

选择最小的大小超过针导管适合正在交付的静脉治疗,治疗,根据该机构的政策的预期的长度。可能需要重复的用品,为四屡次。

返回到病人的房间。将所有的物品放在床边的架子上,再洗你的手。现在,打开预的注射器和持有你的非显性中指和无名指之间。接下来,使用无菌技术,打开扩展油管。举行油管在您的惯用手和取男结束使用非主导拇指和食指的帽。然后,将延长管女性年底附加到男性注射器末端。

随后,举行延长油管与上限男性末端指向天花板。现在推动注射器柱塞主要的无针式连接器和延长油管直到所有空气已被都删除,从结束已表达生理盐水滴几滴。然后将延长管和连接的注射器倒在桌子上,伸手的引物无针式连接器。

现在,从透明敷料移除支持并将其粘-一边向上,触手可及。接下来,从 transpore 磁带卷卸下四个条状的磁带并打开纱布、 洗必泰包装、 四胶粘剂固定装置和创可贴包装。

下一步是选择的插入位置。明显地检查双臂为合适的静脉。头,贵中, 位数肘,和背手脉是首选。应用止血带缠在手臂,空房的插入部位近端的 10-15 厘米。止血带不应太紧以至于抹杀的远端的脉冲。评估到位止血带的空房的静脉。如果它是软和免费的并发症,如硬化、 瘀伤、 静脉炎或浸润,暂时移除止血带,并将吸水垫在手臂下。在继续之前,请再次执行手卫生。

现在,取过针导管从包装、 拆卸帽,然后把它圈与非优势手中指。检查导管和违规行为,如折弯、 绝缘层有无破损或钩子的针。移动导管中心顺时针方向,然后回到原来的位置,打破任何剩余的从灭菌过程的吸张力。这将允许顺利推进的导管。盖上盖子导管和设置过针导管很容易到达。你现在准备好继续进行导管插入

再洗你的手和不干净的手套。重新应用止血带于病人的手臂,然后点击几次到消心静脉空房的插入网站。使用洗必泰擦洗擦洗插入网站来来回回的 30 秒内,确保抗微生物穿透任何裂缝和裂隙的皮肤。然后允许的洗必泰对干完全 — — 这将使完整的杀菌活性。

下一步,取过针导管的帽和在您的惯用手握住导管。然后,使用你的非惯用手,伸展皮肤教和稳定静脉 4-5 厘米下面插入网站,注意不要污染的插入点。

现在,举行过针导管之间占主导地位的拇指和中指,用起来,锥,在 15-20 ° 角,刺破皮肤,直接在静脉。直到血倒叙的进展是可见的。然后在此基础上,几度下降的导管角度,推进用针几毫米,确保提示已传递到静脉。接下来,使用占主导地位的食指,推进枢纽的导管完全入静脉按住针稳定。然后释放你的非惯用手与止血带和闭塞静脉以帮助减少出血后针去除。

从导管,从事针安全装置,如果可用,删除针针和针下来放在床边的桌子。快速拆卸帽和插入预涂底漆的四扩展名设置入导管中心男性末尾。现在,同时稳定四扩展设置、 压低的注射器柱塞和冲洗生理盐水四确保通畅。肿胀、 发红、 或泄漏四、 现场观察和问病人是否他们感到任何的不适,在此过程中。它不是不寻常的病人要注意冷感或咸的味道在嘴里。

如果有无不良反应,然后再慢慢地,冲洗 PIV 同时从事位于四扩展设置以防止血液备份进油管钳。然后拔下注射器,将它放在床边的桌子上。

下一步是要应用敷料。第一次打开屏障解决方案包装和传播障碍解决方案 1 厘米远离和周围插入网站光膜。现在,放置在枢纽的 PIV 防止肌肤底层的压力下的两次折叠 2 x 2 纱布。随后,半透透明敷料置于插入网站和导管和挤压锚定到位的枢纽。然后从胶粘剂四固定设备移除支持并将粘边对皮肤直接下导管中心确保导管集线器到此设备。

现在,循环四、 延长油管在 U 形,向上插入网站过去并确保它与磁带到皮肤和敷料。此外,标签附加到敷料的时间和日期的插入、 您的姓名缩写和由该机构所需的任何其他信息。确保插入网站仍然可见未来评价。接下来,去掉所有包装和预的注射器在一个垃圾箱和处置过针针中的锐器盒。最后,文件 PIV 插入病人的电子健康记录之前离开病人的房间。

“利用以上针导管进行输液治疗外周静脉留置针的位置是无菌的无接触过程”。

“在 PIV 放置一个常见的错误包括清洗与消毒液,从而污染插入网站后触摸穿刺点。另一个常见的错误不允许洗必泰足够的时间干,这可能会导致降低抗菌效果和不足胶粘剂行动。”

“删除和重新从导管针插入在插入过程中应避免。因为这可能会增加用针穿刺导管或甚至导致导管进入静脉的可能性。输液护理协会定期研究和修改静脉导管安置程序。每个护士应该是指它在定期的基础上。

你刚看了朱庇特的视频上四扩展名外周静脉留置针插入设置。您应该了解所需的用品和无菌无接触技术通常执行程序。一如既往,感谢您收看 !

Applications and Summary

使用以上针导管静脉穿刺输液治疗的 PIV 的位置是无菌、 无接触的过程。总是教育有关的程序和可能出现的并发症,在静脉穿刺前病人。告知病人有关的过程和伴随插入的疼痛。此外,很多病人误以为后静脉穿刺针留在静脉。它是重要的是强调只有软、 柔性导管部分仍然和他们将能够自由移动的肢体,而造成额外的伤害。

任何输液外渗、 渗透等并发症可能会出现。指导病人的症状和体征的入渗和外渗,注意到疼痛可以并发症的最初迹象之一。事件中由于不准确放置过程中第二次穿刺是必要准备重复用品前静脉穿刺。移民和归化局建议每医务人员只有两种静脉穿刺尝试之前请求额外的帮助。在 PIV 放置一个常见的错误包括清洗与消毒液,从而污染插入网站后触摸穿刺点。另一个常见的错误是不足洗必泰溶液干燥时间,可能会导致降低抗菌行动和胶粘剂采取适当行动。卸下和重新从导管针插入在插入过程中应避免。这可能会增加用针穿刺导管或甚至导致导管进入静脉的可能性。 移民和归化局定期研究和修正四导管安置程序;因此,每个护士应提到它在定期的基础上。

References

  1. Policies and procedures for infusion nursing, Fourth Edition. Chapter 5: Vascular access device site selection and placement. Infusion Nurses Society. (2011).
  2. Potter, P. A., Perry, A. G. Fundamentals of Nursing, Seventh Edition. Elsevier. St. Louis, MO. (2009).

Transcript

The placement of a peripheral intravenous catheter is a frequently performed nursing procedure. Peripheral venous access is necessary for many aspects of patient care, including the infusion of medications, fluids, dyes, and radioactive tracers.

In this video, we will demonstrate the aseptic “no-touch” technique for insertion of a peripheral intravenous, or PIV, catheter, with the attachment of an IV extension set.

The most common sites for the placement of a PIV catheter are the arms and hands in adults, and the feet in children. The feet should be avoided in adults because of the risk of thrombophlebitis. Also, the median cubital vein and cephalic vein in the wrist should be avoided when possible due to the risk of nerve damage. Always use the most distal site possible, so that more proximal sites are still available in the case of infiltration or extravasation. Other considerations when choosing a site include pain, presence of wounds, decreased circulation, previous cerebrovascular accident, dialysis fistulas, or mastectomy.

The first step, upon entering the patient’s room, is to wash your hands with soap and warm water for 20 seconds, or use sanitizer with vigorous friction if the hands are not visibly soiled.

Next, at the bedside computer, review the patient’s electronic health record and the order for PIV insertion. Also review the patient’s history for the risk of bleeding complications, such as bleeding disorders, anticoagulant therapy, and low platelet count. Then, explain the procedure to the patient, emphasizing that only the soft, flexible catheter will remain in their vein after the venipuncture, allowing them to move the limb freely, and obtain their consent for the procedure.

It is important to verify the patient’s identity using two independent identifiers, such as the patient’s name and medical record number. Do not utilize the patient’s room or bed number as identifiers. Next, place the patient in a comfortable position and adjust the bed height to maintain an ergonomic nursing position and decrease back strain. Also, ensure that the lighting is adequate and that a bedside stand or over-the-bed table is clear for use.

For supply preparation, exit the patient’s room and wash your hands again, as previously described. Now gather the necessary supplies, which might be available as an IV insertion kit. The list of needed supplies includes a tourniquet, absorbent pad, chlorhexidine swabs, 2 pairs of latex-free gloves, appropriate size over-the-needle catheter, IV needleless connector, prefilled saline flush syringe, IV extension tubing, barrier solution, IV adhesive securement device, transparent occlusive dressing, transpore tape, 2 x 2 sterile gauze, and adhesive bandage.

Choose the smallest size over-the-needle catheter suitable for the intravenous therapy being delivered and the expected length of therapy, in accordance with the policies of the institution. Duplicate supplies, for repeated IV attempts, may be needed.

Return to the patient’s room. Place all of the supplies on the bedside stand, and wash your hands again. Now, open the prefilled syringe and hold it between your non-dominant middle and ring fingers. Next, using aseptic technique, open the extension tubing. Hold the tubing in your dominant hand and remove the cap from the male end using your non-dominant thumb and forefinger. Then, attach the female end of the extension tubing to the male end of the syringe.

Subsequently, hold the extension tubing with the capped male end pointing towards the ceiling. Now push the syringe plunger to prime the needleless connector and extension tubing until all air has been removed and a few drops of saline have been expressed from the end. Then place the primed needleless connector with extension tubing and attached syringe down on the table, within reach.

Now, remove the backing from the transparent occlusive dressing and place it sticky-side-up, within reach. Next, remove four strips of tape from the transpore tape roll and open the gauze, chlorhexidine packaging, IV adhesive securement device, and adhesive bandage packaging.

The next step is to choose an insertion site. Visibly inspect both arms for suitable veins. The cephalic, basilic, median cubital, and dorsal hand veins are preferred. Apply a tourniquet around the arm, 10-15 cm proximal to the chosen insertion site. The tourniquet should not be so tight as to obliterate the distal pulses. Assess the chosen vein with the tourniquet in place. If it is soft and free of complications such as sclerosis, bruising, phlebitis, or infiltrates, temporarily remove the tourniquet and place an absorbent pad under the arm. Before proceeding, perform hand hygiene again.

Now, take the over-the-needle catheter from the packaging, remove the cap, and place it between the ring and middle fingers of the non-dominant hand. Check the catheter and needle for irregularities, such as bends, nicks, or hooks. Move the catheter hub clockwise, and then back to the original position to break any suction tension remaining from the sterilization process. This will allow for smooth advancement of the catheter. Replace the catheter cap and set the over-the-needle catheter within easy reach. Now you are ready to proceed with catheter insertion

Wash your hands again and don clean gloves. Re-apply the tourniquet to the patient’s arm and tap the chosen insertion site several times to vasodilate the vein. Use the chlorhexidine swab to scrub the insertion site back and forth for 30 seconds, ensuring that the anti-microbial penetrates any cracks and fissures in the skin. Then allow the chlorhexidine to dry completely-this will enable complete microbicidal activity.

Next, remove the cap from the over-the-needle catheter and hold the catheter in your dominant hand. Then, using your non-dominant hand, stretch the skin taught and stabilize the vein 4-5 cm below the insertion site, taking care not to contaminate the point of insertion.

Now, hold the over-the-needle catheter between the dominant thumb and middle finger, with the bevel up, and pierce the skin at a 15-20° angle, directly over the vein. Advance until a flashback of blood is visible. Then, drop the angle of the catheter a few degrees and advance it with the needle a few millimeters to ensure that the tip has passed into the vein. Next, using the dominant index finger, advance the hub of the catheter fully into the vein while holding the needle steady. Then release the tourniquet with your non-dominant hand and occlude the vein to help reduce bleeding after needle removal.

Remove the stylet needle from the catheter, engaging the needle safety device, if available, and place the needle down on the bedside table. Quickly remove the cap and insert the male end of the pre-primed IV extension set into the catheter hub. Now, while stabilizing the IV extension set, depress the plunger of the syringe and flush the IV with normal saline to ensure patency. Observe for swelling, redness, or leaking at the IV site and ask the patient if they feel any discomfort during this process. It is not unusual for the patient to notice a cold sensation or a salty taste in the mouth.

If there are no adverse reactions, then flush the PIV again slowly, while engaging the clamp located on the IV extension set to prevent the blood from backing up into the tubing. Then remove the syringe and place it on the bedside table.

The next step is to apply the dressings. First open the barrier solution packaging and spread a light film of barrier solution 1 cm away from and around the insertion site. Now, place a twice-folded 2 x 2 gauze under the hub of the PIV to prevent pressure on the underlying skin. Subsequently, place the semi-permeable occlusive transparent dressing over the insertion site and catheter and squeeze to anchor the hub in place. Then remove the backing from the adhesive IV securement device and place the sticky side against the skin directly under the catheter hub to secure the catheter hub to this device.

Now, loop the IV extension tubing in a U-shape, pointing up past the insertion site and secure it with tape to the skin and the occlusive dressing. Also, attach a label to the occlusive dressing with the time and date of insertion, your initials, and any other information required by the institution. Ensure that the insertion site remains visible for future evaluation. Next, discard all packaging and the prefilled syringe in a trash receptacle and dispose of the over-the-needle stylet in a sharps container. Finally, document the PIV insertion on the patient’s electronic health record before leaving the patient’s room.

“Placement of a peripheral intravenous catheter using an over-the-needle catheter for infusion therapy is an aseptic no-touch procedure.”

“A common mistake in PIV placement includes touching the venipuncture site after cleaning with antiseptic solution, thereby contaminating the insertion site. Another common mistake is not allowing the chlorhexidine enough time to dry, which can cause a decrease in antimicrobial action and inadequate adhesive action.”

“Removing and reinserting the needle from the catheter during insertion should be avoided. As this may increase the possibility of puncturing the catheter with the needle or even causing the catheter to break into the vein. The Infusion Nursing Society regularly researches and revises intravenous catheter placement procedures. Every nurse should refer to it on a regular basis.”

You’ve just watched JoVE’s video on the insertion of a peripheral intravenous catheter with an IV extension set. You should understand the supplies needed and the aseptic no-touch technique of this commonly performed procedure. As always, thanks for watching!