Indwelling needles have become indispensable in clinical work, such as geriatrics, pediatrics, surgical patients, patients who need a lot of fluid replacement, and critical illnesses that may be rescued at any time Of course, some patients will take the initiative to tie an indwelling needle in order to reduce the pain caused by repeated puncture.
Although the indwelling needle can effectively reduce the pain caused by the puncture to the patient, bring convenience to the medical staff, and can also earn money for the rescue of the patient After a certain period of time, there are also many negative problems, one of which is a blocked needle.
Case 1
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Ma, a 65-year-old male patient, was hospitalized due to gastrointestinal bleeding. Because of his critical condition, the nurse placed an indwelling needle for him. On the second day of admission, when the nurse connected the fluid for him, he found The needle was blocked, so I subconsciously folded the infusion tube above the dropper with my hand, and squeezed the dropper several times. One side of the limb was severely swollen and painful, and was transferred to a higher-level hospital for examination and treatment. The diagnosis was thrombosis. For this, the hospital gave corresponding compensation and also dismissed the nurse.
Case 2
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Zhang Mou, male patient, 50 years old, after appendicitis, the indwelling needle was blocked during infusion, and the nurse also adopted the method of squeezing the dropper to deal with it. Although the above case did not occur, the patient However, the nurse complained to the hospital because of the severe vascular pain caused by the indwelling needle. Finally, after the hospital came forward for adjustment, the nurse apologized to the patient, and the incident ended in the paragraph.
Case Three
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Patient, Fan, female, 61 years old, was admitted to the hospital due to “diagnosed cervical cancer more than 2 months ago and required radiotherapy”.
The patient suffered from acute cerebral infarction in the left frontal lobe a week ago. After treatment, the patient’s condition is now stable, but he has aphasia and is speechless.
Due to treatment needs, the responsible nurse placed a superficial vein trocar on the back of her left hand.
During the morning shift, the night shift nurse said: The indwelling needle that Fan put on the back of his hand slipped off yesterday (see Figure 1), and it took a long time to find it on the patient’s back of.
Figure 1
After the shift, the responsible nurse C An indwelling needle was placed on the back of the right hand.
In order to prevent it from falling off again, Xiao C thought of a way to ask his family to buy a roll of self-adhesive tape (the price is about 10 yuan) and fix the straps into a “glove” shape. The family is very satisfied after seeing it, and now there is no need to worry about it falling off again.
The method is as follows
Figure 3
Fixed properly, the front effect is shown in Figure 4 , side effectThe result is shown in Figure 5.
Figure 4
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Have you paid attention to the details of the use of indwelling needles?
1, Y-type indwelling needle Heparin cap
As shown in Figure 6 below, one interface of the Y-shaped indwelling needle does not use a heparin cap, and is directly connected to the nipple of the infusion set.
In addition, it can be seen from the picture that the needle wing of the other injection needle is not fixed properly. This situation can easily lead to the disconnection of the interface from the infusion set, resulting in problems such as fluid leakage or bleeding.
Figure 6
Recommended: fix with heparin cap at another interface, or use a threaded interface The infusion set is connected to the interface.
2 and 12 gauge needles pierce the heparin cap flushing tube
as shown in Figure 7 below As shown in the figure, after the indwelling needle is punctured, the nurse uses a 12-gauge injection needle (matched with a 10ml syringe) to directly pierce the heparin cap to flush the tube. This situation tends to cause the heparin-capped rubber stopper particles to be pushed into the vessel. When these particles enter the blood circulation, they stimulate the inner wall of the blood vessel, damage the intima of the blood vessel, cause platelet aggregation and adhesion, and induce phlebitis.
Figure 7
Suggestion: use a 7-gauge injection needle for flushing and sealing the tube.
3. The indwelling needle is twisted
as shown in Figure 8 below shown, the indwelling needle under the restraint band is already twisted. This situation may cause the infusion to not drip or the indwelling needle to break.
Figure 8
Suggestion: The indwelling needle fixation site should be avoided when the restraint band is fixed. When using restraint straps, evaluate strictly as required.
1. Why can’t I squeeze the dropper by force after the indwelling needle is blocked?
The blockage of the indwelling needle is caused by the coagulation of blood at the orifice into a thrombus. , resulting in thrombosis in patients. Not only that, if the improper extrusion pressure is too high, it is easy to cause the patient’s blood vessels to rupture, and the consequences are unimaginable.
Second, how to avoid such a thing from happening?
If it is found that the patient’s indwelling needle is blocked, it must be avoided to squeeze it hard. You can flush the tube with a little normal saline first, and then use heparin sodium. And use positive pressure sealing tube or pulse sealing tube to seal the tube. After the tube is sealed, the indwelling needle clip should be moved to the nearest position to the needle core, and the indwelling needle clip should be clamped first, and then the syringe should be removed. Thereby reducing the occurrence of indwelling needle blockage.
3. What should I do after the indwelling needle is blocked?
1. If the indwelling needle is blocked by insoluble particles, the indwelling needle should be removed immediately, and the puncture site should be re-selected for puncture. Flush the tube forcibly to avoid harm to the patient.
2. If the newly formed clot blocks the indwelling needle, use an empty syringe to gently withdraw the clot as much as possible. And if the patient allows, dilute with prepared heparin sodium and clip the indwelling needle for a few minutes and then withdraw it again with an empty syringe. (Note: be sure to withdraw, do not push heparin into the indwelling needle Sodium or saline.)
Fourth, after the indwelling needle is placed, how should the patient be educated about it?
1. During the indwelling needle indwelling period, instruct the patient not to over-mobilize the puncture side To avoid phlebitis and poor blood flow caused by the indwelling needle moving back and forth in the blood vessel, the blood coagulation at the cannula tip will be shortened, and the indwelling time will be shortened.
2. During the indwelling needle infusion process, continuous hot compresses on the punctured limb, especially moist heat compresses, have the best effect. Hyperthermia improves blood circulation, promotes venous return, increases patient metabolism and phagocytic function of white blood cellsIt can help the repair of vascular wall wounds and enhance the local anti-inflammatory ability of patients.
3. For malnourished and immunocompromised patients, nutrition should be strengthened to enhance the body’s ability to repair vascular wall wounds and to resist local inflammation.
Source: Nursing Network
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