Another case of indwelling needle extravasation infection, try these tricks, it works!

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Indwelling needle infection case sharing

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The patient is an elderly male, who received the income on May 12 as “left femoral neck fracture” due to “fall injury of left hip with pain and limited mobility for more than 2 hours” In the hospital, the patient has a clear consciousness and a good spirit. He has a history of hypertension for more than 10 years, a history of diabetes for 5 years, and a history of cerebral infarction for 1 year.

The course of treatment

On May 19, the patient The left total hip arthroplasty was performed under combined epidural anesthesia in the operating room, and the patient returned to the ward after the operation. The pink vein indwelling needle on the right wrist received smooth fluid input, and there was no redness, swelling and extravasation at the puncture site. From the 20th to the 22nd, routine withdrawal was performed before the infusion, and a positive pressure pulse sealing tube was given at the end of the infusion, and there was no redness, swelling and extravasation at the puncture site. However, on the 23rd, extravasation occurred at the place where the indwelling needle was withdrawn during routine infusion, and the indwelling needle was removed, and another indwelling needle in the right upper arm was built for intravenous infusion. On the 24th, during the inspection, it was found that the patient’s right wrist vein indwelling needle was infected at the puncture point, and iodophor was given to disinfect the infected area and the patient was instructed to keep the affected area clean.

Drug extravasation/exudation< p>

Drug extravasation/exudation refers to the local redness, pain, swelling, heat or coolness caused by the infiltration of the drug solution into the surrounding tissues from the blood vessels during the intravenous infusion process. Phenomenon is a common adverse event in intravenous fluid therapy.

02Analysis of the causes of extravasation of indwelling needles

1. Due to the low self-resistance of elderly diabetic patients, reduced peripheral blood circulation, and poor vascular elasticity, the risk of infection of venous indwelling needles is significantly increased. According to relevant literature, the infection rate of intravenous indwelling needles in diabetic patients aged >70 years is significantly increased. The ability of proteins, phagocytes to kill pathogenic microorganisms, and monocytes to kill pathogenic microorganisms is significantly reduced, resulting in a significant increase in the risk of intravenous indwelling needle infection.

2. If the puncture site is improperly selected, the risk of infection of the venous indwelling needle will increase significantly. A thick, straight, filled blood vessel with a suitable length for the indwelling needle should be selected for puncture. Try not to use the dorsal vein of the hand, so as not to interfere with the patient’s daily activities. Pay attention to avoid joints, venous valves, and injured limbs. Paralyzed patients should choose the healthy side blood vessels. For patients who can get out of bed, lower extremity veins should not be used. Puncture catheters are contraindicated in skin diseases and infections.

According to the 2016 edition of the American INS “Standards of Practice for Infusion Therapy”, it is recommended that the outer diameter of the catheter should account for 45% of the inner diameter of the blood vessel. The following are the values ​​of the inner diameter of each vein and the outer diameter of each type of catheter to help the clinic choose the indwelling vein more scientifically.

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Note: All veins with anatomical names are middle or great veins!

3. Improper selection of instrument specifications and models, According to relevant research, the pink indwelling needle is an 18G indwelling needle, which is mainly used for surgical operations and rescue patients. However, due to its large diameter, it is necessary to select large blood vessels, and it is easy to touch the human venous valve, mechanical stimulation related to puncture and veins. Increased wall trauma can easily lead to the occurrence of indwelling needle infection. According to 6.2.2 of “Code of Practice for Intravenous Therapy Nursing” and the 2016 version of INS “Practice Standards for Infusion Therapy”, it is recommended that the protection of peripheral veins should be considered when formulating the treatment plan for access, and the choice of the one that can be applied to the treatment plan and meets the needs of the patient is recommended. The smallest size peripheral catheter. Therefore, 20-24 G catheters should be considered for most treatments, 24-26 G catheters should be considered for neonates, children and the elderly, and larger-sized catheters should be considered when rapid blood transfusion is required, which can prolong the indwelling time.

03External prevention and control measures

Use indwelling for patients We can take external prevention and control measures from the following aspects:

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1. Select the appropriate infusion method and infusion site:

Before intravenous administration, first evaluate the nature of the infused drug, infusion volume, infusion time, the patient’s blood vessels and underlying diseases, etc., and then choose the infusion drug. If possible, use a central venous catheter as much as possible. When infusion of drugs with pH < 5 or pH > 9 and osmotic pressure > 600 mOsm/L, chemical phlebitis can be formed within 24 hours, so such drugs are strictly prohibited to be infused through peripheral venous access. For peripheral intravenous infusion, the safest intravenous infusion site is the forearm, followed by the back of the hand, and the medial elbow is the worst. At the same time, repeated, multiple puncture and re-puncture below the venipuncture point on the same side within 48 hours should be avoided. Except for superior vena cava compression, intravenous infusion of lower extremity should not be selected, and intravenous infusion should be avoided as far as possible in the extremities with lymphedema and in the position of neurological dysfunction.

2. Improve puncture technique:

should be strengthened Training in venipuncture techniques for junior nursing staff to improve their puncture success rate. Once the puncture fails, the puncture should be performed again by changing the person or the site to avoid mechanical damage to the blood vessel caused by repeated puncture.

3. Strengthen the inspection and record:

clinical Nurses should strengthen the inspection of patients with intravenous infusion and make relevant records. For patients infused with high-risk drugs, elderly, critically ill, and with poor venous circulation, warning signs should be hung on the infusion stand. During each observation, the venous return should be checked, and the patient’s chief complaint should be paid attention to. Once drug extravasation is found, the infusion should be stopped immediately, and corresponding measures should be taken.

4. Establish an adverse event reporting system:

Drug extravasation is a common adverse event in intravenous infusion therapy. At present, it is mainly reported by nurses. The process is too complicated, and it is prone to omission or untimely reporting. The quality control department can establish a drug extravasation adverse event information reporting system, which collects data for more objective, accurate, and real-time information aggregation and analysis. At the same time, it can also realize intelligent reminders, and automatically collect and analyze data to provide nursing decision support.

5. Do a good job in health education:

vein Before infusion, explain the precautions of intravenous infusion to patients and caregivers, instruct the patient to maintain local braking, and inform the nursing staff that abnormal conditions such as swelling and pain at the infusion site should be notified in time. Inform the infusion of high-risk drugs or the danger of drug extravasation, which will attract the attention of patients and caregivers. If necessary, patients or caregivers can be asked to sign an informed consent form.

6. Clinical Nursing Guidelines:

Clinical Nursing Guidelines Magnesium sulfate group: while receiving infusion therapy, 33% magnesium sulfate gauze was given externally at the infusion site. Control group: no preventive measures were taken. Conclusion: Prophylactic use of 33% magnesium sulfate wet compress can effectively prevent extravasation edema of intravenous infusion, which has practical clinical significance and is worthy of promotion!

Comparison of extravasation edema in two groups Clinical observation of infusion extravasation[J].Northwest National Defense Medicine Journal,2005(05):392.

References:

[1] Zhong Lijuan. Analysis of the effect of nursing management on preventing the infection of venous indwelling needles in elderly diabetic patients [J]. Modern Diagnosis and Treatment, 2017, 28(4) :764-766.

[2] Liao Min. Analysis of nursing countermeasures for the use of intravenous indwelling needles in elderly diabetic patients [J]. Diabetes New World, 2019,11: 162-163.

[3] Wu Haiping. Strategy analysis of intravenous infusion nursing with intravenous indwelling needle in elderly diabetic patients [J]. Diabetes New World, 2020,2 :107-108.

[4] Zhong Huimei, Wang Yu, et al. Research on nursing intervention effect of hydrocolloids in elderly patients with intravenous fluid exudation. China Medical Innovation, 2020, 17(33).

[5] Xu Honglian. Care of wounds with drug extravasation. Shanghai Nursing, 2021, 21(3).

[6] Cheng Sujing, Li Changyan , et al. Advances in the prevention and nursing of chemotherapeutic drug extravasation. Jilin Medicine, 2016, 37(6).

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Case source China Nursing Management  

Article source: Guanfeng Pharmaceutical

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