The back of the hand is the first choice for venipuncture? Wrong!

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Traditionally, the puncture site for intravenous infusion should not be the back of the hand or the forearm. Puncture infusion in the lower extremity. Patients with long-term intravenous infusion, the elderly, children, weight loss, and poor vascular conditions need to select and protect large blood vessels in a planned way, so that the blood vessels damaged by long-term infusion can be restored. The use principle of “end” makes the puncture range wider.

So, how do you choose the intravenous infusion site clinically?

Venipuncture is crazy for you

Recently, the author saw a picture of intravenous infusion taken by a nursing colleague in the circle of friends. As can be seen from the figure, it is estimated that the patient used the two finger veins for infusion this week. It is understood that the patient is an old patient with cholangiocarcinoma and has been hospitalized for more than ten times.

Anyone who chooses finger vein puncture must be a helpless choice. I admire this colleague’s venipuncture technique very much. !

Coincidentally, I also saw it during my nursing rounds recently. A patient in the surgical ward is instilling intravenous fluids in the thumb, and it is understood that such a difficult puncture can only be done by a master.

Similar situations are not uncommon in clinical practice, the above picture , the intravenous indwelling needle on the back of the patient’s hand was maintained for two-way micropump administration.

Intravenous fluids Do you prefer the back of the hand or the forearm?

Then the question is, how to choose the puncture site for intravenous infusion? If you still choose the puncture site and vein according to the traditional principles, you are wrong! The latest “2016 version of the standard of practice for infusion therapy” recommends that the puncture site for intravenous infusion is: the forearm is the first choice.

Therefore, if the forearm has optional indwelling blood vessels, the forearm should be preferred rather than the back of the hand. So, we really need to change the old concept.

To compare the difference between the 2011 version and the 2016 version of the standard:

Needle or central vein?

Although the concept of “zero tolerance for steel needles” has been advocated for many years, it is still difficult to fully promote it due to various reasons. Let’s take a look at the latest practice standards for infusion therapy:

1. The basic principles for selecting blood vessels and infusion tools are: according to the patient’s condition and the length of the course of treatment , the speed of infusion, the characteristics of the drugChoose different blood vessels and different puncture tools according to sex.

2. The vascular access device planning needs to consider: the characteristics of the infusion fluid, the available puncture sites, and the protection of peripheral venous vessels.

Therefore, as in this article, if PICC or CVC can be selected as infusion fluid The approach may be more reasonable.

Adult infusion, why should not choose lower limbs?

Whether it is the traditional concept or the latest standards, it is not recommended for adult patients to choose lower extremity intravenous infusion for the following reasons:

Due to the effect of gravity and the distal end of the lower extremity, the venous circulation of the lower extremity is not as good as that of the upper extremity. The lower extremity infusion drug can pump blood through the heart to reach the effect of the whole body at a slower time than the upper extremity infusion.

Because the elderly are weak and need to stay in bed for a long time after major surgery, the blood circulation of the lower extremity veins is poor. Water, blood loss, blood thickening, slow blood flow, and thus easy to form lower extremity venous thrombosis.

If the infusion needle is stuck in the lower extremity, the movement of the patient’s lower extremity will be restricted, which will result in poorer blood circulation in the veins of the lower extremity and worsen. Lower extremity venous thrombosis is prone to occur. If the thrombus in the vein falls off, once the embolism is embolized in the lung, brain, kidney and other parts, it will also cause serious consequences.

Source: China Medical Network

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