The pain caused by the indwelling needle is a normal complication and does not constitute a medical accident.
1. Complications of indwelling needles
1. Exudation/necrosis: Symptoms and signs include tenderness, swelling, and tight and shiny skin. The temperature of the puncture site or distal end is low, there is no blood return or light pink blood return, and there is fluid leakage from the puncture point
Prevention: Use an indwelling catheter made of soft material; fix it stably; choose the puncture site correctly and avoid puncture at joints; correct puncture techniques; observe closely and make early judgments; master the speed and angle of needle insertion to avoid damaging the venous intima; understand and master tube sealing techniques.
2. Phlebitis: inflammation of the intima of the vein wall. It is divided into five types: mechanical phlebitis, chemical phlebitis, bacterial phlebitis, thrombophlebitis, and post-needle withdrawal phlebitis.
INS classification (International Venous Organization):
Grade 0: No symptoms.
Grade 1: Redness at the infusion site with or without pain.
Grade 2: Pain at the infusion site accompanied by redness and/or swelling.
Grade 3: including grade 2, cord-like formation, and cord-like veins that can be palpated.
Grade 4: Including grade 3, the length of palpable cord-like veins is greater than 1 inch, and thick fluid flows out.
Prevention: Choose an indwelling catheter made of soft material to avoid puncture at joints, stably fix the catheter and infusion tube to reduce movement; be proficient in puncture technology; fully dilute the blood and slow down the infusion speed; strictly implement asepsis Operate and observe the puncture site regularly.
3. Catheter blockage: blockage caused by blood or drugs forming emboli in the intravenous catheter.
Prevention: Intermittent infusion or positive pressure flushing; understand the incompatibility of drugs, and normal saline should be flushed between the two drugs; regularly observe liquid infusion; avoid catheter discounts, correctly select puncture points and fixed care are the key Basic elements.
4. Systemic complications:
Catheter embolism: The catheter is damaged and falls off into the circulatory system, and can move to the chest, located in the pulmonary artery or right ventricle.
Prevention: Do not insert the needle core into the catheter again, and avoid using scissors or other sharp objects near the catheter.
Air embolism:
Prevention: Exhaust air, use screw connectors, and have people guard the pressurized infusion.
Seal the tube with 10u/ml heparin, and observe whether the skin at the indwelling needle is red, swollen or cord-like when receiving rehydration every day; when the tube is not flowing smoothly, observe whether there is any obstruction by small thrombus or detachment. Tube and fold; observe whether the fixed tape and 3M film are floating, curled, or loose, and whether the skin around the splint is damaged or pressure sores. If there is any abnormality, deal with it promptly; check the contamination of the transparent dressing (there is exudate inside) , bleeding, sweating, air, etc.) should be replaced at any time.
2. Daily care of indwelling needles
After the medication, you can gently massage the peripheral blood vessels of the limbs and gently rub the back of the hands and feet to promote venous blood return. Infants and young children can use a clean small towel or The loose cotton sock bag is placed outside the indwelling needle, which reduces the psychological burden of parents worrying that the indwelling needle will slip out due to friction when the child turns over while sleeping, and also plays a role in keeping warm in winter; when the indwelling needle is on the head, avoid facing the needle side when breastfeeding or sleeping; When the indwelling needle is placed in the lower limbs, when holding the child, pass one hand through the legs and spread the feet apart. When sleeping, place small clothes and small cushions between the legs and separate the feet to avoid kicking the indwelling needle; inform older children to avoid excessive use of the indwelling needle in the limb. Activities, inducing infants and young children to use indwelling needle limbs to reduce flapping, and avoid standing or crawling for too long; when putting on undressing pants, put on the limb with the indwelling needle first, and take off the limb without the indwelling needle first; do not put the limb with the indwelling needle in the water.
3. Composition of medical accidents
1. The subjects of medical accidents are legal medical institutions and their medical staff;
2. Medical institutions and their medical staff violated medical and health management laws and regulations, as well as diagnosis, treatment and nursing norms and routines;
3. The direct perpetrator of the medical accident had subjective negligence in diagnosis, treatment and care;
4. The patient has personal injury consequences;
5. There is a causal relationship between medical behavior and harmful consequences.