Indwelling needles: Through clinical observation, in the application of peripheral intravenous indwelling needles in pediatric wards, good fixation of the indwelling needle is the key to the indwelling time and clinical application. Through more than one year of clinical practice, our department has adopted corresponding splints and fixation methods for intravenous indwelling needles in different parts of children, and achieved good results. Now we will list the intravenous indwelling needles of our hospital from June 2005 to December 2005. The needle fixation method and analysis experience are reported below. ?
1 Clinical data: Our department uses the disposable Intima-Ⅱ intravenous indwelling needle (24G) produced by BD Company. The total length of the extension tube is 9cm. It uses a needle-free sealed infusion Clav connector. Cases of use*** Total 380 cases. Retention time 96h[1]. There were 8 neonates, 176 infants, 132 infants, 104 children, 72 scalp veins, 206 upper limb veins, and 112 lower limb veins, including 12 cases with a retention time of 72 hours, 24 cases with a retention time of 48 to 60 hours, and the rest. The needles were removed within the specified retention time.
2 Method?
2.1 Supplies preparation In addition to the conventional intravenous indwelling needle puncture supplies, prepare small three-part splints of different specifications, 0.3mm thick, 3cm wide, 4cm wide, 6cm long , 8cm, 10cm, 12cm, after cutting, wrap the raw edges around it with cloth adhesive plaster, and then wrap it with a bandage in an "S" shape (note that both ends should be thick to prevent the child from damaging the skin when rubbing hard), or a sponge splint produced by BD Company. First cover the sponge with plastic wrap to prevent blood from contaminating the sponge, then wrap it with a bandage for later use (this board can be bent into the desired shape at will, especially suitable for lower limbs), and prepare an elastic mesh bandage, 4cm wide. , 6cm. ?
2.2 Fixation?
2.2.1 Apply and fix the steps. Master the superficial venipuncture technique. After the puncture is successful, use a sterile dry cotton ball pad on the Y-shaped area to prevent pressure sores. After the disinfectant has completely dried naturally [2], if the child cries violently and sweats for a long time, wipe off the sweat. Pay attention to the hair on the head so that the hair does not stick to the film. Droop the 3M Tegadem film naturally, and place the puncture point in the center of the film. Gently press the transparent adhesive tape around the puncture point, peel off the frame starting from the pre-cut of the frame structure, and gently press the tape while peeling off to better secure the indwelling needle [3], and fold the extension tube to fix it higher than the puncture point. , to prevent high venous pressure from returning blood to the extension tube, then indicate the puncture date and time, and select a suitable splint for fixation. ?
2.2.2 What are the different fixation methods for each puncture site?
2.2.2.1 The skin of newborns and infants on the head is thin and tender. It is easy to sweat after crying and is difficult to fix. Use cloth tape to fix the head circumference of the 3M film for a week, and pay attention to exposing the top of the puncture point for observation). Cut a 6cm elastic mesh bandage of appropriate length and put it on the child's head. Avoid or reduce pillows, quilts, putting on and taking off clothes, and the patient's head. It can prevent the friction of the indwelling needle from various external forces such as the child's hand pulling to prevent mechanical phlebitis and prevent detubation or partial detubation. ?
2.2.2.2 Upper limbs Choose an appropriate splint based on the size of the child’s hand and the thickness and length of the arm. For the back of the hand, choose a splint with the lower end longer than the upper end of the fingers and 1cm longer than the wrist. Children of school age who can cooperate may not need a splint. The two ends of the wrist and lower 1/3 of the forearm should be 3~6cm longer than the puncture point. The middle 1/3 of the forearm does not need a splint. The splints at both ends of the elbow joint are 3~6cm longer than the puncture point. Use 3M tape to separate the upper, middle and lower strips (can be adjusted according to the child's condition) to fix the splint. Children who are afraid or curious about the possibility of removal of the indwelling needle can cut it off. Put a 6cm or 4cm elastic mesh bandage of appropriate length on your hands to prevent accidents. ?
2.2.2.3 Use a sponge splint for the lower limbs and bend it into an "L" shape according to the size of the child's foot. Pay attention to the heel being close to the splint. Dry cotton balls can be used to plug the gaps to ensure the child's foot function. position, avoiding the discomfort and joint pain caused by forced fixation of the straight plate to the child, and then fixing it with 4 to 6 tapes to ensure the functional position of the child's lower limbs.
3 Nursing?
3.1 Guidance for children: For school-age or young children, it is necessary to praise the children for their bravery and well-behaved timely, and choose stickers of various colors that the children like, such as five-pointed stars and smiling faces. etc., stick it on the tape or forehead as a reward to encourage and stimulate the children's confidence in protecting the indwelling needles, reduce the children's fear of injections and discomfort with the indwelling needles, and tell the children in easy-to-understand words not to Pull out the needle, do not play with the exposed connector, and tell the nurse, aunt, or parents if it hurts or itch. ?
3.2 Use 10u/ml heparin to seal the tube in routine care [4]. When receiving rehydration every day, observe whether the skin at the indwelling needle is red, swollen or streaky; when the tube is not flowing smoothly, observe whether there are any small Thrombus obstruction, or whether there is detachment or folding; 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 whether the transparent application is Contamination conditions (exudation, blood oozing, sweating, air, etc.) should be replaced at any time [5]. ?
3.3 After daily maintenance medication, you can gently massage the peripheral blood vessels of the limbs and gently rub the backs of the hands and feet to promote venous blood return. Infants and young children can use a clean towel or loose cotton socks to cover the indwelling needle. , reduce the psychological burden of parents worrying that the indwelling needle will slide out due to friction when the child turns over while sleeping, and it also plays a role in keeping warm in winter; when the indwelling needle is placed on the head, avoid facing the needle when breastfeeding or sleeping; when the indwelling needle is placed on the lower limbs, when holding the child, Put one hand through both 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 over-activity of the indwelling needle and indwelling limbs, and induce infants and young children to indwell the indwelling needle in their limbs. 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. ?
4 Discuss that the use of intravenous indwelling needles can reduce children’s pain caused by repeated venipuncture and fear of injections, reduce parents’ anxiety, facilitate clinical medication, and rescue emergency and critical patients. Medication can reduce the workload of nurses and reduce the pain of children [6]. Therefore, intravenous indwelling needles are widely used in clinical practice. In the face of this special group of children, the length of time in which intravenous indwelling needles are left and the comfort of children become important issues for nurses and parents. The most concerning issue is also a sign of successful use and a prerequisite for promotion of indwelling needles. ?
The traditional fixing method is generally to use local materials, fold them with discarded empty cartons, or use small thick plywood (0.5~0.8cm). The material is too thin or too hard, has poor air permeability, and the head is simple. Fixing with the head circumference method is easy to pull off, and the functional position of the child is generally not considered when fixing. Through continuous clinical improvement, we have self-made splints of various specifications, which are breathable and comfortable, easy to disinfect (ultraviolet irradiation, wiping with chlorine-containing disinfectant), and can be used repeatedly. After using the above methods and care, there is no case of skin damage caused by improper fixation. There were 2 cases of pressure sores in which the children extubated themselves, 3 cases were allergic to tape, and 1 case was allergic to 3M film. They were cured after timely treatment. Therefore, the author believes that good fixation and correct maintenance of pediatric indwelling needles ensure the retention time of intravenous indwelling needles. , while also providing comfortable and humanized care for children. However, the problem of early decannulation due to clinical decannulation or mechanical phlebitis remains to be further explored. ?
References?
1. BD Company. Peripheral intravenous indwelling needle puncture manual?
2, 3. Chen Hedi. Causes caused by transparent application of intravenous indwelling needles Discussion on neonatal skin problems. Chinese Journal of Practical Nursing, 2004; 20(5): 38?
4. Yao Qinghua, Zhifeng, Li Baoli. Observation on the sealing effect of intravenous indwelling needles in children. China Journal of Nursing, 2000; 35(10): 624
5. Jing Ji, Yan Xiulan, Guo Ying, et al. Discussion on the replacement time of the protective film of superficial vein indwelling needles [J]. Journal of Practical Nursing, 2002; 18(16): 47?
6. Li Yumei, Zhu Huifang. Application and experience of intravenous indwelling needles in neonates. Chinese Journal of Practical Medicine, 2003; 3(2)