Objective To solve the problem of sputum sample collection in patients with coma, cough fatigue and artificial airway. Methods Sputum samples were collected by Murphy's dropper combined with negative pressure suction. Results Through the clinical observation of 68 patients, the effective rate of taking sputum samples by this method was 99.5%. Conclusion Sputum can be taken from the deep respiratory tract by using Murphy's dropper for blood transfusion combined with negative pressure suction, and the sputum in Murphy's dropper for blood transfusion is not easy to directly enter the liquid storage bottle, which has a large container capacity, a large amount of residual sputum, high accuracy and success rate, and makes the detection result more accurate.
Murphy dropper; Negative pressure suction; Sputum specimen
Sputum laboratory examination and bacterial culture drug sensitivity test are commonly used as auxiliary diagnostic methods for clinical diseases, and the correctness of sputum sample collection methods directly affects the results of laboratory examination. Most patients are conscious, can actively cooperate, and cough sputum into the specimen container by themselves. However, patients with cough fatigue, coma and artificial airway cannot cough sputum into the specimen container by themselves. Therefore, it brings some difficulties to clinical nursing. Therefore, our hospital used disposable blood transfusion Murphy's dropper combined with negative pressure aspirator for sputum sampling, and achieved satisfactory results.
Clinical data of 1
1. 1 General data There were 68 patients in this group, including 52 males and 6 females 16. The age ranged from 65438 0.5 to 78 years, with an average of 565438 0 years. There were 23 cases of brain trauma, 38 cases of cerebral hemorrhage and 7 cases of brain tumor.
1.2 method
1.2. 1 disposable blood transfusion device, negative pressure aspirator, therapeutic bowl (containing normal saline) in therapeutic tray, sterile holding forceps, 1 sterile scissors, 1 alcohol lamp, sputum suction tube, tongue depressor or mouth opener.
1.2.2 the patient prepares the patient to take the supine position or lateral position, with his head tilted to one side, and cleans the patient's mouth with sterile saline cotton balls [1]. The outer tube of tracheotomy patients was disinfected with 70% alcohol, and the metal inner tube was boiled and disinfected, and then sputum samples were taken. Disposable tracheal intubation and the inner and outer ends of tracheal intubation are cleaned with sterile saline cotton swabs.
1.2.3 operation method: connect the sputum suction tube and negative pressure aspirator, suck physiological saline and try to suck it smoothly, remove the sputum suction connecting tube, unpack the blood transfusion device, and feed bananas with Mofan. Cut the cm with sterile scissors, and note the bed number, name and inspection purpose with marks. The lower end is connected with the glass connector of the aspirator, and the upper end is connected with the sputum suction tube. Adjust the negative pressure, try to suck sterile saline to check whether the connection is smooth, wet the sputum suction tube, and hold the sterile curved pliers in your right hand to clamp the front end of the sputum suction tube. For patients with artificial airway, sputum should be suctioned from the periphery of the airway first, and then a new sputum suction tube should be replaced, and then inhaled into the deep trachea of the patient to stimulate the patient to cough. When there is sputum sound, turn on the negative pressure, and use the left hand indicator to release the suction. When you see the required amount of sputum in the dropper, quickly bend the connector to block it, disconnect the dropper from the connector of the aspirator, turn off the negative pressure, pull out the sputum suction tube, discard the sputum suction tube, and disinfect the two broken ends of the dropper with alcohol lamp flame to soften it. If the sputum is thick and difficult to cough up, you can knock on your back before sputum aspiration or use a sputum discharge machine to discharge sputum, so as to reduce the adhesion of sputum to the tracheal wall through vibration and facilitate drainage. It can also be atomized and inhaled with normal saline to dilute sputum, 15 ~ 20min before inhalation [3]. Patients with artificial airway can inject 5 ~ 10ml of normal saline into the airway before sputum aspiration, and then 1 ~ 2min later, sputum can be aspirated in the above way. You can also use the infusion pump to continuously drip the humidification liquid until it is humidified and expectorant [4], and the humidification liquid can use 0.45% sodium chloride injection to avoid using antibiotics. When the coma patient sucks sputum, his head leans to one side to prevent suffocation caused by sputum and secretions blocking the airway when coughing. Patients with poor cough response can be given suprasternal depression trachea compression to stimulate their cough.
Results Through the clinical observation of 68 patients, the effective rate of taking sputum samples by this method was 99.5%.
2 discussion
Laboratory examination of sputum is an important means to provide reliable basis for diagnosis, treatment and medication. For patients with cough fatigue, coma and artificial airway, it is the focus and difficulty of nursing work to take sputum samples correctly. The patient's sputum is thick and deep, so it can't be coughed into the specimen container correctly. Because of the large capacity of the container, this method not only solves the problem that the patient's sputum blocks the respiratory tract, but also keeps the sputum sample for bacteriological laboratory inspection. In the past, many methods have been tried to solve this problem: washing the sputum in the glass joint with an empty needle filled with physiological saline, picking it with a sterile cotton swab, directly sucking the sputum with an empty needle connected to a sputum suction tube, and taking a sputum sample with a 1ml syringe combined with negative pressure suction [5]. Because the amount of sputum left is very small, it is easy to inhale the sputum into the liquid storage bottle, which is easy to pollute and extremely inconvenient. In this study, the method of blood transfusion dropper and negative pressure aspirator was used to successfully solve the problem of difficult retention of sputum samples and overcome the shortcomings of the above sputum samples. The container has a large capacity, and the Murphy dropper of the infusion set is difficult to suck. The radian of the filter and dropper can effectively prevent sputum from being directly sucked into the liquid storage bottle, leaving a large amount of sputum, which is not easy to be polluted and does not cause waste of resources. Negative pressure suction provides negative pressure suction, which solves the problem of insufficient suction, can retain sputum in the deep respiratory tract, and has high accuracy and success rate, which makes the test results more accurate, provides a reliable basis for treatment, diagnosis and medication, and achieves satisfactory clinical results. It is simple and easy to operate, convenient to obtain materials, economical and practical, and worth popularizing.
refer to
Zhang Fengyun (1): Comparison of two methods of sputum specimen collection in improving the accuracy of etiological diagnosis. Journal of Modern Nursing, 2004, 10 (5): 449.
Dai Cuiping: Self-made disposable simple tracheal intubation plugging method. Journal of Practical Nursing, 2004,20 (2): 44.
Zhao Shufang: Atomizing sputum aspiration after tracheotomy. Journal of Practical Nursing, 1995, 1 1 (10): 46.
Liu Xiaoyan: Application of continuous infusion of humidified fluid controlled by infusion pump in artificial airway. Contemporary Nurses (Academic Edition), 2004, 6: 48-49.
Zhang Yanli: Application of 1ml syringe combined with negative pressure aspirator in sputum collection. China Journal of Practical Nursing, February, 20051(1): 49.