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靜脈輸液醫治的寧靜辦理與風險提防

來歷:本站采編 閱讀次數: 日期:2018-07-26 16:35:23


JINGMOSHUYESHIZHIBIRANLIANGDEWUJUNRONGYEHUOYAOYEJIANJIESHUCHUJINGMONEIDEFANGSHI。SHUYEYONGLIANG:ZHONGGUO8PING/RENJUN,FACAIGUODU3.33PING/RENJUN。



一、輸液東西的成長


1、TOUPIZHEN:LIUZHISHIHOU:YUEMO2—4h(1957NIANFAMINGDE)

2、LIUZHIZHEN:LIUZHISHIHOU:3—5TIAN

3、ZHONGJIANJINGMODAOGUAN(CVC):LIUZHISHIHOU:2ZHOU

4、ZHIRUSHIZHONGXINJINGMODAOGUANTIXI

5、SHUYEGANG(VPA):KECHIJIULIUZHIHUOBUKENDING。

BIEDE:SHUYEJIA、JINMISHUYEQI、WEILIANGDAZHENBENG、BIANXIESHISHUYEBENG

二、靜脈炎的品質辦理標準


1、JINGMOYANDECHANSHENGYINGSHIWEIHUANZHEYIZHIDEBULIANGJIEGUO,WEIZHAOGUHUSHIBULIANGSHIWU,YINGTIANXIEBULIANGFANYINGBAOGAODAN。

2、JINGMOYANDEQUANHENGFANSHIYIMEIGUOINS(MEIGUOJINGMOSHUYEZHAOGUHUSHIXUEHUI)DEBIAOZHUNWEIZHU。

3、CHENGLIFANGZHIJINGMOYANCHANSHENGZHINAN,DUIJINGMOYANDECHANSHENG、SHUIPING、YUANYOUHESUOJIENADEGANSHEGANYUBANFAEZHITONGJI,BINGYUYIBAOBAOCUNDANG。

4、ZAICHANSHENGJINGMOYANSHI,HUSHIYINGJUBEIDUIJINGMOYANDEBUWEIEZHIPINGJIADECAINENG,NENGJIENATONGYIDEBIAOZHUNLIANGBIAOLAIPANDINGJINGMOYANDESHUIPINGHEYANJUNXING,BINGJUEYISHIBUSHIXUYAOYIZHIZHAOGUHUSHIGANSHEGANYU。

5、JINGMOYANCHANSHENGHOUSUOJIENADEGANSHEGANYUBOSHOUWAN、YIZHIHEGAIZHENGBANFAJIHUANZHEXUANJIAODENGWAIRONGYINGJISHIYUHUANZHEDEBINGLIZHONG。

6、RENHEBEIPINGWEI2JIHUOYISHANGJINGMOYANCHANSHENGHOU,YINGTIANXIELINCHUANGSHUYEBINGFAZHENGJIANCEBAOBIAO,BINGANZHAOJINGMOSHUYEBINGFAZHENGJIANCESHANGBAOLIUCHENGBAOGAOYOUGUANBUFEN。

7、ANZHAOGUOJIBIAOZHUN,JINGMOYANCHANSHENGLVBIXUJIEZHIZAI5%GUIMOYINEI。

三、靜脈輸液風險身分


環境身分


GUANGMANG、CHENAI、ZHAZI、YETIPINGKOUXIAODUYUFOUDENGDENG。

裝備身分


YIZHICHEFENGSUOSHIYUKAIFANGSHI。

藥物身分


YAOWUBENSHENYOUFENGXIANZHIFANYINGYUAN。

職員身分


DAIKOUZHAO、ZHUZHONGWUJUNSHOUYI。

患者身分


TIZHICHA、GUOMINTIZHI、YAOPINJIXUDENG。

職業身分


四、靜脈輸液并發癥
(一)外滲、滲漏


LINCHUANGBIAOXIAN:PIFUFABAIHUOBANTONGMINGHUOSHUIZHONG,BANYOUTONGKUBEISHANG,PIFUJINBENG,YOUPAIXIE,(HUO)PIFUBIANSE、YOUYUSHANG、XUEZHONGZHANGDENG。

MEIGUOJINGMOSHUYEZHAOGUHUSHIXUEHUI(INS)


級別排泄:外滲臨床表現

0:BUBINGZHENG

1:皮膚發白,水腫規模最大處直徑小于1英寸,皮膚發涼、伴有或不伴有痛苦悲傷。

2—3:皮膚發白,水腫規模最大處直徑1-6英寸,皮膚發涼,伴有或不伴有痛苦悲傷。

4:皮膚發白,半通明狀,水腫規模大于6英寸,皮膚發涼,輕到中度痛苦悲傷,能夠有麻痹感。皮膚緊繃,有排泄。皮膚變色,有瘀傷,腫脹。可凹性水腫,輪回妨礙,中度到重度痛苦悲傷,任何容量的血液成品、安慰性或侵蝕性的液體排泄。

HUALIAOYAOWUWAISHENDELINCHUANGBIAOXIAN


1、SHUYEZHONGYOUZHONGZHANGJIJIXINGZHIKAOTONG。

2、WAISHENBUWEIGOUCHENGYINGJIE,YANJUNCHENGXIANCUPAOZHENJISHUIPAO、KUIYANGHUOBANKUAI,ZAIKUIYANGHUOBANKUAIXIAMIANKEJIANGOUZAOHUAISI。

3、KUIYANG、BANKUAIBUWEIZHONGJIUCHENGXIANJIANGUDEXUANSEJIAOJIA。

4、SHUNIUSHENGYING、GOUDANGSHOUXIAN。

HUALIAOYAOWUWAISHENHOUDECHUZHIZHUNSHENG


1、DANGJIEZHISHUCHU,JINKENENGHUICHOU。

2、GAIHUANSHUYEQI,SHUCHUXINLIYANSHUI。BUFENFENGSUO。

3、JUGAOHUANZHI48XIAOSHI,BUFENLENGFUHUOBINGFU(PUTONGYONGLIUSUANMEISHIFU)SHIHOUYUEWEI24XIAOSHI。

4、BUFENFENGSUO:CHANGCHANGLIYONGYAOWUYOU:XINLIYANSHUI5-10ml、TANSUANQINGNAHUOLIUDAILIUSUANNA2ml、LIDUOKAYIN2ml、DISAIMISONG1mlBUFENFENGSUODEFANGSHI:YONG20mlDAZHENQICONGCHUANCIDIANXIA1-2cmCHUZUOSHANXINGPIXIADAZHEN。DAZHENGUIMOZHIJINGDAYU10cm。

5、YOUBUFENPIFUPOKUISHIBUYAOTURENHEGAOJI,YINGDANGJIENAWUJUNHUANYAODEFANGSHICHUZHI,QINGSUANCHUANGMIANHOUYENENGGOUYONGGAOSHENYANSHUISHABUSHIFU,XIAMIANLONGGAIFANSHILINSHABU。RUOSHIYOUYANJUNDEBUFENGOUZAOHUISHANGHUOHUAISI,NENGGOUQINGNEIKEHUIZHEN,QINGCHUANGCHUZHI。

JINGMOWAISHENDECHUZHI


1、熱敷:


JIAODUOXUEZHEBAODAO,REFUKEYONGYUXUEGUANSUODUANJI、YANGLIZIRONGYE、GAOSHENYE,RUQUJIASHENSHANGXIANSU、SHENSHANGXIANSU、ALAMING、LVHUAGAI、PUTAOTANGSUANGAI、LVHUAJIA、GANLUCHUN、YANSUANANJIEDENG。

2、冷敷:


LENGFUKEYISHIBUFENXUEGUANSUODUAN,JIAZHONGBUFENSHUIZHONGHEYAOWUDEFENSAN,CONGERJIAZHONGBUFENGOUZAODEQINHAI,SHOUYAOYONGYUKANGZHONGLIUYAOWU。

3、藥物濕敷:


LINCHUANGSHANGZUICHANGCHANGLIYONGLIUSUANMEIEZHIGELEIYAOWUWAISHENDESHIFU。YOULINCHUANGSHIYANBAODAO:HONGHUACHUN+654-2+HUANGLIANHUANGBO+3%PENGSUAN+FUFANGDANCANYIZHIJIEGUOJIAOZHUYOUYULIUSUANMEI。

4、拮抗處置:


XUEGUANSUODUANYAOWU(RUQUJIASHENSHANGXIANSU、DUOBAAN、ALAMING)WAISHENKEJIENAFENTUOLAMING5-10mgRONGYU20mlXINLIYANSHUIZHONGZUOBUFENDAZHEN,GAOSHENYEYONGTONGMINGZHISUANMEIDENG。

FANGBEIYAOWUWAISHENDEFANGSHI


1、YONGSHIDANGDEYETINONGSUOYAOYE,FANGZHINONGDUGUOGAO。

2、HUALIAOQIANYINGDANGBIANRENLINGHUISUOSHUCHUYAOWUDEXINGZI,DUIBUFENHEJINGMOANWEISHUIPING。

3、ZHUNQUEPINGJIASUOTIAOXUANDEJINGMOHECHUANCIDEBUWEI。

4、ZAISHUCHUYAOWUQIANYAOCHOUHUIXUELAIZHENGSHIJINGMOSHIBUSHICHANGDA,YOUBIEDEYIWEIHUSHIQUERENBEICHUANCIDEJINGMOSHIBUSHIYIBAN,YIBANQIANFANGKEZHUYAO。

5、GEIYAOJINCHENGZHONGBUSHICHAKANJINGMOHUANJING,BUSHIKOUWENBINGRENCHUANCICHUYOUMEIYOUTONGKUBEISHANGHEZHIKAOGAN,DUIYANFANGAI、RENSHIQIANQINGHUANZHEZHONGDIANCUNJUAN。

6、JINGYOUJINCHENGNANDAOSHIDIGUANSHIBUYAOSIYUYALI。

7、DUIYEWOSHOUSHUHOUSHANGZHISHUIZHONGDEBINGRENBUTIAOXUANHUANZHIJINGMOGEIYAO。

8、YOUSHANGQIANGJINGMOZHAQUZONGHEZHENGDEBINGRENYINGDANGTIAOXUANXIAZHIJINGMO。

9、XIANSHUCHUFEIANWEIXINGHEFEIFAPAOJIYAOWU;RUOSHIDOUSHIANWEIXINGHEFAPAOJIYAOWU,YINGDANGXIANSHUCHUNONGSUOJIAOSHAODEYAOWU。LIANGZHONGYAOWUZHIJIANYAOSIYUXINLIYANSHUIHUOPUTAOTANGYETI。

10、RANGHUANZHELINGHUIYAOWUWAISHENDEBINGZHENG,ZIDONGDAOCHANGCHUQICHAKAN,DUIFANGBEIYAOWUWAISHENYOUZHUDONGGANHUA。

(二)靜脈炎


1、臨床表現:


YANJINGMOZOUXIANGCHENGXIANTIAOSUOZHUANGHONGXIAN,BUFENGOUZAOFAHONG、ZHONGZHANG、CHIRE、TONGKUBEISHANG,OURANBANWEIHANFASHAODENGMANSHENBINGZHENG。

MEIGUOZHAOGUHUSHIXUEHUI4JIFENJIBIAOZHUN


0JI:SHUYEBUWEIWUHONG、ZHONG、RE、TONGJIBUSHIGANSHOU

1JI:BUFENTONGKUBEISHANG、HONGZHONGJINGMOWUTIAOSUOZHUANGZHUANBIAN,WEISHEJIYINGJIE

2JI:BUFENTONGKUBEISHANG、HONG、ZHONG,JINGMOTIAOSUOZHUANGZHUANBIAN,WEISHEJIYINGJIE

3JI:BUFENTONGKUBEISHANG、HONGZHONG,JINGMOTIAOSUOZHUANBIAN,KESHEJIYINGJIE

2、防備:


(1)YANKUSHIXINGWUJUNSHOUYICAOZONGZHUNSHENG,YAOWUJIDAZHENYONGWUJUNHESHICAOZONGQINGQIU,JINFANGSHUYEWEILIJINRUXUEGUAN。

(2)YANJINZAITANHUANDEZHITIXINGJINGMOCHUANCIHEBUYE,SHUYEZUIHAOXUANYONGSHANGZHIJINGMO。SHUCHUANWEIXINGJIAOQIANGDEYAOWU、ANJISUANLEIHUOQIYUGAOSHENYAOYESHI,YINGJINKENENGXUANYONGCUXUEGUAN,SHUZHUSULVYAOMAN。

(3)YANKUBAWOYAOWUPEIWUJIHUI。

(4)DUICHIJIUJINGMOSHUYEZHEYAOYOUDASUANDEGAIHUANDAZHENBUWEI。YOULIUZHIZHENDEHUANZHE,ZENGQIANGLIUZHIZHENLIUZHISHIDAIDEZHAOGUHUSHI。

(5)ZENGQIANGYANGFEN,ZENGQIANGJITIDUIXUEGUANBICHUANGSHANGDEXIUFUCAINENGHEDUIBUFENYANZHENGDEKANGYANCAINENG。

3、處置:


YIDANCHANSHENGJINGMOYAN,DANGJIEZHIZAICIBUWEISHUYE,ZHIDONGBINGJUGAOHUANZHI。BUFENYONG50%LIUSUANMEIGANLENGFU,MEICI20FENZHONGYISHANG,ZHURILIANGCI。HUOEZHICHAODUANBOLILIAOHUOYONGGELEIFANGSHIEZHIZHONGYAONEIFU,RUGUIBINGCHUANRAN,ZUNYIZHUSIYUKANGSHENGSUYIZHI。

(三)發燒反映


1、臨床表現:


ZAISHUYEJINCHENGZHONGCHENGXIANFALENG、HANJINHEFASHAO。QINGZHE38CBAIBU,BINGBANYOUTOUTONG、EXIN、TUNI、XINJI,ZHONGZHEGAORE、HUXIJIANKU、FANZAOBUAN、XUEYAJIANGLUODENG。

2、防備:


(1)ZENGQIANGYIWUXIN,YANKUSHIXINGHEDUIGUIZHI。DANGZHENCHACHAOYAOWUJIDAZHENYONGWUSHIBUSHIHESHIQINGQIU。

(2)YANKUSHIXINGWUJUNCAOZONGZHUNSHENG:ANPINGGEJUHOUXIAODU;JIAYAODAZHENQIYAOYANKUSHIXINGYIRENYIJU,BUDEPINPINLIYONG;SHUYECAOZONGBIAOZHUN,FANGZHIYETISHUCHUCAOZONGSHIJINGHUADENG。

(3)JIAYAOSHIFANGZHIPINPINLVCITONGYIBUWEICHUANCIPINGSAI。

(4)JINBUCHUANCISHOUYI,JINKENENGZUODAOTIGANGQILING,CHUANCISHENGLIHOULAOGUHAO,YIFANGZHIPINPINCHUANCIJINGMOZENGTIANJINGHUADEFENGXIAN。

(5)ZHUZHONGYAOWUPEIWUJIHUI。

3、處置:


(1)FASHAOFANYINGQINGZHE,JIANMANSHUYESULV,ZHUZHONGBAONUAN。

(2)GAOREZHESIYUWULIJIANGWEN,CHAKANXINGMINGTIZHENG,ANYIZHUSHISHICHUZHI。

(3)DUIYANJUNFASHAOFANYINGZHEYINGEZHISHUYE,YUDUIZHENGCHUZHIWAI,YINGBAOLIUSHUYEYONGJUHERONGYEBEICHA。

(四)氛圍栓塞


1、臨床表現:


HUANZHETUFAXINGXIONGMEN,XIONGGUHOUTONGKUBEISHANG、XUANYUN,XUEYAJIANGLUO,SUIJIHUXIJIANKU,YANJUNZIGAN,BINGRENYOUBINSIGAN。

2、防備:


(1)CHACHAOSHUYEZHUANGPEIPILIANSHIBUSHIWUQUE,CHUANCIQIANWANQUANPAIQI。

(2)SHUYEJINCHENGZHONGQINXUNCHA,SHISHIGAIHUANZENGJIAYAOWU,SHUYEZHONGLESHISHIBOZHEN,JIAYASHUYEXUZHUANRENBAOHU。

3、處置:


(1)DANGJIZHIHUANZHEYUZUOBIANWOWEI,BINGJIANCHITOUDIZUGAOWEI。

(2)SIYUGAOLIULIANGYANGQIXIRU。ZHOUMICHAKANHUANZHEBINGQINGBIANGENG。

(五)急性肺水腫


1、臨床表現:


HUANZHEERANCHENGXIANHUXIJIANKU、XIONGMEN、QICU、KESOU、KEPAOMOTANHUOPAOMOYANGXUEXINGTAN。

2、防備:


(1)ZUOHAOANKANGJIAODAO,ANZHAOCHABIERENQUN、CHABIEHUANZHEDEBINGQINGDIAOLIHAODISU,BINGQIEFENGGAOHUANZHEQIEWUSUIBIANDIAOLI。

(2)CHANGCHANGXUNCHAHUANZHE,CHAKANSHUYESULVHEHUANZHEFANYINGGANSHOU。

3、處置:


CHANSHENGFEISHUIZHONGSHIDANGJIJIANMANHUOEZHISHUYE,ZAIBINGQINGXUKEHUANJINGXIASHIHUANZHEQUWEIZUOWEI,LIANGTUIXIACHUI,SIYUGAONONGDUYANGQIXIRU(6-8L/min),YU20—30%DEYICHUNRONGYESHIHUAYANGQI,ZUNYIZHUSIYUPINGJING、QIANGXIN、LINIAOZHANZHENGCHUANDEYAOWU,XUYAOSHIEZHISIZHILUNZHA,XUEJIANZHUANYIXUELIANG。

(六)導管相干性靜脈血栓構成


1、臨床表現:


SHUYESULVJIANMANHUOEZHI;FASHAOHUOBUSHUCHANG;MEIFACHONGSHUADAOGUAN;CHECHUDAOGUANSHIFAMINGDAOGUANCUZHUOBUPING;XIONGTONG;XINDONGGUOSU。

2、產生緣由:


DAOGUANZAIXUEGUANQUZHECHUHUOSHUNIUCHUSHOUYAHUOWAIQU,DAOGUANNEIYOUYIWUSAIGUANQIANG。

3、處置:


BADIAODAOGUAN,ANZHAOYIZHURONGSHUAN。






 關頭詞:靜脈輸液





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