Standard "Care of the peripheral venous and subclavian catheter". How to care for your central venous catheter Daily catheter care

Wash your hands.

Assemble a standard vein catheterization kit that includes: sterile tray, waste tray, syringe with 10 ml of heparinized solution (1:100), sterile cotton balls and wipes, adhesive tape or adhesive dressing, skin antiseptic, peripheral IV catheters of several sizes, adapter or connecting tube or obturator, tourniquet, sterile gloves, scissors, splint, medium-width bandage, 3% hydrogen peroxide solution.

Check the integrity of the packaging and the shelf life of the equipment.

Make sure you have a patient in front of you who is scheduled for vein catheterization.

Provide good lighting, help the patient to take a comfortable position.

Explain to the patient the essence of the upcoming procedure, create an atmosphere of trust, give him the opportunity to ask questions, determine the patient's preferences in relation to the place of placement of the catheter.

Prepare a sharps disposal container.

Select the site of the proposed vein catheterization: apply a tourniquet 10-15 cm above the proposed catheterization zone; ask the patient to squeeze and unclench the fingers of the hand to improve the filling of the veins with blood; select a vein by palpation, taking into account the characteristics of the infusate, remove the tourniquet.

Choose the smallest catheter, considering the size of the vein, the required rate of insertion, the schedule for intravenous therapy, the viscosity of the infusate.

Clean your hands with antiseptic and put on gloves.

Re-apply the tourniquet 10-15 cm above the selected area.

Treat the catheterization site with a skin antiseptic for 30-60 seconds, let it dry. DO NOT TOUCH THE TREATED AREA!

Fix the vein by pressing it with your finger below the intended insertion site.

Take the catheter of the selected diameter and remove the protective sheath. If there is an additional plug on the case, do not throw the case away, but hold it between the fingers of your free hand.

Insert the catheter on the needle at an angle of 15° to the skin, observing the appearance of blood in the indicator chamber.

If blood appears in the indicator chamber, reduce the angle of the needle-stylet and insert the needle a few millimeters into the vein.

Fix the stylet needle, and slowly slide the cannula all the way from the needle into the vein (the stylet needle is not completely removed from the catheter yet).

Remove the tourniquet. Do not allow the stylet needle to be inserted into the catheter after it has been moved into the vein!

Clamp the vein to reduce bleeding and permanently remove the needle from the catheter, dispose of the needle in a safe manner.

Remove the cap from the protective sheath and close the catheter or attach the infusion set.

Secure the catheter with a fixation bandage.

Dispose of waste in accordance with the safety regulations and the sanitary and epidemiological regime.

Daily catheter care

It must be remembered that maximum attention to the choice of a catheter, the process of its placement and quality care for it are the main conditions for the success of treatment and prevention of complications. Strictly observe the rules for operating the catheter. Time spent in careful preparation is never wasted!

Each catheter connection is a gateway for infection to enter. Touch the catheter as little as possible, strictly follow the rules of asepsis, work only with sterile gloves.

Change sterile plugs frequently, never use plugs that may have been contaminated on the inside.

Immediately after the introduction of antibiotics, concentrated glucose solutions, blood products, flush the catheter with a small amount of saline.

To prevent thrombosis and prolong the functioning of the catheter in the vein, additionally flush it with saline during the day between infusions. After the introduction of saline, do not forget to inject a heparinized solution (at a ratio of 2.5 thousand units of sodium heparin per 100 ml of saline).

Monitor the condition of the fixing bandage, change it if necessary.

Regularly inspect the puncture site for early detection of complications. With the appearance of edema, redness, local fever, catheter obstruction, pain during the administration of drugs and their leakage, the catheter must be removed.

When changing the adhesive bandage, it is forbidden to use scissors, as this can cut off the catheter, and it will enter the circulatory system.

For the prevention of thrombophlebitis, thrombolytic ointments (lyoton-1000, heparin, troxevasin) should be applied in a thin layer to the vein above the site of function.

If your patient is a small child, be careful not to remove the dressing and damage the catheter.

When adverse reactions on the drug (pallor, nausea, rash, shortness of breath, rise in body temperature), call your doctor.

Regularly record information on the volume of drugs administered per day, the rate of their administration in the patient's observation chart in order to monitor the effectiveness infusion therapy.

CARE OF YOUR CENTRAL VENOUS CATHETER (CVC)

Indications for the use of central veins: 1) the need for long-term infusion therapy; 2) the introduction of vasoactive and irritating peripheral veins of substances; 3) for rapid volumetric infusion of solutions; 4) carrying out hemosorption and plasmapheresis; 5) in the absence of venous access in the periphery; 6) monitor monitoring of pressure in the cavities of the heart; 7) rational, "without pain", blood sampling for analysis.

General information. Catheterization of the central vein is carried out by a doctor. The procedural nurse is responsible for preparing the workplace, preparing the patient for the procedure, helping the doctor put on sterile overalls, assisting him in performing catheterization. After the procedure, the child is placed on his back without a pillow with his head turned to the side (prevention of aspiration of vomit). He controls his drinking regimen: he is allowed to drink no earlier than 2 hours later, eat - 4 hours after catheterization. Conducts constant monitoring of blood pressure, heart rate, respiratory rate. Provides care for the central venous catheter.

How to care for your central venous catheter

To prevent purulent complications, you should follow the rules of asepsis and antisepsis, at least 1 time in 3 days, if necessary more often, change the fixing bandage with the treatment of the puncture hole and the skin around it with an antiseptic; wrap a sterile napkin around the junction of the catheter with the system for intravenous drip infusions, and after infusion - the free end of the catheter. Repeated contact with the element of the infusion system should be avoided, access to it should be minimized. Carry out a change of infusion systems for intravenous infusion of solutions, antibiotics daily, replacement of tees and conductors - once every two days (for patients with a cytopenic state - daily). The use of a sterile fixing bandage provides protection against infection from the outer surface of the catheter.

In order to prevent thrombosis of the catheter by a blood clot, it is preferable to use catheters with an anticoagulant coating. If the catheter is thrombosed, it is unacceptable to flush it to remove the thrombus.

To prevent bleeding from the catheter, the plug should be tightly closed, tightly fixed with a gauze cap, and the position of the plug should be constantly monitored.

In order to prevent air embolism, it is necessary to use catheters with a lumen diameter of less than 1 mm. Manipulations, which are accompanied by disconnection and attachment of syringes (droppers), are preferably carried out on exhalation, pre-blocking the catheter with a special plastic clamp, and if there is a tee, blocking its corresponding channel. Before connecting a new line, make sure it is completely filled with mortar. It is preferable to use small highways (the probability of an air embolism decreases).

To prevent spontaneous removal and migration, use only standard catheters with needle pavilions, fix the catheter with adhesive tape (a special fixing bandage). Before infusion, check the position of the catheter in the vein with a syringe. Do not use scissors to remove the adhesive tape, as the catheter may be accidentally cut off and migrate into the circulatory system.

Workplace equipment: 1) a bottle with a filled system for intravenous drip infusions of a single use, a tripod; 2) a bottle of heparin with a volume of 5 ml with an activity of 1 ml - 5000 IU, an ampoule (bottle) with a solution of sodium chloride 0.9% - 100 ml; 3) syringes with a capacity of 5 ml, single-use injection needles; 4) sterile catheter plugs; 5) sterile material (cotton balls, gauze triangles, napkins, diapers) in biks or packages; 6) tray for sterile material; 7) tray for used material; 8) caps in the package; 9) sterile tweezers; 10) tweezers in a disinfectant solution; 11) file, scissors; 12) a container-dispenser with an antiseptic agent for treating the skin of patients and the hands of staff; 13) a container with a disinfectant for processing ampoules and other injectable dosage forms; 14) plaster (regular or Tegoderm type) or other fixative bandage; 15) mask, medical gloves (single use), waterproof decontaminated apron, protective glasses(plastic screen); 16) tweezers for working with used tools; 17) containers with a disinfectant for disinfecting surfaces, washing used needles, syringes (systems), soaking used syringes (systems), soaking used needles, disinfecting cotton balls, gauze wipes, used rags; 18) clean rags; 19) tool table.

Preparatory stage of the manipulation. 1.

3. Wash hands with running water, lathering twice. Dry them with a disposable napkin (individual towel). Treat hands antiseptic.

4. Put on an apron, mask, gloves.

5. Treat the surface of the manipulation table, tray, apron, bix with a disinfectant solution. Wash gloved hands with soap and running water, dry.

6. Put the necessary equipment on the tool table.

7. Cover the sterile tray, putting everything you need on it. There is another option for working with sterile material when it is in packages.

Connecting the infusion system to the CVC. 8. Treat the vial with isotonic sodium chloride solution.

9. Draw 1 ml of solution into one syringe, 5 ml into the other.

11. Clamp the catheter with a plastic clamp. Clamping the catheter prevents bleeding from the vessel and air embolism.

12. Remove the "old" pear-shaped bandage from the catheter cannula.

13. Treat the catheter cannula and plug with an antiseptic, keeping the end of the catheter suspended at a certain distance from the cannula.

14. Put the treated part of the catheter on a sterile diaper, placing it on the baby's chest.

15. Treat gloved hands with an antiseptic.

16. Remove the cork from the cannula and discard. If there are no additional sterile plugs, then put it in an individual container with alcohol(used once).

17. Attach the syringe with sodium chloride solution 0.9%, open the clamp on the catheter, remove the contents of the catheter.

18. Using another syringe, flush the catheter sodium chloride solution 0.9% in an amount of 5-10 ml.

To avoid air embolism and bleeding, it is necessary to pinch the catheter with a plastic clamp each time before disconnecting the syringe, system, plug from it.

19. Attach the system for intravenous drip infusion to the cannula of the jet-to-jet catheter.

20. Adjust the rate of introduction of drops.

21. Wrap a sterile cloth around the junction of the catheter with the system.

Disconnecting the infusion set from the CVC. Heparin "lock". 22. Check the stickers on the bottles with heparin And sodium chloride solution 0.9%(name of the drug, quantity, concentration).

23. Prepare vials for manipulation.

24. Draw 1 ml of heparin into the syringe. Introduce 1 ml of heparin into a vial with a solution of sodium chloride 0.9% (100 ml).

25. Draw 2 - 3 ml of the resulting solution into a syringe.

26. Close the dropper, pinch the catheter with a plastic clamp.

27. Remove the gauze covering the joint between the catheter cannula and the system cannula. Transfer the catheter to another sterile napkin (diaper) or to the inner surface of any sterile package.

28. Treat your hands with an antiseptic solution.

29. Disconnect the dropper and attach a syringe with diluted heparin to the cannula, remove the clamp and inject 1.5 ml of the solution into the catheter.

30. Clamp the catheter with a plastic clamp, disconnect the syringe.

31. Process the catheter cannula ethyl alcohol, to remove traces of blood, another protein preparation, glucose from its surface.

32. Put a sterile cork on a sterile napkin with sterile tweezers and close the catheter cannula with it.

33. Wrap the catheter cannula with sterile gauze and secure with a rubber band or adhesive tape.

Changing the bandage that fixes the CVC. 34. Remove the old fixing bandage.

35. Treat gloved hands with an antiseptic solution (put on sterile gloves).

36. Treat the skin around the catheter insertion site first 70% alcohol, then antiseptic iodobac (betadine etc.) in the direction from the center to the periphery.

37. Cover with a sterile napkin, withstand exposure for 3-5 minutes.

38. Dry with a sterile cloth.

39. Apply a sterile dressing to the catheter entry site.

40. Fix the bandage with a Tegoderm plaster (Mefix, etc.), completely covering the sterile material.

41. Indicate on the top layer of the patch the date of applying the bandage.

Note. If an inflammatory process occurs around the site of catheter insertion (redness, induration), after consultation with the attending physician, it is advisable to use ointments (betadine, seen, ointment with antibiotics). In this case, the dressing is changed daily, and on the patch, in addition to the date, “ointment” is indicated.

42. Disinfect used medical instruments, catheters, infusion systems, apron in appropriate containers with a disinfectant solution. Treat work surfaces with a disinfectant solution. Remove gloves and decontaminate them. Wash hands under running water with soap, dry, treat with cream.

43. Provide a protective regime for the child.

44. Record in medical records indicating the date, time of infusion, the solution used, its amount.

Possible complications: 1) purulent complications (suppuration of the puncture canal, thrombophlebitis, phlegmon, sepsis); 2) thrombosis of the catheter with a blood clot; 3) bleeding from the catheter; 4) air embolism, thromboembolism; 5) spontaneous removal and migration of the catheter; 6) sclerosis of the central vein in case of frequent change of the catheter; 7) infiltration; 8) an allergic reaction to medications and etc.

PUNCTION AND CATHETERIZATION OF PERIPHERAL VEINS

General information. The use of a peripheral venous catheter (PVC) enables long-term infusion therapy, makes the catheterization procedure painless, and reduces the frequency of psychological trauma associated with numerous punctures of peripheral veins. The catheter can be inserted into the superficial veins of the head, upper and lower extremities.

The duration of operation of one catheter is 3-4 days. For patients receiving long-term treatment, it is advisable to start venous catheterization with a peripheral catheter from the veins of the hand or foot. In this case, during their obliteration, the possibility of using higher-lying veins remains. When operating a peripheral venous catheter, the rules of asepsis and antisepsis should be strictly observed. Thoroughly clean the connection points of the catheter with the system for intravenous drip infusions, connector, cork from blood residues, cover with a sterile napkin. Monitor the condition of the vein and skin in the puncture area. To prevent bleeding from the catheter, air embolism, firmly fix the plug on the catheter cannula, press the vein to the top of the catheter each time before removing the plug, turning off the system, syringe. If a connector (wire) with a tee is attached to the catheter, block the corresponding channel of the tee. To avoid thrombosis of the catheter with a blood clot, the catheter temporarily not used for infusion must be filled with a heparin solution (see paragraphs 20-31 “Care of the central venous catheter”). To prevent external migration of the catheter with the formation of subcutaneous hematoma and/or paravasal injection medicinal substance constantly monitor the reliability of fixation of the catheter, check its position in the vein with a syringe. When placing a catheter in the joint area, use a splint.

Workplace equipment: 1) a bottle (ampoule) with a solution of sodium chloride 0.9%; 2) peripheral venous catheter, plugs for the catheter; 3) syringes with a capacity of 5 ml, single-use injection needles; 4) sterile material (cotton balls, gauze wipes, diapers) in bixes or packages; 5) tray for sterile material; 6) tray for used material; 7) hoes in packages; 8) sterile tweezers; 9) tweezers in a disinfectant solution; 10) nail file, scissors; 11) tourniquet; 12) a container-dispenser with an antiseptic agent for treating the skin of patients and the hands of staff; 13) a container with a disinfectant solution for processing ampoules and other injectable dosage forms; 14) plaster (regular or Tegoderm type) or other fixative bandage; 15) mask, medical gloves (single use), waterproof apron, goggles (plastic screen); 16) tool table; 17) tweezers for working with used tools; 18) containers with a disinfectant for disinfecting surfaces, washing used syringes (systems), soaking used syringes (systems), soaking used needles, disinfecting cotton and gauze balls, used rags; 19) clean rags.

Preparatory stage of the manipulation. 1.Inform the patient (close relatives) about the need to perform and the nature of the procedure.

2. Obtain the consent of the patient (close relatives) to perform the procedure.

3. Wash hands with running water, lathering twice. Dry them with a disposable napkin (individual towel). Treat your hands with an antiseptic.

4. Put on an apron, mask, gloves.

5. Treat the surface of the manipulation table, tray, apron, bix with a disinfectant solution. Wash gloved hands with running water and soap, dry, treat with an antiseptic.

6. Put the necessary equipment on the tool table. Check the expiration dates, the integrity of the packages.

7. Cover the sterile tray, putting everything you need on it. There is another option for working with sterile material when it is in packages.

8. Treat the vial with sodium chloride solution 0.9%.

9. Draw 5 ml of the solution into the syringe.

10. Put on safety goggles (plastic shield).

The main stage of the manipulation. 11. Apply a tourniquet above the intended site of the catheter. In young children, it is better to use digital vein pressure (performed by a nurse assistant). 12. Treat the skin in the area of the veins of the back of the hand or the inner surface of the child's forearm with an antiseptic agent (two balls, wide and narrow).

13. Treat hands with an antiseptic.

14. Take the catheter in your hand with three fingers and, pulling the skin in the vein area with the other hand, puncture it at an angle of 15-20.

15. When blood appears in the indicator chamber, slightly pull the needle while pushing the catheter into the vein.

16. Remove the tourniquet.

17. Press the vein to the top of the catheter (through the skin), remove the needle completely.

18. Connect a syringe with isotonic sodium chloride solution to the catheter, rinse the catheter with the solution.

19. In the same way, pressing the vein with one hand, disconnect the syringe with the other hand and close the catheter with a sterile stopper.

20. Clean the outer part of the catheter and the skin under it from traces of blood.

21. Fix the catheter with a plaster.

22. Wrap the cannula of the catheter with a sterile gauze, fix it with adhesive plaster, bandage it.

23. Transfer (transport) the child to the ward, connect the dropper (syringe pump). If intravenous infusions through a peripheral venous catheter will not be carried out in the near future, fill it with a solution of heparin (see paragraphs 22-33 "Care of the central venous catheter").

The final stage of the manipulation. 24. Disinfect used medical instruments, catheters, infusion systems, apron in appropriate containers with a disinfectant solution. Treat work surfaces with a disinfectant solution. Remove gloves and decontaminate them. Wash hands under running water with soap, dry, treat with cream.

25. Provide a protective regime for the child.

26. Make an entry in the medical records indicating the date, time of infusion, the solution used, its amount.

Possible Complications

Puncture of the veins of the calvarium

BUTTERFLY NEEDLE WITH CATHETER

General information. In young children, drugs can be injected into the superficial veins of the head. During the procedure, the child is fixed. His head is held by a nurse assistant, hands to the body and legs are fixed with a diaper (sheet). If there is hairline at the site of the intended puncture, the hair is shaved off.

Workplace equipment: 1) “butterfly” needle with a single-use catheter; 2) a bottle with a filled system for intravenous drip infusions of a single use, a tripod; 3) an ampoule (bottle) with a solution of sodium chloride 0.9%; 4) a single-use syringe with a volume of 5 ml, injection needles; 5) sterile material (cotton balls, gauze triangles, napkins, diapers) in packages or bixes; 6) tray for sterile material; 7) tray for used material; 8) caps in the package; 9) sterile tweezers; 10) tweezers in a disinfectant solution; 11) file, scissors; 12) a container-dispenser with an antiseptic agent for treating the skin of patients and the hands of staff; 13) a container with a disinfectant solution for processing ampoules and other injectable dosage forms; 14) plaster (regular or Tegoderm type) or other fixative bandage; 15) medical gloves (single use); mask, goggles (plastic screen), waterproof decontaminated apron; 16) tweezers for working with used tools; 17) containers with a disinfectant for surface treatment, washing of used needles, syringes (systems), soaking of used syringes (systems), needles, disinfection of cotton balls and gauze wipes, used rags; 18) clean rags; 19) tool table.

Preparatory stage of the manipulation. 1.Inform the patient (close relatives) about the need to perform and the nature of the procedure.

2. Obtain the consent of the patient (close relatives) to perform the procedure.

3. Wash hands under running water, lathering twice. Dry hands with a disposable napkin (individual towel). Treat your hands with an antiseptic. Wear an apron, gloves, mask.

4. Treat the surface of the manipulation table, tray, apron, stand for the system with a disinfectant solution. Wash gloved hands under running water with soap, dry, treat with an antiseptic.

5. Put the necessary equipment on the tool table.

6. Cover the sterile tray.

7. Print out packages with a butterfly catheter, syringes, put on a tray. There is another option for working with sterile material when it is in packages.

8. Treat the ampoule (vial) with sodium chloride solution 0.9%.

9. Draw 2 ml into the syringe connect to the catheter, fill it and put it on the tray.

10. Fix the child (performed by a nurse assistant). Put a sterile diaper next to the baby's head.

11. Put on safety goggles (plastic screen).

The main stage of the manipulation. 12. Select a vessel for puncture and treat the injection site with two balls with an antiseptic (one wide, the other narrow) in the direction from the parietal to the frontal region. For better blood supply to the vein, it is convenient to use a special elastic band applied around the head below the punctured area (above the eyebrows). Local digital vein clamping is ineffective due to the abundance of venous anastomoses of the cranial vault. The crying of the baby also contributes to the swelling of the veins of the head.

13. Treat gloved hands with an antiseptic.

14. Stretch the skin in the area of the proposed puncture to fix the vein.

15. Puncture a vein with a butterfly needle with a catheter in three stages . To do this, direct the needle along the blood flow at an acute angle to the surface of the skin and puncture it. Then advance the needle approximately 0.5 cm, pierce the vein and direct it along its course. If the needle is not in the vein, return it without removing it from under the skin and re-puncture the vein.

Insertion of a needle into a vessel immediately after skin puncture may result in puncture of both walls of the vessel.

16. Pull the plunger of the syringe connected to the catheter. The appearance of blood indicates the correct position of the needle. If an elastic band was used to increase blood supply to the vein, remove it.

17. Inject 1 - 1.5 ml sodium chloride solution 0.9%, to avoid thrombosis of the needle with a blood clot and to exclude the possibility of extravasal administration of the drug.

18. Fix the needle with three strips of adhesive tape: 1st - across the needle to the skin. 2nd - under the "wings" of the "butterfly" needle with a cross over them and fixation to the skin, 3rd - across the wings of the "butterfly" needle to the skin.

19. Roll up the catheter and fix it with adhesive tape on the scalp to prevent its displacement.

20. If necessary, if the angle of the needle with respect to the curve of the skull is large, place a gauze (cotton) ball under the cannula of the needle.

21. Pull the plunger of the syringe connected to the catheter to recheck the position of the needle in the vein.

22. Disconnect the syringe, connect the dropper on the solution jet.

23. Use the clamp to adjust the rate of drug administration.

24. Cover the junction of the cannulae of the catheter and dropper with a sterile gauze.

The final stage of the manipulation. 25. After completion of the infusion, clamp the dropper tube with a clamp. Carefully peel off the adhesive tape from the skin. Press the ball with an antiseptic into the place where the needle enters the vein. Remove the needle (catheter) along with the adhesive tape.

26. Apply a sterile napkin to the puncture site, a pressure bandage on top.

27. Disinfect used medical instruments, catheters, infusion systems, apron in appropriate containers with a disinfectant solution. Treat work surfaces with a disinfectant solution. Remove gloves and decontaminate them. Wash hands under running water with soap, dry, treat with cream.

28. Provide a protective regime for the child.

29. Make an entry in the medical records indicating the date, time of infusion, the solution used, its amount.

Possible Complications: 1) purulent complications (suppuration of the puncture channel, thrombophlebitis, phlegmon, sepsis); 2) thrombosis of the catheter with a blood clot; 3) bleeding from the catheter; 4) air embolism; 5) spontaneous removal and migration of the catheter; 6) vein sclerosis in case of frequent catheter change; 7) infiltration; 8) an allergic reaction to drugs, etc.

Annex 5

to the Instructions for the execution technique

medical and diagnostic procedures and manipulations in the disciplines "Nursing in Pediatrics", "Pediatrics" in the specialties 2-79 01 31 "Nursing", 2-79 01 01 "General Medicine"

High-quality catheter care is the main condition for the success of treatment and prevention of complications. It is necessary to strictly follow the rules for the operation of the catheter.

Each connection of the catheter is a gateway for infection. Touch the catheter as little as possible, strictly follow the rules of asepsis, work only with sterile gloves.

Change sterile plugs more often, never use plugs that may have been contaminated on the inside.

Immediately after the introduction of antibiotics, concentrated glucose solutions, blood products, you need to wash it with a small amount of saline.

To prevent thrombosis and prolong the functioning of the catheter in the vein, additionally rinse it with saline during the day between infusions. After the introduction of saline, it is necessary to inject a heparin solution (prepared in the ratio of a part of heparin to 100 parts of saline).

Monitor the condition of the fixing bandage, if necessary, change it.

Regularly inspect the puncture site for early detection of complications.

When changing the adhesive bandage, it is forbidden to use scissors, as this can cut off the catheter, and it will enter the circulatory system.

To prevent thrombophlebitis, a thin layer of thrombolytic ointments (heparin, troxevasin) is applied to the vein above the puncture site.

Algorithm for removing a venous catheter.

Assemble a standard vein catheter removal kit:

sterile gloves;

sterile gauze balls;

adhesive plaster;

thrombolytic ointment;
skin antiseptic;
trash tray;
sterile test tube, scissors and tray (used if the catheter is thrombosed or if infection is suspected).

Wash your hands.

Stop the infusion, remove the protective bandage.

Clean your hands with antiseptic, put on gloves.

Moving from the periphery to the center, remove the fixing bandage without scissors.

Slowly and carefully withdraw the catheter from the vein.

Caution for 2-3 min. press the catheterization site with a sterile gauze pad.

Treat the catheterization site with a skin antiseptic.

Place a sterile pressure bandage over the catheterization site and secure it with adhesive tape.

Check the integrity of the catheter cannula. In the presence of a thrombus or suspected infection of the catheter, cut off the tip of the cannula with sterile scissors, place it in a sterile tube and send it to a bacteriological laboratory for examination (as prescribed by a doctor).

Record the time, date, and reason for removal of the catheter in the documentation.

Dispose of waste in accordance with the safety regulations and the sanitary and epidemiological regime.

Complications with parenteral administration of drugs

Technique of any manipulation, including parenteral administration medicines must be strictly adhered to, since the effectiveness medical care largely depends on the quality of the manipulations. Most of the complications after parenteral injections arise as a result of not fulfilling in full the necessary requirements for observing asepsis, methods of manipulation, preparing the patient for manipulation, etc. Exceptions are allergic reactions to the administered drug.

Infiltrate

Infiltrate is a local reaction of the body associated with limited irritation or tissue damage.

Infiltrate, the most common complication after subcutaneous and intramuscular injection, occurs when performing with a blunt needle, using short needles for intramuscular injection, incorrectly determining the injection site, performing an injection at the same place.

The infiltrate is characterized by the formation of a seal at the injection site, which is easily determined by palpation (palpation).

The infiltrate is characterized by local signs of inflammation:

hyperemia;

swelling;

pain on palpation;

local rise in temperature.

If an infiltrate occurs, local warming compresses are shown in the shoulder area and a heating pad on the buttocks area.

Abscess

If asepsis is violated during injection, an abscess develops in patients - a purulent inflammation of the soft tissues with the formation of a cavity filled with pus.

The cause of injection and post-injection abscesses is the insufficient treatment of the hands of a medical worker, the treatment of syringes, needles, and the skin of patients at the injection site.

The appearance of an abscess that aggravates the patient's condition is considered one of the most serious violations.

The clinical picture of an abscess is characterized by general and local signs.

Common signs include:

fever at the beginning of the disease of a permanent, and later laxative type;

increased heart rate;

intoxication.

Local features include:

redness, swelling at the injection site;

temperature increase;

pain on palpation;

a symptom of fluctuation over the focus of softening.

Medical embolism

Drug embolism can occur when oily solutions are injected subcutaneously or intramuscularly. The oil, once in the artery, will clog it, and this leads to malnutrition of the surrounding tissues, their necrosis.

Signs of necrosis:

increasing pain in the injection area;

redness or red-cyanotic coloration of the skin;

increase in body temperature.

When oil enters a vein, it enters the pulmonary vessels with blood flow.

Symptoms of pulmonary embolism:

a sudden attack of suffocation;

cough ;

cyanosis of the upper half of the body;

feeling of tightness in the chest.

Necrosis(tissue death)

Tissue necrosis develops when a failed venipuncture or erroneous injection of a significant amount of a highly irritating drug under the skin. Most often this happens with inept intravenous administration 10% calcium chloride solution. With a puncture of a vein and the outflow of a medicinal substance in the tissue around the vessel, a hematoma, swelling, and soreness at the injection site are observed.

Thrombophlebitis

Thrombophlebitis - acute inflammation blood vessels, accompanied by the formation of infected blood clots.

The process begins in the lumen of the inflamed venous wall and spreads to the periphery with the involvement of surrounding tissues, causing the formation of a thrombus fixed on the vein wall.

On examination, a well-defined tumor in the form of snake-like convoluted vessels is determined in the affected area. The skin is slightly reddened. The tumor is well mobile in relation to the underlying tissues, but soldered to the skin. There is a local increase in temperature, but the pain is small and does not interfere with the function of the limb.

Hematoma

Hematoma - bleeding under the skin with intravenous injection.

The cause of the hematoma is an inept venipuncture. In this case, a purple spot appears, swelling of the vein at the injection site from the puncture of both walls of the vein and the outflow of blood that has penetrated into the tissues.

Anaphylactic shock

Anaphylactic shock develops with the introduction of antibiotics, vaccines, therapeutic sera. Development time anaphylactic shock- from a few seconds or minutes from the moment the drug is administered. The faster the shock develops, the worse the prognosis. The lightning-fast course of shock ends lethally.

Most often, anaphylactic shock is characterized by the following sequence of symptoms:

general redness of the skin, rash;

coughing fits;

expressed anxiety;

violation of the rhythm of breathing;

decrease in blood pressure, palpitations, arrhythmia.

Symptoms can appear in various combinations. Death occurs from acute respiratory failure due to bronchospasm and pulmonary edema, acute cardiovascular failure.

The development of an allergic reaction in a patient to the administration of a drug requires emergency assistance.

allergic reactions

Allergic reactions include:

local allergic reaction

hives,

angioedema,

A local allergic reaction may develop as a response to subcutaneous or intramuscular injection. A local allergic reaction is expressed by thickening of the tissues at the injection site, hyperemia, swelling, but necrotic changes in the tissues at the injection site may also occur. There are common features such as headache, dizziness, weakness, chills, fever.

Hives

It is characterized by swelling of the papillary layer of the skin, which manifests itself in the form of a rash on the skin of itchy blisters. The skin around the blisters is hyperemic. Rashes of blisters are accompanied by severe itching. The rash may spread throughout the patient's body. Chills, fever of the patient's body, insomnia are noted. Urticaria can occur as a response to the ingestion of various allergens (drugs, cosmetics, food).

Quincke's edema

Agnioneurotic edema with spread to the skin, subcutaneous tissue and mucous membranes. Edema is dense, pale, itching is not observed. Most often, edema captures the eyelids, lips, mucous membranes of the oral cavity, can spread to the larynx, cause suffocation. In this case, there is a barking cough, hoarseness, difficulty in both inhalation and exhalation, shortness of breath. With further progression, breathing becomes stridor. Death can come from asphyxia. With the localization of edema on the mucous membrane of the gastrointestinal tract, there may be severe pain in the abdomen, stimulating the clinic of an acute abdomen. When the meninges are involved in the process, meningeal symptoms, lethargy, stiff neck, headache, convulsions appear.

Damage to the nerve trunks

Damage to the nerve trunks occurs with intramuscular and intravenous injections or mechanically with the wrong choice of injection site: chemically, when the depot of the drug is near the nerve. The severity of the complication can be different - from neuritis (inflammation of the nerve) to paralysis (loss of limb function). The patient is prescribed thermal procedures.

Sepsis

Sepsis is one of the complications that occurs with gross violations of asepsis rules during intravenous injection, as well as when using non-sterile solutions for intravenous infusions.

Serum hepatitis. HIV infection.

Long-term complications arising from non-compliance with anti-epidemic and sanitary and hygienic measures during manipulations include serum hepatitis - hepatitis B and C, as well as HIV infection, incubation period which ranges from 6-12 weeks to several months.

Treatment of these complications is carried out in specialized medical institutions.

Examination of surgical patients. Preparation of patients for X-ray and instrumental studies

Patient preparation

to endoscopic examinations

In a surgical clinic, one of the most common instrumental diagnostic methods is endoscopic examination, which consists in a visual examination (sometimes accompanied by manipulations) of hollow internal organs and cavities using instruments equipped with an optical system. Schematically, any endoscope is a hollow tube with a light bulb, which is inserted into the lumen of the organ or cavity under study. The design of the corresponding endoscope, of course, depends on the shape, size, depth of occurrence of a particular organ. Diagnostic and therapeutic endoscopy, depending on the degree of invasiveness, is carried out in specialized rooms, as well as in the operating room or dressing room.

Laryngoscopy(examination of the larynx) is most often carried out by an anesthesiologist. This manipulation is one of the first stages of endotracheal anesthesia (a tube is inserted into the trachea under the control of a laryngoscope). Otorhinolaryngologists also use laryngoscopy. Usually surgeons and nurses - anesthetists own this method.

Bronchoscopy performed with diagnostic (in these cases, the mucous membrane of the tracheobronchial tree is examined through the bronchoscope up to the subsegmental bronchi, and a biopsy is also performed) and therapeutic (evacuation of the secret from the tracheobronchial tree, its toilet, administration of drugs, removal of foreign bodies) purposes.

Esophagoscopy(examination of the esophagus), gastroscopy(examination of the stomach) and duodenoscopy(examination of the duodenum) is performed to verify the diagnosis visually or with a biopsy, as well as for the purpose of medical procedures (removal of foreign bodies, stopping bleeding, removal of polyps, installation of endoprostheses). Because in clinical practice most often, the esophagus, stomach, and duodenum are simultaneously examined with a flexible fiberscope; the term fibroesophagogastroduodenoscopy (FEGDS) is usually used.

By doing sigmoidoscopy a rigid or flexible endoscope is used to examine the rectum and sigmoid colon with diagnostic and therapeutic purposes(for removal of polyps, coagulation of ulcers, fissures, biopsy, etc.). For a complete examination of the colon, colonoscopy flexible fiberscope.

In urological practice, a routine study is cystoscopy(examination of the mucous membrane of the urethra and Bladder) for diagnostic and therapeutic purposes. In the gynecological departments, an endoscopic examination of the uterine cavity is performed - hysteroscopy. In case of pathology of large joints, one of the diagnostic and treatment methods is arthroscopy.

To examine the abdominal and pleural cavities, respectively, laparoscopy And thoracoscopy. It should be emphasized once again that in a large percentage of cases, all endoscopic procedures are not only diagnostic, but also therapeutic. Currently, the development of endoscopic technologies has led to the creation of laparoscopic, arthroscopic surgery.

Most endoscopic procedures can be compared in terms of complexity and tolerability with operations, the success of which largely depends on proper preparation, since hollow organs through which the endoscope passes and which are subject to inspection should be as free as possible from the contents. In addition, throughout the path of the endoscope, the muscles should be relaxed, and the pain zones should be anesthetized.

The attending physician, prescribing endoscopy to the patient under local anesthesia, in a preliminary conversation, shows him the position in which the study is performed. These positions are very different even with the same type of endoscopy and depend on a number of reasons, including anesthesia. Naturally, under anesthesia, the procedures are performed in the supine position of the patient. Inspection of the larynx, respiratory tract, esophagus and stomach is carried out either under anesthesia or under local anesthesia, which consists in irrigation of the mucous membranes with a 10% lidocaine aerosol. These procedures are done on an empty stomach. 30 minutes before laryngo-, bronchoscopy, laparo- and thoracoscopy, premedication is carried out: atropine, narcotic analgesic. These studies are carried out in a special endoscopic room, in the dressing room or in the operating room, where the patient is taken on a gurney (you must definitely remove the dentures). Laparo- and thoracoscopy are, in fact, surgical intervention and require the same preparation as abdominal surgery.

Before recto-and cystoscopy, you can allow the patient to drink a glass of sweet tea. Cystoscopy often requires no preparation other than a good bowel cleansing. The patient is prepared for rectoscopy for several days: they limit carbohydrates in food, put daily cleansing enemas in the morning, in the evening and, in addition, early in the morning on the day of the study, to which the patient is sent on a gurney. For a complete and more comfortable colonoscopy for the patient, adequate preparation of the colon is required. Optimal (with the exception of patients with stenosing tumors of the colon) is the use of Fortrans (macrogol) - a laxative that most effectively frees the colon from feces. The action of macrogol is due to the formation of hydrogen bonds with water molecules and its retention in the intestinal lumen. Water liquefies the contents of the intestine and increases its volume, increasing peristalsis and thereby exerting a laxative effect. The drug is completely evacuated from the intestine along with its contents. Fortrans is not absorbed in the intestines and is not metabolized in the body, it is excreted unchanged. The preparation of the colon using Fortrans is carried out as follows. On the morning of the day before the study, the patient takes a light breakfast. Subsequently, the patient does not have lunch or dinner (only sweet tea). Around noon, the patient prepares 3 liters of cool boiled water and dissolves 4 bags of Fortrans in it. The solution is taken in portions of 100 ml in such a way that by the evening 100-200 ml of the solution remains. The patient takes this portion of the solution in the morning on the day of the study in such a way that the drug was completed 3 hours before the procedure. A light breakfast is allowed.

It is not recommended to prepare patients before colonoscopy with the use of vaseline oil as a laxative, since the oil, getting on the optics of the endoscope, causes its clouding and worsens the quality of the examination. It should be remembered that after cysto - and rectoscopy, patients may experience pain, discomfort during urination and defecation, while sometimes there is an admixture of blood in the urine and feces. In these cases, pain is well relieved by suppositories with anesthesin, belladonna.

Somewhat different preparation of patients for emergency endoscopic examinations. So, when conducting an emergency FEGDS for gastroduodenal bleeding, the fastest possible release of the stomach from blood and food masses is required. For this purpose, a thick gastric tube is installed and the stomach is washed with ice water (hemostasis agent) until liquid blood and its clots are completely removed. Water is injected into the probe with Janet's syringe, water is evacuated from the stomach by gravity or when a slight vacuum is created using a syringe. For effective preparation of the stomach in this situation, at least 5-10 liters of water is required.

For emergency colonoscopy, laxatives are not used due to the long waiting time for the effect. After taking them, several cleansing enemas are used to prepare the colon, and if they are ineffective, a siphon enema is used until a significant amount of feces and gases are discharged.

Patient preparation

to X-ray studies

A frequently used examination method in a surgical clinic is to perform fluoroscopy or radiography. In some cases (thoracic x-ray) special preparation is not required, and often the information content of the study depends on the correct preparation of the patient.

Careful preparation is needed for x-ray examination of the gastrointestinal tract. Within 2-3 days, black bread, cereals, vegetables, fruits, milk should be excluded from food in order to limit the formation of toxins and gases; for the same purpose, patients suffering from intestinal gas retention should be given activated charcoal or espumizan, chamomile enemas in the morning and evening, warm chamomile infusion (1 tablespoon of chamomile per glass of hot water) 1 tablespoon 4-5 times a day. day. In no case should saline laxatives be used before an X-ray examination of the gastrointestinal tract, as they increase the accumulation of gases in the intestines and irritate the intestinal wall. On the evening before the study, a cleansing enema is given, and in a number of institutions, another enema is required in the morning, but not less than 3 hours before the fluoroscopy.

The study of the upper gastrointestinal tract is carried out on an empty stomach. Having received a light supper in the evening, the patient does not eat, does not drink, does not take any medicine, does not smoke in the morning. Even the smallest pieces of food and a few sips of liquid prevent the uniform distribution of the contrast suspension on the walls of the stomach, prevent its filling, and nicotine enhances the secretion of gastric juice, stimulates gastric motility. In patients with impaired evacuation from the stomach, before being sent to the X-ray room, the stomach is emptied (but not washed!) With a thick probe. A full study can only be done if the stomach is empty.

Preparation for the study of the large intestine by barium enema (injection of a contrast agent directly into the intestine) differs slightly from the preparation for colonoscopy described above. Within 2-3 days, the patient is given semi-liquid, non-irritating to the intestines and easily digestible food. At 6 o'clock in the morning on the day of the study, another cleansing enema is given, in addition, a light breakfast is allowed: tea, egg, white cracker with butter. If the patient suffers from constipation, it is advisable to prepare him with siphon enemas or ingestion of castor oil ( Ol. ricini 30 g, per os), not saline laxatives. It is possible to prepare the colon with the help of Fortrans. In preparation for an x-ray examination of the large intestine, the appointment of antispasmodics or prokinetics is canceled, since these drugs, acting on the muscular elements of the intestinal wall, can change the relief of the mucosa.

A contrast agent that makes it possible to visualize the lumen of the digestive tube is usually injected in the x-ray room. When examining the upper gastrointestinal tract, the patient is given to drink a barium suspension of various consistency, diluting the barium powder with an appropriate amount of water, and when examining the large intestine, it is administered in an enema. In addition, there are research methods that provide for the preliminary administration of contrast agents inside. So, sometimes a patient in the department (it is necessary to clarify the time of giving the contrast agent) is given a barium suspension to drink (in each individual case, it is important to find out how many grams of barium and in what volume of water should be diluted), and the next day at a certain time they send him to the X-ray cabinet: by this time, the barium suspension should fill the studied sections of the intestine. This is how the ileocecal angle of the intestine is examined or the place of the obstacle is established in case of intestinal obstruction. Usually, after the examination, the radiologist tells the patient whether he needs to come again on the same day or tomorrow. In some cases, the patient is warned to starve for some more time (for example, with a delay in evacuation from the stomach or duodenum) or refrain from defecation (when examining the colon) and come back at a certain hour to the x-ray room. Sometimes the radiologist asks the patient to lie down in a certain position (for example, on the right side).

Examination of the urinary tract (urography) includes overview (without the use of contrast) urography, excretory or excretory (intravenously administered contrast agent which is secreted by the kidneys and makes the urinary tract visible: kidneys with pelvises and calyces, ureters and bladder), as well as retrograde (a contrast agent is injected through a catheter directly into the ureters or even into the renal pelvis in order to fill the entire urinary system- from the kidney to the bladder inclusive).

Urography requires careful preparation of the bowel (cleansing enema in the evening and early morning) so that accumulations of gases and feces do not interfere with the detection of urinary tract stones. On the morning of the study, you can allow the patient to drink a glass of tea with a piece of white bread. Before examining the urinary tract, it is not necessary to force the patient to lie down, but, on the contrary, to recommend him to take a walk. As with other X-ray examinations, the patient should urinate. This limits the preparation for survey urography, the task of which is only to identify the renal shadow (which can be used to approximately judge the position or size of the kidneys) and large stones. With excretory urography, a slowly water-soluble contrast agent is injected intravenously in the X-ray room. Intravenous administration of the drug is carried out by the procedural sister of the ward department. When conducting emergency urography, in addition to the radiologist, the attending physician should be next to the patient, ready to assist in the event of a frequent allergic reaction to the contrast agent. Usually, with intravenous contrast, the patient feels a slight pain or burning sensation along the vein, sometimes bitterness in the mouth. These feelings pass quickly. It should be remembered that accidental extravasal administration of certain contrast agents can lead to thrombophlebitis, necrosis of fatty tissue.

No preparation is required for an x-ray examination of the skull (women must remove hairpins and hairpins from their hair). When taking a picture of the bones of the extremities, iodine should be removed from the skin, massive oil dressings should be replaced with light aseptic ones, and strips of sticky plaster should be removed. If a plaster bandage is applied, it is necessary to check with the doctor whether to take a picture in a bandage or whether it needs to be removed. This is usually done in the presence of a doctor, who, after examining the still wet image, decides on further immobilization. It must be well understood that the accompanying personnel, without special instructions from the doctor, cannot remove the plaster cast, give the limb the position necessary for the picture, transport the patient without fixing the limb. These rules are of particular importance for trauma or orthopedic patients, but they should also be known to staff caring for patients in surgical departments, where interventions on bones and joints are sometimes performed. For a picture of the shoulder girdle (scapula, collarbone), sternum, ribs, cervical and thoracic spine, no special preparation is required. On the contrary, for a qualitative x-ray examination of the lumbosacral spine, a preliminary emptying of the intestine is required, therefore enemas and restriction of the food regimen on the eve of the study are necessary.

CARE OF YOUR CENTRAL VENOUS CATHETER (CVC)

How to care for your central venous catheter

To prevent bleeding from the catheter, the plug should be tightly closed, tightly fixed with a gauze cap, and the position of the plug should be constantly monitored.

Workplace equipment: 1) a bottle with a filled system for intravenous drip infusions of a single use, a tripod; 2) a bottle of heparin with a volume of 5 ml with an activity of 1 ml - 5000 IU, an ampoule (bottle) with a solution of sodium chloride 0.9% - 100 ml; 3) syringes with a capacity of 5 ml, single-use injection needles; 4) sterile catheter plugs; 5) sterile material (cotton balls, gauze triangles, napkins, diapers) in biks or packages; 6) tray for sterile material; 7) tray for used material; 8) caps in the package; 9) sterile tweezers; 10) tweezers in a disinfectant solution; 11) file, scissors; 12) a container-dispenser with an antiseptic agent for treating the skin of patients and the hands of staff; 13) a container with a disinfectant for processing ampoules and other injectable dosage forms; 14) plaster (regular or Tegoderm type) or other fixative bandage; 15) mask, medical gloves (single use), waterproof decontaminated apron, goggles (plastic screen); 16) tweezers for working with used tools; 17) containers with a disinfectant for disinfecting surfaces, washing used needles, syringes (systems), soaking used syringes (systems), soaking used needles, disinfecting cotton balls, gauze wipes, used rags; 18) clean rags; 19) tool table.