Ib txoj hlab ntshav (lossis IV rau luv) kab yog ib qho ntawm ntau yam, cov cuab yeej tseem ceeb hauv cov tshuaj niaj hnub no. IVs tso cai rau cov kws saib xyuas kev noj qab haus huv tswj cov kua dej, cov khoom lag luam ntshav, thiab tshuaj ncaj qha rau hauv tus neeg mob cov ntshav los ntawm lub raj me. Qhov no tso cai rau kev nqus sai thiab tswj tau ntau npaum li cas ntawm cov tshuaj uas tau siv, uas yog qhov tseem ceeb rau ntau yam txheej txheem kev kho mob, suav nrog muab cov kua dej los kho lub cev qhuav dej, muab ntshav rau tus neeg mob poob sai, lossis muab tshuaj tua kab mob kho. Txhawm rau tso IV, koj yuav tsum xub dhau los ua tus kws tshaj lij kho mob. Npaj kom nkag mus rau IV, nkag mus rau cov hlab ntshav, thiab tswj IV rau qhov ua tau zoo tshaj plaws.
Cov kauj ruam
Ntu 1 ntawm 3: Npaj Npaj Pib IV
Kauj Ruam 1. Sau koj cov ntaub ntawv
Txawm hais tias pib IV tsis ze li qhov hnyav ntawm kev ua raws li cov txheej txheem nyuab dua, nws tseem xav tau tib qib theem pib ntawm kev npaj thiab ceev faj raws li cov txheej txheem kho mob me. Ua ntej koj pib, koj yuav xav kom muaj tag nrho cov cuab yeej thiab khoom siv uas koj xav tau yooj yim thiab koj yuav xav paub tseeb tias txhua yam ntaub ntawv uas yuav cuam tshuam nrog tus neeg mob lub cev - tshwj xeeb yog koj cov koob - tshiab thiab tsis muaj menyuam. Txhawm rau pib ua kab IV raug, koj yuav xav tau:
- Cov hnab looj tes pov tseg uas tsis muaj menyuam
- Qhov loj me uas tsim nyog "dhau-tus-rab koob" IV catheter (feem ntau yog 14-25 ntsuas)
- Hnab ntawm IV kua
- Non-latex tourniquet
- Cov ntaub qhwv tsis huv los yog hnav khaub ncaws
- Hnav khaub ncaws
- Dej cawv so
- Daim kab xev kho mob
- Ntim Sharps
- Cov ntaub qhwv los yog ntawv tsis muaj menyuam (teeb cov cuab yeej me me ntawm qhov no kom lawv nyob ze ntawm tes)
Kauj Ruam 2. Qhia koj tus kheej rau tus neeg mob
Ib feem tseem ceeb ntawm txheej txheem pib IV yog qhia koj tus kheej rau tus neeg mob thiab piav qhia cov txheej txheem uas yuav tshwm sim. Tham nrog cov neeg mob thiab sib qhia cov ntaub ntawv yooj yim no pab ua rau lawv yooj yim thiab ua kom ntseeg tau tias tsis muaj ib feem ntawm cov txheej txheem ua rau lawv xav tsis thoob lossis ua rau lawv poob siab. Ib qho ntxiv, nws ua kom ntseeg tau tias koj muaj lawv qhov kev tso cai tag nrho los mus. Thaum koj ua tiav, kom tus neeg mob pw lossis rov qab qhov chaw uas lawv yuav tau txais lawv li IV.
- Thaum cov neeg mob tshee tshee, lawv cov leeg ntshav tuaj yeem sib cog me ntsis hauv tus txheej txheem hu ua vasoconstriction. Qhov no ua rau nws nyuaj rau pib IV, yog li xyuas kom koj tus neeg mob so kom txaus thiab xis nyob raws li qhov ua tau ua ntej mus.
- Koj yuav xav nug seb tus neeg mob puas muaj teeb meem nrog IVs yav dhau los. Yog li, tus neeg mob tuaj yeem tuaj yeem qhia rau koj paub tias cov vev xaib twg nkag tau yooj yim.
Kauj Ruam 3. Npaj IV tubing
Tom ntej no, ua tus IV tubing los ntawm kev ncua lub hnab IV los ntawm qhov chaw sawv ntsug, sau lub raj nrog cov kua ntsev, thiab tshuaj xyuas seb puas muaj npuas. Yog tias tsim nyog, clamp lub tubing kom cov tshuaj tsis poob rau hauv av. Nco ntsoov tshem tawm cov npuas los ntawm tubing los ntawm maj mam kov, nyem, lossis yaug lawv tawm ntawm kab. Daim ntawv sau hnub tim thiab kos npe yuav tsum muab tso rau ntawm ob lub IV tubing thiab lub hnab IV.
- Txhaj cov pa cua mus rau hauv tus neeg mob cov ntshav tuaj yeem ua rau mob hnyav hu ua embolism.
- Ib qho txheej txheem yooj yim rau tshem cov npuas los ntawm IV tubing yog tshem tawm cov tubing mus rau nws qhov ntev tag nrho thiab khiav cov menyuam lub qhov rooj tag nrho txoj kev mus txog rau hauv chav tso dej. Tom ntej no, txhawm rau lub hnab IV nrog lub tubing ntsia hlau loj thiab ntsaws lub qhov tso dej. Qhib cov menyuam lub valve thiab tso tawm kab - cov kua yuav tsum ntws los ntawm qhov ntev ntawm qhov tubing yam tsis muaj cov npuas.
Kauj Ruam 4. Xaiv lub raj tshuaj ntsuas kom haum rau qhov xwm txheej
Feem ntau, IV catheters tau teeb tsa hla lub koob siv los txhawm rau cov hlab ntshav. Tom qab nkag mus rau txoj hlab ntshav, lub raj tso rau hauv qhov chaw kom nkag tau yooj yim rau cov leeg. Catheters tuaj hauv ntau qhov sib txawv hu ua gauges. Qhov me me ntawm tus lej ntsuas, lub raj yas tuab dua thiab tuaj yeem siv tshuaj sai dua thiab cov ntshav tuaj yeem kos tau. Txawm li cas los xij, cov catheters tuab kuj tseem ua rau mob hnyav ntxiv, yog li nws yog qhov tseem ceeb tsis txhob siv lub raj uas loj dua qhov koj xav tau.
Feem ntau, rau IVs, koj yuav xav tau lub raj uas kwv yees li 14-25 ntsuas. Tend rau siab dua-gauge (thinner) catheters rau cov menyuam yaus thiab cov neeg laus, tab sis nyiam mus rau qis-gauge (thicker) catheters thaum xav tau kev hloov pauv sai
Kauj Ruam 5. Muab cov hnab looj tes uas tsis muaj menyuam
Tso ib qho IV hla cov tawv nqaij thiab qhia cov cuab yeej siv txawv teb chaws ncaj qha rau hauv cov ntshav. Txhawm rau zam kev pheej hmoo ntawm kev kis tus kab mob txaus ntshai, nws yog ib qho tseem ceeb kom ntxuav koj txhais tes thiab so lawv nrog cov ntaub so tes huv si ua ntej pib, tom qab ntawd muab hnab looj tes tsis huv ua ntej koj tuav koj cov cuab yeej thiab kov tus neeg mob. Yog tias thaum twg los xij koj cov hnab looj tes 'tsis muaj menyuam tuaj yeem cuam tshuam, tshem lawv tawm thiab muab tso rau khub tshiab; nws zoo dua kom nyab xeeb dua li thov txim. Hauv qab no yog cov xwm txheej uas feem ntau cov qauv kev kho mob xav tau hloov hnab looj tes:
- Ua ntej kov tus neeg mob
- Ua ntej cov txheej txheem ntxuav/aseptic (zoo li kev siv tshuaj IV)
- Tom qab cov txheej txheem nrog kev pheej hmoo ntawm lub cev tso dej tawm
- Tom qab kov tus neeg mob
- Tom qab kov tus neeg mob ib puag ncig
- Ua ntej tsiv mus rau lwm tus neeg mob
Kauj Ruam 6. Saib rau cov leeg tseem ceeb
Tom ntej no, koj yuav xav nrhiav lub xaib ntawm tus neeg mob los tswj hwm IV. Rau cov neeg mob laus, txoj hlab ntshav nkag tau yooj yim tshaj plaws yog ntev, ncaj nyob rau sab saud uas tsis nyob ze pob qij txha thiab nyob deb tshaj plaws ntawm lub cev. Rau menyuam yaus, tawv taub hau, txhais tes, lossis ko taw zoo dua li qhov chaw IV dua li txhais ceg, caj npab lossis lub luj tshib. Thaum muaj cov hlab ntsha nkag tau tuaj yeem siv los pib IV, nws yog qhov zoo tshaj kom tsis txhob leeg ntshav ntawm tus neeg mob lub xub ntiag. Yog tias koj tus neeg mob muaj keeb kwm ntawm cov leeg tsis yooj yim, nug qhov chaw kws kho mob yav dhau los tau ua tiav. Feem ntau, cov neeg mob uas muaj kev nyuaj IV dhau los yuav paub qhov twg lawv cov leeg ntshav nkag tau yooj yim tshaj plaws. Nco ntsoov tias, tsis hais txog qhov muaj cov leeg ntshav, muaj qee qhov chaw koj yuav tsis xav tso IV. Cov no suav nrog:
- Qhov chaw uas IV yuav cuam tshuam nrog kev phais
- Nyob rau qhov chaw zoo ib yam li lwm qhov IV
- Hauv qhov chaw uas pom cov tsos mob ntawm tus kab mob (liab, o, ua rau khaus, thiab lwm yam)
- Hauv ib txhais ceg ntawm tib sab ntawm lub cev ua mastectomy lossis vascular graft (qhov no tuaj yeem ua rau muaj teeb meem)
Kauj Ruam 7. Thov siv lub tourniquet
Txhawm rau kom koj cov leeg ntshav tau xaiv tuaj yeem o tuaj rau qhov yooj yim nkag, thov siv lub dav hlau ncig tom qab (hauv qhov kev taw qhia ntawm lub cev) lub hom phiaj IV. Piv txwv li, yog tias koj yuav tso IV rau hauv qhov chaw raug ntawm sab hauv qab ntawm lub xub pwg, koj yuav tso qhov ncig ncig ncig ntawm txoj kev nce caj npab.
- Tsis txhob khi lub tourniquet nruj heev - qhov no tuaj yeem ua rau nqaij tawv, tshwj xeeb yog cov neeg laus. Nws yuav tsum nruj, tab sis tsis nruj heev uas koj tsis tuaj yeem ntiv tes ntiv tes hauv qab.
- Kev tso tus ceg ntoo limp mus rau hauv pem teb thaum muaj kev ncig ncig ncig tuaj yeem pab cov leeg ua kom muaj zog dua los ntawm kev ua kom cov ntshav ntws mus rau qhov nqua.
Kauj Ruam 8. Palpate cov hlab ntshav yog tias tsim nyog
Yog tias koj muaj lub sijhawm nyuaj nrhiav cov leeg ntshav tsim nyog, nws tuaj yeem pab ua kom palpate tus neeg mob daim tawv nqaij hauv thaj tsam ntawm IV qhov chaw. Teem koj tus ntiv tes raws txoj hlab ntshav, tom qab ntawv nias rau ntawm daim tawv nqaij saum nws. Koj yuav tsum hnov cov hlab ntsha "thawb rov qab". Txuas ntxiv nrog cov lus tsa suab kom ntev li 20-30 feeb. Qhov leeg yuav tsum loj dua.
Ntu 2 ntawm 3: Kev Nkag Mus Rau Txoj Cai
Kauj Ruam 1. Tshuaj tua kab mob IV
Tom ntej no, qhib qhib cawv cawv tshiab (lossis siv txoj hauv kev kom tsis muaj menyuam zoo ib yam li chlorhexidine) thiab siv nws rau ntawm daim tawv nqaij hauv thaj chaw uas IV yuav tso. So maj mam tab sis kom huv, kom ntseeg tau tias muaj lub tsho loj ntawm cawv. Qhov no tua cov kab mob ntawm daim tawv nqaij, txo qhov muaj feem kis mob thaum daim tawv nqaij raug rau qhov.
Kauj Ruam 2. Npaj lub raj rau kev tso
Tshem lub catheter los ntawm nws cov ntim tsis huv. Luv luv tshuaj xyuas nws kom ntseeg tau tias nws ua tau zoo thiab ua haujlwm. Nias ntawm lub flashback chamber kom ntseeg tau tias nws nruj. Tig lub catheter hub kom ntseeg tau tias nws zaum xoob rau ntawm rab koob. Tshem lub hau tiv thaiv thiab tshuaj xyuas rab koob, saib xyuas kom ntseeg tau tias rab koob tsis kov dab tsi. Yog tias txhua yam zoo nyob rau hauv kev txiav txim, npaj kom ntxig rau rab koob.
Tsis txhob tso tus catheter lossis rab koob tuaj ntsib nrog lwm yam uas tsis yog tus neeg mob daim tawv nqaij hauv IV qhov chaw. Qhov no tuaj yeem cuam tshuam lawv qhov tsis muaj menyuam thiab ua rau muaj kev pheej hmoo kis mob ntau ntxiv
Kauj Ruam 3. Ntxig rau rab koob
Siv tes tsis tseem ceeb los tswj tus neeg mob lub caj dab nrog lub siab maj, saib xyuas kom tsis txhob kov qhov chaw IV ncaj qha. Nqa cov raj hauv koj txhais tes tseem ceeb thiab ntxig rau rab koob (bevel ntsej muag) los ntawm daim tawv nqaij. Txo lub kaum sab xis ntawm kev nkag thaum koj nce qib koob rau hauv cov hlab ntshav - siv txoj hauv kev nqaim -angled.
Saib rau qhov rov qab los ntawm cov ntshav ntawm lub catheter hub. Nov yog lub cim qhia tias koj tau ua tiav txoj hlab ntshav. Thaum koj pom qhov rov qab los, ua ntej siv rab koob ntxiv ib centimeter (cm) rau hauv cov leeg
Kauj Ruam 4. Yog tias koj plam txoj hlab ntshav, piav thiab sim dua
Kev tso IV yog cov txuj ci me me-qee zaum, txawm tias cov kws kho mob thiab kws saib xyuas neeg mob plam txoj hlab ntshav ntawm lawv thawj zaug, tshwj xeeb tshaj yog tias tus neeg mob muaj cov leeg ntshav nyuaj. Yog tias koj nce koob thiab tsis pom ntshav rov qab, piav qhia rau tus neeg mob tias koj tau ploj lawm thiab yuav rov sim dua. Sim ua kom txaus siab rau tus neeg mob - cov txheej txheem no tuaj yeem mob heev.
- Yog tias koj tsis nco qab cov hlab ntsha, thov zam txim rau tus neeg mob, tshem lub koob thiab lub raj, thiab rov sim dua ntawm lwm tus txhais tes nrog rab koob tshiab thiab lub raj raj. Kev sim ua ntau qhov ntxig rau tib leeg leeg tuaj yeem ua rau mob heev rau tus neeg mob thiab ua rau mob nqaij tawv tas mus li.
- Koj tuaj yeem nplij tus neeg mob los ntawm kev piav qhia vim li cas nws thiaj li tsis ua haujlwm thiab tseem hais qee yam xws li, "Qee zaum cov no tsuas yog tshwm sim. Nws tsis muaj leej twg ua txhaum. Peb yuav tsum tau txais nws yog lub sijhawm tom ntej."
Kauj Ruam 5. Tshem tawm thiab muab rab koob pov tseg
Kev tswj xyuas qhov tawv nqaij, rub lub koob (tsuas yog rab koob - tsis yog lub raj) txog 1 centimeter (0.4 in) rov qab tawm ntawm cov leeg. Maj mam nce tus catheter mus rau hauv cov hlab ntshav thaum tswj lub siab ntawm cov leeg thiab tawv nqaij. Thaum lub cannula zaum hauv cov hlab ntshav, tshem lub tourniquet thiab ruaj ntseg lub raj los ntawm kev muab cov ntaub qhwv tsis huv los yog hnav khaub ncaws (zoo li Tegaderm) hla qis ib nrab ntawm lub raj raj.
Nco ntsoov tsis txhob thaiv qhov IV tubing txuas nrog koj cov khaub ncaws
Kauj Ruam 6. Tshem rab koob thiab muab lub raj tso rau hauv
Tuav mus rau lub catheter hub nrog koj tus ntiv tes xoo thiab ntiv tes ntsuas. Khaws nws ruaj ntseg zaum hauv cov leeg. Siv koj txhais tes, ua tib zoo rub rab koob (thiab tsuas yog rab koob) tawm ntawm cov leeg. Muab rab koob pov rau hauv ib lub taub ntim kom raug. Tom ntej no, tshem daim npog tiv thaiv los ntawm qhov kawg ntawm cov txheej txheem IV tubing thiab ua tib zoo ntxig nws mus rau hauv lub raj catheter. Ruaj ntseg nws hauv lub raj raj los ntawm kev ntswj thiab xauv rau hauv qhov chaw.
Kauj Ruam 7. Ruaj Ntseg IV
Thaum kawg, ruaj ntseg IV tiv thaiv tus neeg mob daim tawv nqaij. Muab ib daim kab xev hla lub catheter hub, tom qab ntawd ua lub voj nyob rau hauv lub raj raj thiab kaw qhov no nrog daim thib ob ntawm daim kab xev hla thawj zaug. Ruaj ntseg rau lwm qhov kawg ntawm lub voj nyob saum qhov chaw ntawm IV nrog daim kab xev thib peb. Muab cov loops tso rau hauv lub raj txo qhov ua rau lub IV catheter, ua rau nws yooj yim dua rau tus neeg mob thiab tsis tshua muaj feem yuav raug tshem tawm ntawm cov hlab ntshav.
- Nco ntsoov tias tsis muaj kinks hauv lub voj - qhov no tuaj yeem cuam tshuam nrog cov dej ntws mus rau hauv cov hlab ntshav.
- Tsis txhob hnov qab tso daim ntawv lo nrog hnub thiab sijhawm ntawm kev ntxig rau IV hnav khaub ncaws.
Ntu 3 ntawm 3: Tswj IV
Kauj Ruam 1. Txheeb xyuas cov dej ntws mus rau hauv IV
Qhib lub IV cov menyuam clamp thiab saib rau cov dej ntws sib sau ua ke hauv chav dej. Txheeb xyuas tias IV tau nkag mus rau hauv cov hlab ntshav los ntawm kev thaiv cov hlab ntshav (nias qis rau nws txhawm rau thaiv nws cov ntws) mus rau qhov chaw ntawm IV (deb ntawm lub cev). Cov dej ntws los yuav tsum qeeb thiab nres, tom qab ntawv rov ntws thaum koj nres qhov hlab ntshav.
Kauj Ruam 2. Hloov cov khaub ncaws raws li xav tau
IVs tshuav nyob rau ncua sijhawm ntxiv yog qhov muaj feem yuav kis tau ntau dua li IVs tsuas yog siv rau kev ua haujlwm lossis txheej txheem nkaus xwb. Txhawm rau txo qhov kev pheej hmoo kis mob, nws yog ib qho tseem ceeb kom ua tib zoo tshem tawm cov hnav khaub ncaws, ntxuav qhov chaw ntawm IV, thiab tso khaub ncaws tshiab tso rau qhov chaw. Feem ntau, kev hnav khaub ncaws pob tshab yuav tsum tau hloov pauv ntxhib txhua lub lim tiam, thaum hnav khaub ncaws hnav yuav tsum tau hloov ntau dua vim tias lawv tsis tso cai rau kev tshuaj xyuas IV qhov chaw.
Tsis txhob hnov qab ntxuav koj txhais tes thiab hnav lub hnab looj tes tshiab txhua lub sijhawm koj kov tus neeg mob IV chaw. Qhov no yog qhov tshwj xeeb tshaj yog rau thaum koj tab tom hloov kev hnav khaub ncaws, vim tias kev siv txuas mus ntev IV kev cuam tshuam nrog kev nce tus kab mob
Kauj Ruam 3. Tshem IV kom nyab xeeb
Txhawm rau tshem tawm IV, ua ntej, kaw cov menyuam clamp kom tsis txhob ntws cov kua. Maj mam tshem daim kab xev thiab hnav khaub ncaws kom nthuav tawm lub catheter hub thiab IV qhov chaw. Muab ib daim ntaub huv huv tso rau ntawm qhov chaw IV thiab siv lub zog me me thaum koj rub lub raj tawm, maj mam muab.
Ruaj ntseg cov ntaub qhwv hla qhov chaw raug mob nrog kab xev lossis ntaub qhwv, xws li Coban
Kauj Ruam 4. Muab pov tseg txhua rab koob kom raug
Cov koob siv los pib IV qhov tsim nyog raws li kev kho mob ntse thiab yuav tsum tau muab tso rau hauv lub thawv ntim zoo kom pom sai sai tom qab siv. Vim tias rab koob tuaj yeem hloov pauv tus kab mob sib kis thiab txawm tias muaj ntshav los ntawm ib tus neeg mus rau lwm tus yog tias ua tsis raug, nws tseem ceeb heev kom ntseeg tau tias cov koob no tsis raug pov tseg nrog cov thoob khib nyiab, txawm tias koj paub tseeb tias tus neeg mob noj qab nyob zoo.
Kauj Ruam 5. Paub txog teeb meem ntsig txog IV
Txawm hais tias IVs feem ntau yog cov txheej txheem muaj kev nyab xeeb, ib txwm muaj tsawg heev tab sis muaj caij nyoog uas yuav muaj teeb meem tshwm sim los ntawm IV. Nws yog ib qho tseem ceeb kom paub cov tsos mob feem ntau ntawm IV teeb meem tuaj yeem muab kev saib xyuas zoo tshaj plaws rau tus neeg mob thiab, yog tias xav tau, kom paub thaum twg yuav tau txais kev saib xyuas xwm txheej ceev. Qee qhov teeb meem IV (thiab lawv cov tsos mob hauv qab no:
- Kev nkag mus: tshwm sim thaum cov kua dej raug txhaj sab nraum cov hlab ntshav mus rau cov nqaij mos ib puag ncig. Yuav ua rau o thiab du, tawv nqaij hauv thaj chaw cuam tshuam. Yuav yog qhov me me lossis teeb meem loj nyob ntawm cov tshuaj uas tau muab tshuaj.
- Hematoma: tshwm sim thaum cov ntshav ntws los ntawm cov hlab ntshav mus rau hauv cov ntaub so ntswg ib puag ncig, feem ntau tom qab ntau dua ib txoj hlab ntshav phab ntsa raug yuam. Feem ntau nrog los ntawm qhov mob, ua pob, thiab khaus. Feem ntau yuav daws tsis pub dhau ob peb lub lis piam lub teeb pom kev.
- Embolism: tshwm sim tom qab txhaj tshuaj rau hauv cov hlab ntshav. Feem ntau tshwm sim los ntawm huab cua npuas hauv IV tubing. Cov menyuam yaus muaj kev pheej hmoo tshwj xeeb. Hauv cov xwm txheej loj, ua rau muaj teeb meem ua pa, mob hauv siab, tawv nqaij xiav, ntshav siab, thiab txawm tias mob hlab ntsha tawg thiab plawv nres.
- Thrombosis thiab endarteritis: Cov teeb meem uas txaus ntshai rau lub neej uas tuaj yeem tshwm sim los ntawm kev txhaj tshuaj rau hauv cov hlab ntshav, tsis yog leeg ntshav. Tuaj yeem ua rau mob hnyav, mob sib cais (mob siab rau ntawm cov leeg ua rau mob hnyav "nruj" lossis "tag nrho" kev xav) gangrene, lub cev tsis ua haujlwm, thiab txawm tias qhov kawg ntawm qhov tsis muaj ceg.
Yees duab - Los ntawm kev siv qhov kev pabcuam no, qee cov ntaub ntawv yuav raug muab qhia rau YouTube
Lub tswv yim
Sau txhua yam koj ua thaum IV tso. Khaws cov ntaub ntawv kom zoo tiv thaiv kev tsis txaus siab thiab kev foob
Lus ceeb toom
- Tsis txhob sim nrhiav cov leeg ntshav ntau dua ob zaug. Yog tias tom qab zaum thib ob koj tsis tuaj yeem nrhiav cov leeg nrog rab koob, thov kev pab ntawm lwm tus kws tshaj lij.
- Ib txwm tshuaj xyuas cov neeg mob cov ntaub ntawv kom ntseeg tau tias tsis muaj cov lus qhia tshwj xeeb ua raws rau tus neeg ua ntej tso rau IV.
- Tsuas yog muab IV yog tias koj yog tus kws tshaj lij kho mob.
