Kev kuaj ntshav rau kev kuaj ntshav feem ntau yog txheej txheem niaj hnub thiab tsis muaj txiaj ntsig. Tab sis txij li txhua tus neeg mob txoj kev kho mob sib txawv, yog li lawv cov leeg. Nov yog cov lus qhia dav dav rau kev daws teeb meem venipuncture uas cov ntshav ntws tsis tau pib tsim thaum txhaj koob. Txawm hais tias cov txuj ci tsim nyog thiab txheej txheem yuav siv tau rau ob qho xwm txheej, cov ntsiab lus no feem ntau yog tsom mus rau cov ntshav ntshav siv cov hlab tso pa tawm (xws li BD Vacutainer®), ntau dua IV cov raj tso raj.
Cov kauj ruam
Ntu 1 ntawm 3: Rov Ntsuas Lub Koob
Kauj Ruam 1. Rov qab rab koob tawm kom txog thaum lub bevel nyob hauv qab daim tawv nqaij
Qhov kev txiav txim ua ntej no tso cai rau koj hloov kho rab koob txoj haujlwm kom zoo. Ceev faj tsis thim rab koob kom tag lossis lwm yam uas koj yuav ua rau poob lub raj nqus thiab pib hematoma thaum lub bevel tawm ntawm daim tawv nqaij.
Kauj Ruam 2. Palpate cov hlab ntshav siv koj qhov ntsuas tsis tseem ceeb lossis ntiv tes nruab nrab
Lub hom phiaj yog txhawm rau nrhiav cov leeg ntshav cuam tshuam nrog koj rab koob.
- Nco ntsoov tias cov leeg ntshav yuav tsum yog qhov zoo tshaj plaws. Cov txheej txheem tawv thiab tuab tuaj yeem yog cov leeg lossis leeg. Cov tawv nqaij subcutaneous xav tias squishy thiab cov leeg xav tias nyuaj. Yog tias cov hlab ntshav hnov nyuaj, nws yuav muaj caws pliav lossis sclerosed.
- Lus ceeb toom: Nco ntsoov tias koj muaj kev ntseeg siab tias cov qauv uas koj tab tom ua palpating yog qhov tseeb. Kev tsis quav ntsej cov hlab ntsha ua rau mob hnyav. Ib qho ntxiv, hematoma tuaj yeem ua rau cov hlab ntsha puas tsuaj thiab ua rau muaj kev puas tsuaj mus sij hawm ntev.
Kauj Ruam 3. Maj mam kho lub koob lub kaum ntse ntse thiab txoj haujlwm kom kab nws nrog cov leeg
Ceeb Toom: Tsis txhob txav ib sab (sab-rau-sab) txav nrog rab koob. Qhov no yog qhov mob heev, txaus ntshai rau lub hauv paus txheej txheem, thiab nthuav dav lub qhov rab koob kom ncua sijhawm los ntshav
Kauj Ruam 4. Thauj tog rau nkoj cov leeg li koj tuaj yeem ua tau
Txhawm rau ua qhov no, tso koj tus ntiv tes xoo uas tsis tseem ceeb me ntsis qis dua cov leeg thiab rub cov tawv nqaij thiab cov nqaij subcutaneous nqes mus. Qhov no ua kom cov hlab ntshav ruaj khov kom tiv thaiv nws los ntawm kev dov.
- Cov neeg mob laus feem ntau muaj tawv nqaij tawv thiab cov leeg uas yob tau yooj yim, Thaum cov hlab ntsha yob, rab koob zoo li thawb cov hlab ntshav ib sab es tsis nkag mus. Yog li ntawd, koj lub thauj tog rau nkoj yuav tsum maj mam tab sis khov kho kom tiv thaiv cov hlab ntshav txav deb ntawm koj.
- Ceeb Toom: Qee tus kws kho phlebotomists siv txoj hauv kev ntawm kev hu ua "C-hold", uas tus ntiv tes ntsuas rub mus rau qhov siab dua thaum tus ntiv tes xoo rub qis dua. Thaum qhov no yuav ua tau zoo hauv qee qhov nyuaj, qhov kev pheej hmoo ntawm kev raug mob hnyav dua yog tias tus neeg mob muaj kev thim rov qab thiab rab koob rov qab los rau hauv koj tus ntiv tes.
Kauj Ruam 5. Ua ntej koob rov qab mus rau ntawm daim tawv nqaij, saib xyuas cov ntshav ntws los lossis rov qab
Soj ntsuam tus neeg mob thiab nres yog nws/nws hnov mob tsis txaus. Yog tias koj tsim cov ntshav ntws, sau koj cov hlab kom raug rau qhov kos thaum ua kom ruaj khov.
Tswv yim: Txawm tias muaj teeb meem nyuaj, nco ntsoov hloov koj lub raj. Qhov no yog qhov tshwj xeeb tshaj yog thaum khaws EDTA (lavender saum) lossis heparin (ntsuab saum) raj. Cov ntshav tag nrho yuav tsis tuaj yeem tshuaj xyuas yog tias muaj cov hlab ntsha me me.
Ntu 2 ntawm 3: Teeb meem teeb meem tshwj xeeb
Kauj Ruam 1. Txheeb xyuas koj lub raj
Cov ntshav yuav tsis ntws txaus yog tias koj siv lub sijhawm tas sij hawm, puas ntsoog, lossis lub raj poob vim lub tshuab nqus tsev tsis txaus. Txheeb xyuas lub raj kom paub tseeb tias nws nyob hauv tus tuav kom raug thiab rab koob sab hauv tau nkag los ntawm cov roj hmab nres. Tswj xyuas rab koob thaum hloov raj.
Tswv yim: Yog tias koj paub tias koj tau sau tsis raug ntawm kev kos, tshem lub raj, ntxig qhov raug, sau nws ib nrab ua ntej muab pov tseg, tom qab ntawd ntxig ib lub raj tshiab thiab sau kom tiav. Kev muab pov tseg thawj zaug txo qis qhov cuam tshuam ntawm ib qho muaj peev xwm ua kom muaj kab mob sib kis.
Kauj Ruam 2. Teeb meem qhov koob tsis raug
Txawm hais tias nqe lus saum toj no piav qhia cov kauj ruam yooj yim txhawm rau hloov lub koob, koj yuav xav ua qhov sib txawv me ntsis txhawm rau kho txoj haujlwm koob raws li tau piav qhia hauv qab no.
- Koob tsis tau tso deb txaus: lub bevel yog nyob rau ntawm daim tawv nqaij lossis cov ntaub so ntswg subcutaneous thiab tsis tau nkag mus rau cov leeg. Nov yog qhov tshwm sim tshwm sim thaum kos los ntawm cov neeg mob rog. Txhawm rau kho qhov teeb meem no, maj mam nce rab koob rau pem hauv ntej.
- Koob yog ib nrab lossis tag nrho los ntawm cov leeg: lub bevel nkag mus rau phab ntsa tom qab ntawm cov leeg. Cov ntshav me me tuaj yeem tshwm hauv lub hub thaum lub bevel taug kev los ntawm cov leeg, tab sis tsis muaj cov ntshav ntws los. Qhov no tshwm sim thaum rab koob tau dhau mus deb dhau, nrawm dhau, lossis ntxaum dhau ntawm lub kaum ntse ntse. Lub bevel uas yog ib nrab lossis tag nrho los ntawm cov hlab ntshav muaj peev xwm ua rau muaj hematoma thaum cov ntshav tawm ntawm lub nkoj mus rau cov ntaub so ntswg ib puag ncig. Txhawm rau kho qhov teeb meem no, thauj cov hlab ntshav thiab thim rab koob me ntsis kom txog thaum cov ntshav ntws.
- Koob tsuas yog ib nrab ntawm cov leeg: lub bevel yog hauv qab ntawm daim tawv nqaij thiab tau pib nkag mus rau cov leeg, tab sis tsis tag. Cov ntshav ntws tuaj yeem qeeb heev. Txhawm rau kho qhov teeb meem no, thauj tog rau nkoj cov hlab ntsha thiab nce me ntsis ua ntej koob.
- Koob yog tiv thaiv phab ntsa leeg: lub bevel raug nias tawm tsam phab ntsa ntawm lub nkoj, ua rau cov ntshav tsis txaus. Qhov no tuaj yeem tshwm sim yog tias muaj qhov khoov lossis nkhaus nyob hauv cov hlab ntshav. Txhawm rau kho qhov teeb meem no, thim qhov koob me ntsis los yog tig lub rooj sib txoos ib nrab-tig.
- Koob yog nyob rau hauv kev sib cuag nrog lub valve: lub bevel tau daig hauv lub qhov quav, ua rau cov ntshav tsis txaus. Ib qho kev co me me los yog hnov lub suab hnov zoo li lub valve sim qhib thiab kaw. Qhov no tuaj yeem tshwm sim yog tias muaj qhov khoov lossis nkhaus nyob hauv cov hlab ntshav. Txhawm rau kho qhov teeb meem no, thim rab koob me ntsis.
- Koob yog nyob ib sab ntawm cov leeg: lub bevel thawb thiab swb dhau ntawm cov hlab ntshav es tsis nkag mus rau phab ntsa, qhov tshwm sim hu ua "dov". Qhov no feem ntau tshwm sim thaum cov hlab ntsha tsis ruaj khov thiab khov. Txhawm rau kho qhov teeb meem no, tuav lub thauj tog rau nkoj ruaj khov thiab sim rov ua dua.
Kauj Ruam 3. Paub txog thaum cov hlab ntshav tau tawg
Cov hlab ntsha ntawm phab ntsa nruj thiab kos ua ke, txwv tsis pub ntshav ntws. Qhov no tuaj yeem tshwm sim thaum lub raj nqus dej muaj zog heev, lossis thaum lub tourniquet raug khi nruj dhau lossis ze rau ntawm qhov chaw venipuncture lossis tshem tawm tag nrho.
- Yog tias koj tab tom siv npauj npaim, sim rov qab ncig ncig ncig tus neeg mob caj npab kom nce siab thiab rov tsim cov ntshav ntws.
- Koj kuj tseem tuaj yeem tshem lub raj tawm, tos li ob peb feeb rau cov ntshav ntws rov qab, thiab tom qab ntawd koom nrog kev kos luv.
Ntu 3 ntawm 3: Kev ntsuas ua ntej txhawm rau ua kom muaj kev vam meej
Kauj Ruam 1. Ua kom tus neeg mob zoo dua qub
Yog tias teeb duab los ntawm fossa antecubital fossa, xyuas kom lub caj npab tau nthuav dav kom tau txais qhov siab tshaj plaws. Kev khoov ntawm lub luj tshib tuaj yeem cuam tshuam koj lub peev xwm los palpate leeg.
- Siv cov tog hauv ncoo lossis cov npoo ua npuas kom txhawb nqa caj npab thiab pab txuas ntxiv.
- Yog tias tus neeg mob zaum ntawm lub rooj zaum phlebotomy, xyuas kom lawv zaum ncaj nrog lawv nraub qaum lub rooj zaum. Kho qhov siab thiab tig lub rooj zaum kom ntseeg tau tias koj lub cev nyob nrog txoj hlab ntshav.
- Sim tig lub caj npab kom zoo dua nthuav tawm cephalic lossis basilic leeg.
Tswv yim: Txo caj npab qis dua qib ntawm lub plawv tuaj yeem pab ua kom cov hlab ntsha nqaim.
Kauj Ruam 2. Ua tib zoo xav txog koj qhov kev ncig ncig
Qhov zoo tshaj plaws, nws yuav tsum tau muab tso rau 3-4 ntiv tes-dav dav saum toj no qhov chaw kho kab mob venipuncture. Lub tourniquet yuav tsum nruj txaus kom txhav cov hlab ntshav, tab sis tsis nruj npaum li txiav tawm cov hlab ntsha.
Nco ntsoov tias cov neeg mob laus feem ntau muaj cov leeg tawg. Kev nruj dhau ntawm lub tourniquet tuaj yeem ua rau cov hlab ntsha tawg thaum txhaj tshuaj
Kauj Ruam 3. Txheeb xyuas qhov chaw ua tib zoo
Venipuncture feem ntau yog ua los ntawm fossa antecubital (ntawm qhov nruab nrab cubital, cephalic, thiab cov leeg ntshav), lossis ntawm sab tes ntawm tes.
- Txhua lub sijhawm cov leeg ntshav tau nkag mus nrog rab koob, cov nqaij caws pliav tsim ua ib feem ntawm kev kho lub cev. Nyob rau lub sijhawm thiab nrog ntau qhov kev rov ua dua, qhov tseem ceeb ntawm cov nqaij caws pliav tsim. Qhov no ua rau txhua qhov tom qab khaus tawv dua thiab tawv dua vim tias cov nqaij caws pliav ntau dua fibrous thiab tawv dua rau lub qhov txhab.
- Nrhiav qhov pom qhov muag uas yuav pab txheeb xyuas tus neeg mob. Cov kab mob ntshav liab los yog daj tuaj yeem hais qhia qhov nqaij ntuag tom qab siv tshuaj tiv thaiv kab mob tsis ntev los no. Luam theej duab ntawm daim tawv nqaij rau kab xiav qhia tias pom cov leeg ntshav. Cov qhab nia taug qab tsis yog tsuas yog pom ntawm IV cov neeg siv tshuaj, tab sis kuj tseem nyob rau cov neeg mob hnyav uas xav tau kev nkag mus rau hauv cov hlab ntshav thiab cov ntshav ntxiv thiab tej zaum yuav yog ib qho cim ntawm kev cia siab nyuaj.
- Ua tus txheej txheem hauv koj qhov kev tshawb nrhiav rau leeg. Pib nrog caj npab ze rau koj thiab palpate antecubital fossa. Xav txog qhov nruab nrab cubital ua ntej, cephalic leeg thib ob, thiab cov hlab ntshav basilic thib peb. Hloov mus rau lwm sab caj npab yog tias koj tsis pom dab tsi. Saib sab nraub qaum ntawm tes ua qhov kawg.
Tswv yim: Cov neeg mob uas xav tau kev ua ntshav tsis tu ncua (piv txwv li INR rau cov neeg mob ntawm warfarin) feem ntau paub txog cov leeg uas feem ntau yuav ua haujlwm.
Kauj Ruam 4. Siv cov cua sov tso rau ntawm qhov chaw kom ua rau cov leeg ntshav muaj zog dua
Txheeb xyuas seb koj lub chaw ntim khoom ntim cov menyuam mos sov sov feem ntau siv rau cov hlab ntsha hauv qhov txhab. Yog tias tsis yog, phuam kub lossis hnab looj tes uas muaj dej puv tuaj yeem pab tau. Tso qhov no rau ntawm qhov chaw li 5 feeb ua ntej ntsuas.
Kauj Ruam 5. Siv rab koob uas haum tshaj plaws
Kev xaiv koob yuav tsum yog raws li hom thiab tus naj npawb ntawm cov hlab uas yuav tsum tau sau, qhov xwm txheej ntawm cov hlab ntsha, qhov kev nkag siab ntawm qib kev cia siab nyuaj, thiab koj tus kheej kev txiav txim siab kho mob.
- Ib rab koob 21-gauge (piv txwv li BD Eclipse ntsuab-capped) yog siv rau feem ntau niaj hnub ua thiab tsis yooj yim venipunctures. 23-koob koob (piv txwv li BD Eclipse dub-capped) muaj txoj kab uas hla me dua thiab yuav haum rau cov leeg me dua.
- Butterflies yog cov cuab yeej muaj txiaj ntsig zoo rau kev daws teeb meem nyuaj, vim yog lawv qhov tseeb, luv dua tus ncej ntev, thiab kev ua haujlwm zoo. Los ntawm kev tuav rab koob los ntawm cov yas tis lossis lub hauv paus, phlebotomists tuaj yeem ua tiav lub kaum ntse ntse, feem ntau yog 10-15 degrees.
Tswv yim: Thaum siv npauj npaim thiab sodium citrate yog thawj qhov sau rau hauv daim ntawv xaj, kos lub raj pov tseg yuav tsum tau sau ua ntej ib zaug kom tshem tau cov pa tawm ntawm lub raj. Ua tsis tiav qhov no ua rau muaj qhov sib npaug ntawm cov ntshav-rau-ntxiv qhov sib ntxiv, ua rau cov hnoos tsis haum rau kev tshuaj xyuas.
Kauj Ruam 6. Xav txog kev siv cov raj luv
Cov hlab no me dua ntim thiab yog li ntawd muaj lub tshuab nqus tsev tsis muaj zog los txo qhov kev pheej hmoo ntawm cov hlab ntsha tawg. Cov raj luv luv ua pov thawj muaj txiaj ntsig thaum kos ntshav los ntawm cov neeg laus thiab cov menyuam yaus, nrog rau los ntawm tes leeg.
Tswv yim: BD Vacutainer® hlab siv lub pob tshab kom pom cov cim luv sib txawv. EDTA thiab sodium citrate leeg raj tseem yuav tsum tau ntim rau hauv kab cim cim kom ntseeg tau tias muaj ntshav sib ntxiv.
Lub tswv yim
- Txhim kho koob thaum koj tso koj lub raj. Qee zaum koj yuav tau txais cov ntshav pib, tab sis tom qab ntawd nws nres thaum koj hloov raj. Teem kom ruaj cov flanges ntawm lub raj tuav kom tsis txhob nce qib koob ntxiv rau hauv cov hlab ntshav thaum koj hloov raj. Thaum koj tsim cov ntshav ntws, hloov kho koj txhais tes me ntsis kom ruaj khov rau rab koob tiv thaiv caj npab thiab tiv thaiv kev txav mus los ntxiv.
- Nkag mus rau ntawm daim tawv nqaij ntawm lub kaum sab xis 30 ° txog 45 ° thaum xub thawj (txawm tias tsawg dua nrog npauj npaim), tom qab ntawd thaum koj tau txais lub teeb nyem, txo lub kaum sab xis los ntawm kev nqa rab koob sib dhos los ze rau ntawm caj npab thiab ua kom rab koob me ntsis ntxiv mus rau hauv cov leeg. Qhov no zaum lub bevel rau hauv lub lumen ntawm cov hlab ntshav, thiab tseem yog cov txheej txheem siv los tso lub IV catheter.
- Hloov koj txoj hauv kev thaum cuam tshuam nrog cov neeg mob tsis koom tes, xws li menyuam yaus thiab cov uas muaj kev txhim kho kev puas hlwb lossis puas hlwb. Cov neeg mob hauv cov pejxeem no feem ntau tshee hnyo thiab tuaj yeem ua rau lawv nqua. Kom tus neeg pab tuav lub caj npab ruaj khov los xauv lub luj tshib. Siv npauj npaim los them nyiaj rau tus neeg mob txav mus los.
- Cov neeg mob uas muaj mob ntev lossis raug mob hnyav tuaj yeem ua rau mob hypotensive lossis hypovolemic. Qhov no ua rau pom cov hlab ntshav tsim nyog nyuaj dua vim cov ntshav qis. Nrhiav kev qhia ntawm tus npoj yaig zoo xws li kws saib xyuas neeg mob yog tias koj muaj teeb meem tau txais tus qauv.
Lus ceeb toom
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Nres cov txheej txheem thiab tshem rab koob yog:
- Cov hlab ntsha tau raug txhaws (ua rau pom liab liab, ntshav tawm)
- Cov hlab ntsha tau raug nicks (tus neeg mob tuaj yeem yws ntawm qhov hluav taws xob hnov thiab nce ntawm tus nqaj)
- Lub hematoma pib tsim (npuas hauv qab daim tawv nqaij pib tshwm sai sai ntawm qhov chaw)
- Tus neeg mob tsis nco qab lossis pib qaug dab peg
- Tus neeg mob thov kom koj tsum
- Zam kev soj ntsuam ntau dhau ("nuv ntses"). Qhov muag tsis pom qhov kev siv rab koob hauv daim tawv nqaij yog qhov mob rau tus neeg mob thiab koj ua rau muaj kev pheej hmoo tsoo lub paj hlwb, leeg, lossis leeg ntshav. Koj yuav tsum tsis txhob ua cov txheej txheem no tshwj tsis yog koj paub tseeb tias rab koob nyob ze rau ntawm cov hlab ntshav.
- Cov txheej txheem tsim los ntawm Clinical and Laboratory Standards Institute (CLSI) hais tias tus kws kho phlebotomist yuav tsum tsis txhob siv tshuaj tiv thaiv kab mob ntau dua ob zaug, thiab ntau kawg ntawm peb qhov kev sim yuav tsum ua rau tus neeg mob. Tom qab qhov kev sim zaum thib peb, yuav tsum nrhiav cov lus qhia kho mob ntxiv nrog tus kws kho mob ua ntej mus.
- Tham nrog chav saib xyuas neeg mob lossis koj lub chaw pabcuam cov peev txheej ua ntej kos duab los ntawm kab IV lossis PICC lossis ua kom muaj kev tiv thaiv kab mob ntawm caj npab nrog kab IV nyob hauv qhov chaw. Cov ntshav kuaj los ntawm kab IV yuav tsum tau sau tseg thiab tshuaj xyuas nrog kev saib xyuas. Qhov ntau ntawm cov kua thiab tshuaj tuaj yeem cuam tshuam cov txiaj ntsig kev ntsuas pib. Ib qho ntxiv, cov ntshav yuav tsum tsis txhob nqa ntawm caj npab nrog lub fistula siv rau kev kho ntshav.
- Kev nqus ntshav los ntawm cov hlab ntsha loj (piv txwv li jugular) lossis lub hauv nruab nrab cov hlab ntshav tawm ntawm qhov ua haujlwm ntawm kev lees paub phlebotomist thiab yuav tsum tsuas yog ua los ntawm kws kho mob lossis kws saib xyuas neeg mob siab.
