靜脈輸液并發(fā)癥的預(yù)防與處理

1、靜脈輸液操作并發(fā)癥的預(yù)防與處理一、發(fā)熱反應(yīng)1、原因：因輸入致熱物質(zhì)引起。多由于輸液瓶清潔滅菌不徹底，輸入的溶液或藥物制 品不純、消毒保存不良，輸液器消毒不嚴(yán)格或被污染，輸液過程中未能嚴(yán)格執(zhí)行無菌操作等 所致。2、 癥狀：病人表現(xiàn)為發(fā)冷、寒戰(zhàn)和高熱。輕者體溫在38C左右，停止輸液后數(shù)小時(shí)可自行恢復(fù)正常；嚴(yán)重者起初起寒戰(zhàn)，繼之高熱，體溫可達(dá)41 C，并伴有頭疼、惡心、嘔吐、脈速等全身癥狀。3、預(yù)防及處理：（1）輸液前認(rèn)真檢查藥液質(zhì)量，輸液器包裝及滅菌日期、有效期，嚴(yán)格無菌技術(shù)操作。（ 2）反應(yīng)輕者，可減慢點(diǎn)滴速度或停止輸液，通知醫(yī)生，同時(shí)注意體溫變化。（ 3）對(duì)高熱病人給予物理降溫，觀察生命體征，

2、必要時(shí)遵醫(yī)囑給予抗過敏藥物或激素 治療。（ 4）反應(yīng)嚴(yán)重者，應(yīng)立即停止輸液，并保留剩余溶液和輸液器進(jìn)行檢測，查找反應(yīng)原因。二、急性肺水腫l 、原因：（l ）由于輸液速度過快，短時(shí)間內(nèi)輸入過多液體，使循環(huán)血容量急劇增加，心臟負(fù)荷 過重引起。（ 2）病人原有心肺功能不良，尤多見于急性左心功能不全者。2、癥狀：病人突然出現(xiàn)呼吸困難、胸悶、咳嗽、咯粉紅色泡沫樣痰，嚴(yán)重時(shí)痰液可從 口、鼻涌出，聽診肺部布滿濕啰音，心率快且節(jié)律不齊。3、預(yù)防及處理： （1）在輸液過程中，要密切觀察病人情況，對(duì)老年人、兒童、心肺功能不良的病人尤需注意控制滴注速度不宜過快和輸液量不宜過多。（ 2）出現(xiàn)上述癥狀，立即減慢或停止輸

3、液并通知醫(yī)生，進(jìn)行緊急處理。如病情允許可 使病人端坐，雙腿下垂，以減少下肢靜脈回流，減輕心臟負(fù)擔(dān)。必要時(shí)進(jìn)行四肢輪扎。用橡 膠止血帶或血壓計(jì)袖帶適當(dāng)加壓四肢，以阻斷靜脈血流，但動(dòng)脈血仍可通過。每510min輪流放松一個(gè)肢體上的止血帶， 可有效地減少靜脈回心血量。 癥狀緩解后， 逐漸解除止血帶。(3)給予高流量氧氣吸入，一般氧氣流量為68L/ min，以提高肺泡內(nèi)氧分壓，增加氧的彌散，改善低氧血癥。最好用50%-70%酒精濕化后吸入，酒精能降低泡沫表面張力，從而改善肺部氣體交換，緩解缺氧癥狀。( 4)遵醫(yī)囑給予鎮(zhèn)靜劑、平喘、強(qiáng)心、利尿和擴(kuò)血管藥物。( 5)安慰病人，解除病人的緊張情緒。三、靜脈炎

4、1、原因：由于長期輸注高濃度、刺激性較強(qiáng)的藥液，靜脈內(nèi)放置刺激性大的塑料管或 靜脈留置針放置時(shí)間過長，引起局部靜脈壁發(fā)生化學(xué)性反應(yīng)；也可因輸液過程中未嚴(yán)格執(zhí)行 無菌操作，導(dǎo)致局部靜脈感染。2、癥狀：沿靜脈走向出現(xiàn)條索狀紅線，局部組織發(fā)紅、腫脹、灼熱、疼痛，有時(shí)伴有 畏寒、發(fā)熱等全身癥狀。3、預(yù)防及處理：( 1)嚴(yán)格執(zhí)行無菌操作。對(duì)血管壁有刺激性的藥物應(yīng)充分稀釋后再應(yīng)用。點(diǎn)滴速度宜 慢，防止藥物漏出血管外。同時(shí)，要有計(jì)劃地更換輸液部位，以保護(hù)靜脈。( 2)停止在此部位輸液，并將患肢抬高、制動(dòng)。局部用50硫酸鎂溶液濕敷(早期冷敷，晚期熱敷) ，每日 2 次，每次 20min。( 3)超短波理療，每

5、日 l 次，每次 15 20min。( 4)中藥治療，將如意金黃散加醋調(diào)成糊狀，局部外敷，每日2 次，具有清熱、止痛、消腫的作用。( 5)如合并感染，遵醫(yī)囑給予抗生素治療。四、空氣栓塞l 、原因：( 1)輸液導(dǎo)管內(nèi)空氣未排盡，導(dǎo)管連接不緊，有漏氣。( 2)加壓輸液、輸血時(shí)無人守護(hù)，液體輸完未及時(shí)更換藥液或拔針。發(fā)生空氣栓塞是由于進(jìn)人靜脈的空氣形成的氣栓，隨血流首先被帶到右心房，然后進(jìn)入 右心室。如空氣量少，則被右心室隨血液壓入肺動(dòng)脈并分散到肺小動(dòng)脈內(nèi)。最后經(jīng)毛細(xì)血管 吸收，損害較小；如空氣量大，空氣在右心室內(nèi)阻塞肺動(dòng)脈入口，使血液不能進(jìn)入肺內(nèi)，氣 體交換發(fā)生障礙，引起機(jī)體嚴(yán)重缺氧而立即死亡。2

6、、癥狀：病人感到不適或胸骨后疼痛，隨之出現(xiàn)呼吸困難和嚴(yán)重發(fā)紺，有瀕死感。聽 診前區(qū)可聞及響亮的、持續(xù)的“水泡聲” ，心電圖呈現(xiàn)心肌缺血和急性肺源性心臟病的改變。3、預(yù)防及處理：（1）輸液前認(rèn)真檢查輸液器的質(zhì)量，排盡輸液導(dǎo)管內(nèi)的空氣。（ 2）輸液過程中加強(qiáng)巡視，輸液中及時(shí)更換輸液瓶或添加藥物；輸液完畢及時(shí)拔針； 加壓輸液時(shí)應(yīng)有專人在旁守護(hù)。（3）立即讓病人取左側(cè)臥位并頭低腳高，以便氣體能浮向右心室尖部。避開肺動(dòng)脈入 口，隨著心臟舒縮，將空氣混成泡沫，分次小量進(jìn)入肺動(dòng)脈內(nèi)，逐漸被吸收。（4）立即紿予高流量氧氣吸入，提高病人的血氧濃度，糾正缺氧狀態(tài)；有條件者可通 過中心靜脈導(dǎo)管抽出空氣；嚴(yán)密觀察病人

7、病情變化：如有異常及時(shí)對(duì)癥處理。五、液體外滲 1原因：穿剌時(shí)刺破血管或輸液過程中針頭或留置導(dǎo)管滑出血管外，使液體進(jìn)入穿刺 部位的血管外組織而引起。2癥狀：局部組織腫脹、蒼白、疼痛，輸液不暢，如藥物有刺激性或毒性，可引起嚴(yán) 重的組織壞死。3預(yù)防及處理：（ 1）牢固固定針頭，避免移動(dòng)；減少輸液肢體的活動(dòng)。（2）經(jīng)常檢查輸液管是否通暢，特別是在加藥之前。（ 3）發(fā)生液體外滲時(shí)，應(yīng)立即停止輸液，更換肢體和針頭重新穿刺。（ 4）抬高患肢以減輕水腫，可局部熱敷20 分鐘，促使靜脈回流和滲出液的吸收，減輕疼痛和水腫。六、過敏性休克的急救一旦發(fā)生過敏性休克必須爭分奪秒、迅速及時(shí)、就地急救。 1立即停藥，患者就

8、地平臥，進(jìn)行搶救。2. 立即皮下注射 0.1 鹽酸腎上腺素 0.5-1ml ，病兒酌減，此藥是搶救過敏性休克的首 選藥物，具有收縮血管、增加外周阻力，提升血壓，興奮心肌、增加心輸出量及松弛支氣管 平滑肌的作用。如癥狀不緩解，可每隔 30min 皮下或靜脈注射給藥 0.5ml ，直至脫離危險(xiǎn)。 如發(fā)生心臟驟停立即行胸外心臟按壓術(shù)。3維持呼吸：給予氧氣吸入。呼吸受抑制時(shí)肌內(nèi)注射尼可剎米（可拉明）或絡(luò)貝林等 呼吸興奮劑。喉頭水腫影響呼吸時(shí)，可行氣管插管或氣管切開術(shù)。4抗過敏：根據(jù)醫(yī)囑，立即給予地塞米松5-10mg 靜脈注射或氫化可的松 200 400mg加人5% 10%的葡萄糖液 500ml，靜脈滴

9、注。應(yīng)用抗組胺類藥，如肌內(nèi)注射異丙嗪（非那 根）25 40mg或苯海拉明20mg。5補(bǔ)充血容量：靜脈滴注10%葡萄糖溶液或平衡液擴(kuò)充血容量。如血壓下降不回升，可用低分子右旋糖酐，必要時(shí)可用多巴胺、阿拉明等升壓藥物。6糾正酸中毒。7密切觀察患者體溫、脈搏、呼吸、血壓、尿量及其他病情變化，并做好病情動(dòng)態(tài)記 錄。Prevention and management of complications of intravenous infusionFebrile reactions1, reason: as a result of input heating material. Because the i

10、nfusion bottle is not clean and sterilized, the solution or the medicine product is impure, the disinfection and the preservation are bad, the infusion device is not sterilized or polluted, and the aseptic operation can not be strictly implemented in the infusion process.2 symptoms: the patient pres

11、ented with chills, chills, and high fever. The light temperature at 38 degrees Celsius, a few hours after the cessation of the infusion could return to normal; serious at first followed by high fever, chills, body temperature is 41 degrees centigrade, and accompanied by headache, nausea, vomiting an

12、d other symptoms, pulse rate.3, prevention and treatment:(1) carefully check the quality of the liquid medicine before infusion, the packing and the date of sterilization and the valid period of the infusion, and strictly operate the aseptic technique.(2) the light person can slow down the intraveno

13、us drip or stop the infusion, notify the doctor and pay attention to the change of the body temperature.(3) give physical cooling to patients with high fever, observe vital signs, and give anti allergic drugs or hormone treatment according to doctors orders when necessary.(4) in case of serious reac

14、tion, the infusion should be stopped immediately, and the remaining solution and infusion apparatus are retained for examination and the cause of the reaction is found.Two 、 acute pulmonary edemaL, reasons:(L) as the infusion speed is too fast, too much liquid is input in a short time, which makes t

15、he circulating blood volume increase rapidly and the heart overload causes.(2) the patient has poor cardiopulmonary function, especially in patients with acute left ventricular dysfunction.2 symptoms: the patient suddenly appear dyspnea, chest tightness, cough, cough, pink foam, sputum, sputum from

16、the mouth and nose when serious, auscultation, lungs filled with wet rale, heart rate is fast and irregular rhythm.3, prevention and treatment:(1) in the infusion process, we should closely observe the patients condition, especially for the elderly, children, cardiopulmonary dysfunction patients, es

17、pecially need to pay attention to control the speed of infusion, should not be too fast and the amount of transfusion should not be too much.(2) if the symptoms occur, slow down or stop the infusion and notify the doctor for emergency treatment. If the condition permits, may cause the patient to sit

18、 upright, the legs hang down, reduces the vein of the lower limb to return, reduces the heart burden. If necessary,the limbs are tied. The appropriate pressurerubber tourniquet or limbs blood pressure cuffs, to prevent venous blood flow, but still through the arterial blood. Each 5 to 10min relaxati

19、on of a tourniquet on the limb can effectively reduce the amount of venous blood. Gradually relieved the tourniquet after symptomatic relief.(3) to give high flow oxygen inhalation, the general oxygen flow rate is 6 8L / min, in order to improve the oxygen partial pressure in the alveoli, increase o

20、xygen dispersion, improve hypoxemia. It is best to use 50%-70% alcohol to inhale after wetting. Alcohol can reduce foam surface tension, thereby improving lung gas exchange and alleviating the symptoms of hypoxia.(4) the doctor prescribed sedative, antiasthmatic, cardiac, diuretic and vasodilator dr

21、ugs.(5) comfort the patient and relieve the patients nervousness.Three phlebitis1 reasons: due to long-term infusion of high concentration, strong irritant liquid, placed in the venous irritation of the plastic pipe or venous indwelling needle placed too long, cause local vein wall chemical reaction

22、; as a result of aseptic operation is not strictly enforced in the process of transfusion, resulting in local venous infection.2 symptoms: along the vein to streak the red line, local tissue swelling, redness, burning, pain, sometimes accompanied by chills, fever and other symptoms.3, prevention and

23、 treatment:(1) strictly implement aseptic operation. Drugs that are irritating to the walls of the blood vessel should be fully diluted and then used. Drip speed should be slow, to prevent leakage of drugs outside the vessel. At the same time, replace the infusion site with a plan to protect the vei

24、n.(2) stop the infusion at this site, and raise and brake the affected limb. Local use of 50% Magnesium Sulfate solution wet compress (early cold compress, late hot compress), 2 times a day, every time 20min.(3) ultrashort wave physiotherapy, l times a day, 15 to 20min every time.(4) traditional Chi

25、nese medicine treatment, the powder of Ruyijinhuang Jiacu tune into a paste, local application, 2 times a day, with heat, pain, swelling effect.(5) if infection is combined, antibiotic treatment should be given according to doctors advice.Four. Air embolismL, reasons:(1) the air in the infusion cath

26、eter is not exhausted, the connecting of the catheter is not tight, and the air leak is out.(2) there is no guardian during the pressure infusion or transfusion, and the liquid medicine or needle is not replaced in time.An air embolism is caused by air embolism into the air of the vein, which is fir

27、st taken to the right atrium with the blood stream, and then into the right ventricle. If the air is small, the right ventricle is pumped into the pulmonary artery with blood and dispersed into the pulmonary arteriole. At the end of the capillary absorption, less damage; such as air volume, air bloc

28、king pulmonary artery at the entrance to the right ventricle, so that blood cannot enter the lungs, gas exchange disorder, cause severe hypoxia and immediate death.2 symptoms: the patient discomfort or chest pain, dyspnea and cyanosis appeared serious, a feeling of impending death. The audible, pers

29、istent, bubbling sound in the pre - auscultation area was associated with myocardial ischemia and an acute pulmonary heart disease.3, prevention and treatment:(1) carefully check the quality of the infusion apparatus before transfusion, and drain the air in the infusion catheter.(2) strengthen the i

30、nspection during the infusion process, change the infusion bottle or add the medicine in time, and finish the needle in time after the transfusion; when the infusion is pressed, someone should be in charge of it.(3) immediately let the patient take a leftlie head low foot high, so that the gas will

31、float to the right ventricular apex. Avoid the entrance of the pulmonary artery. As the heart contracts, the air is mixed and the foam is divided into small amounts into the pulmonary artery and gradually absorbed.(4) immediately intravenouslydripped with high flow oxygen inhalation, improve blood o

32、xygen concentration in patients with the correct hypoxia conditions; through central venous catheter from the air condition; close observation of patients with abnormal changes such as: timely symptomatic treatment.Five. Liquid extravasation1. reasons: puncture puncture blood vessel or infusion proc

33、ess, needle or indwelling catheter slide out of the blood vessel, so that the liquid into the puncture site of the vascular tissue caused by.2. symptoms: local tissue swelling, pale, pain, poor infusion, such as drugs irritating or toxic, can cause severe tissue necrosis.3. prevention and treatment:

34、(1) firmly fixing the needle head, avoiding movement; reducing the activities of the transfusion limbs.(2) always check the patency of the infusion tube, especially before dosing.(3) when the liquid extravasation occurs, the infusion should be stopped immediately, the replacement of limbs and needle

35、s, and re puncture.(4) lift affected limbs to reduce edema, local hot compress for 20 minutes, to promote venous reflux and exudate absorption, reduce pain and edema.Six 、 emergency treatment of anaphylactic shockOnce allergic shock occurs, we must race against time, prompt and in situ rescue.1. imm

36、ediately stop the drug, the patient on the horizon, for rescue.2. immediately subcutaneousinjection of adrenaline hydrochloride in 0.1% 0.5-1ml, reduce it, this drug is the drug of choice for rescuing anaphylactic shock, with vasoconstriction, increased peripheral resistance, improve blood pressure, the role of myocardial excitement and increased cardiac output and bronchial smooth muscle relaxation. If symptoms are n