靜脈輸液并發(fā)癥的預(yù)防與處理

1、僅供個(gè)人參考Forpersonaluseonlyinstudyandresearch;notforcommercialuse靜脈輸液操作弁發(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(wú)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)41C,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(wú)菌技術(shù)操作。(

2、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，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(cè)，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

3、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

4、、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1、原因：由于長(zhǎng)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(zhǎng)，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(wú)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(wú)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

5、期熱敷），每日2次，每次20min。（3）超短波理療，每日l(shuí)次，每次1520min。（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(wú)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?。蝗缈諝饬看?，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，

6、引起機(jī)體嚴(yán)重缺氧而立即死亡。2、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

7、空氣；嚴(yán)密觀察病人病情變化：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(zhēng)分奪秒、迅速及時(shí)、就地急救。1立即停藥，患者

8、就地平臥，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200400mg加人510的葡萄糖液500ml，靜脈滴注。應(yīng)用抗組胺類藥，如肌內(nèi)注射異丙嗪（

9、非那根）2540mg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。PreventionandmanagementofcomplicationsofintravenousinfusionFebrilereactions1 ,reason:asaresultofinputheatingmaterial.Becausetheinfusionbottleisnotcleanandsterilized,thes

10、olutionorthemedicineproductisimpure,thedisinfectionandthepreservationarebad,theinfusiondeviceisnotsterilizedorpolluted,andtheasepticoperationcannotbestrictlyimplementedintheinfusionprocess.2 symptoms:thepatientpresentedwithchills,chills,andhighfever.Thelighttemperatureat38degreesCelsius,afewhoursaft

11、erthecessationoftheinfusioncouldreturntonormal;seriousatfirstfollowedbyhighfever,chills,bodytemperatureis41degreescentigrade,andaccompaniedbyheadache,nausea,vomitingandothersymptoms,pulserate.3,preventionandtreatment:(1) carefullycheckthequalityoftheliquidmedicinebeforeinfusion,thepackingandthedateo

12、fsterilizationandthevalidperiodoftheinfusion,andstrictlyoperatetheaseptictechnique.(2) thelightpersoncanslowdowntheintravenousdriporstoptheinfusion,notifythedoctorandpayattentiontothechangeofthebodytemperature.(3) givephysicalcoolingtopatientswithhighfever,observevitalsigns,andgiveantiallergicdrugso

13、rhormonetreatmentaccordingtodoctor'sorderswhennecessary.(4) incaseofseriousreaction,theinfusionshouldbestoppedimmediately,andtheremainingsolutionandinfusionapparatusareretainedforexaminationandthecauseofthereactionisfound.Two、acutepulmonaryedemaL,reasons:(L)astheinfusionspeedistoofast,toomuchliq

14、uidisinputinashorttime,whichmakesthecirculatingbloodvolumeincreaserapidlyandtheheartoverloadcauses.2 2)thepatienthaspoorcardiopulmonaryfunction,especiallyinpatientswithacuteleftventriculardysfunction.3 symptoms:thepatientsuddenlyappeardyspnea,chesttightness,cough,cough,pinkfoam,sputum,sputumfromthem

15、outhandnosewhenserious,auscultation,lungsfilledwithwetrale,heartrateisfastandirregularrhythm.4 ,preventionandtreatment:(1) intheinfusionprocess,weshouldcloselyobservethepatient'scondition,especiallyfortheelderly,children,cardiopulmonarydysfunctionpatients,especiallyneedtopayattentiontocontrolthe

16、speedofinfusion,shouldnotbetoofastandtheamountoftransfusionshouldnotbetoomuch.(2) ifthesymptomsoccur,slowdownorstoptheinfusionandnotifythedoctorforemergencytreatment.Iftheconditionpermits,maycausethepatienttositupright,thelegshangdown,reducestheveinofthelowerlimbtoreturn,reducestheheartburden.Ifnece

17、ssary,thelimbsaretied.Theappropriatepressurerubbertourniquetorlimbsbloodpressurecuffs,topreventvenousbloodflow,butstillthroughthearterialblood.Each5to10minrelaxationofatourniquetonthelimbcaneffectivelyreducetheamountofvenousblood.Graduallyrelievedthetourniquetaftersymptomaticrelief.(3)togivehighflow

18、oxygeninhalation,thegeneraloxygenflowrateis68L/min,inordertoimprovetheoxygenpartialpressureinthealveoli,increaseoxygendispersion,improvehypoxemia.Itisbesttouse50%-70%alcoholtoinhaleafterwetting.Alcoholcanreducefoamsurfacetension,therebyimprovinglunggasexchangeandalleviatingthesymptomsofhypoxia.(4) t

19、hedoctorprescribedsedative,antiasthmatic,cardiac,diureticandvasodilatordrugs.(5) comfortthepatientandrelievethepatient'snervousness.Threephlebitis1 reasons:duetolong-terminfusionofhighconcentration,strongirritantliquid,placedinthevenousirritationoftheplasticpipeorvenousindwellingneedleplacedtool

20、ong,causelocalveinwallchemicalreaction;asaresultofasepticoperationisnotstrictlyenforcedintheprocessoftransfusion,resultinginlocalvenousinfection.2 symptoms:alongtheveintostreaktheredline,localtissueswelling,redness,burning,pain,sometimesaccompaniedbychills,feverandothersymptoms.3 ,preventionandtreat

21、ment:(1) strictlyimplementasepticoperation.Drugsthatareirritatingtothewallsofthebloodvesselshouldbefullydilutedandthenused.Dripspeedshouldbeslow,topreventleakageofdrugsoutsidethevessel.Atthesametime,replacetheinfusionsitewithaplantoprotectthevein.(2) stoptheinfusionatthissite,andraiseandbraketheaffe

22、ctedlimb.Localuseof50%MagnesiumSulfatesolutionwetcompress(earlycoldcompress,latehotcompress),2timesaday,everytime20min.(3) ultrashortwavephysiotherapy,ltimesaday,15to20mineverytime.(4) traditionalChinesemedicinetreatment,thepowderofRuyijinhuangJiacutuneintoapaste,localapplication,2timesaday,withheat

23、,pain,swellingeffect.(5) ifinfectioniscombined,antibiotictreatmentshouldbegivenaccordingtodoctor'sadvice.Four.AirembolismL,reasons:(6) theairintheinfusioncatheterisnotexhausted,theconnectingofthecatheterisnottight,andtheairleakisout.(7) thereisnoguardianduringthepressureinfusionortransfusion,and

24、theliquidmedicineorneedleisnotreplacedintime.Anairembolismiscausedbyairembolismintotheairofthevein,whichisfirsttakentotherightatriumwiththebloodstream,andthenintotherightventricle.Iftheairissmall,therightventricleispumpedintothepulmonaryarterywithbloodanddispersedintothepulmonaryarteriole.Attheendof

25、thecapillaryabsorption,lessdamage;suchasairvolume,airblockingpulmonaryarteryattheentrancetotherightventricle,sothatbloodcannotenterthelungs,gasexchangedisorder,causeseverehypoxiaandimmediatedeath.2symptoms:thepatientdiscomfortorchestpain,dyspneaandcyanosisappearedserious,afeelingofimpendingdeath.The

26、audible,persistent,"bubbling"soundinthepre-auscultationareawasassociatedwithmyocardialischemiaandanacutepulmonaryheartdisease.3,preventionandtreatment:(1) carefullycheckthequalityoftheinfusionapparatusbeforetransfusion,anddraintheairintheinfusioncatheter.(2) strengthentheinspectionduringth

27、einfusionprocess,changetheinfusionbottleoraddthemedicineintime,andfinishtheneedleintimeafterthetransfusion;whentheinfusionispressed,someoneshouldbeinchargeofit.(3) immediatelyletthepatienttakealeftlieheadlowfoothigh,sothatthegaswillfloattotherightventricularapex.Avoidtheentranceofthepulmonaryartery.

28、Astheheartcontracts,theairismixedandthefoamisdividedintosmallamountsintothepulmonaryarteryandgraduallyabsorbed.(4) immediatelyintravenouslydrippedwithhighflowoxygeninhalation,improvebloodoxygenconcentrationinpatientswiththecorrecthypoxiaconditions;throughcentralvenouscatheterfromtheaircondition;clos

29、eobservationofpatientswithabnormalchangessuchas:timelysymptomatictreatment.Five.Liquidextravasation1. reasons:puncturepuncturebloodvesselorinfusionprocess,needleorindwellingcatheterslideoutofthebloodvessel,sothattheliquidintothepuncturesiteofthevasculartissuecausedby.2. symptoms:localtissueswelling,

30、pale,pain,poorinfusion,suchasdrugsirritatingortoxic,cancauseseveretissuenecrosis.3. preventionandtreatment:(1) firmlyfixingtheneedlehead,avoidingmovement;reducingtheactivitiesofthetransfusionlimbs.(2) alwayscheckthepatencyoftheinfusiontube,especiallybeforedosing.(3) whentheliquidextravasationoccurs,

31、theinfusionshouldbestoppedimmediately,thereplacementoflimbsandneedles,andrepuncture.(4) liftaffectedlimbstoreduceedema,localhotcompressfor20minutes,topromotevenousrefluxandexudateabsorption,reducepainandedema.Six、emergencytreatmentofanaphylacticshockOnceallergicshockoccurs,wemustraceagainsttime,prom

32、ptandinsiturescue.1. immediatelystopthedrug,thepatientonthehorizon,forrescue.2. immediatelysubcutaneousinjectionofadrenalinehydrochloridein0.1%0.5-1ml,reduceit,thisdrugisthedrugofchoiceforrescuinganaphylacticshock,withvasoconstriction,increasedperipheralresistance,improvebloodpressure,theroleofmyoca

33、rdialexcitementandincreasedcardiacoutputandbronchialsmoothmusclerelaxation.Ifsymptomsarenotrelieved,0.5mlor30mincanbeadministeredsubcutaneouslyorintravenouslyeverydayuntilitisoutofdanger.Incaseofcardiacarrest,erectchestcompressionsshouldbeperformed.3. maintainbreathing:oxygeninhalation.BreathingbyinhibitionofintramuscularinjectionofNikethamide(Coramine)orcomplexrespiratorystimulantbailyn.