1、1静脉输液操作并发症的预防与处理一、发热反应1、原因：因输入致热物质引起。多由于输液瓶清洁灭菌不彻底，输入的溶液或药物制品不纯、消毒保存不良，输液器消毒不严格或被污染，输液过程中未能严格执行无菌操作等所致。2、症状：病人表现为发冷、寒战和高热。轻者体温在 38左右，停止输液后数小时可自行恢复正常；严重者起初起寒战，继之高热，体温可达 41，并伴有头疼、恶心、呕吐、脉速等全身症状。3、预防及处理：（1）输液前认真检查药液质量，输液器包装及灭菌日期、有效期，严格无菌技术操作。（2）反应轻者，可减慢点滴速度或停止输液，通知医生，同时注意体温变化。（3）对高热病人给予物理降温，观察生命体征，必要时遵医
2、嘱给予抗过敏药物或激素治疗。（4）反应严重者，应立即停止输液，并保留剩余溶液和输液器进行检测，查找反应原因。二、急性肺水肿l、原因：（l）由于输液速度过快，短时间内输入过多液体，使循环血容量急剧增加，心脏负荷过重引起。（2）病人原有心肺功能不良，尤多见于急性左心功能不全者。2、症状：病人突然出现呼吸困难、胸闷、咳嗽、咯粉红色泡沫样痰，严重时痰液可从口、鼻涌出，听诊肺部布满湿啰音，心率快且节律不齐。3、预防及处理：（1）在输液过程中，要密切观察病人情况，对老年人、儿童、心肺功能不良的病人尤需注意控制滴注速度不宜过快和输液量不宜过多。（2）出现上述症状，立即减慢或停止输液并通知医生，进行紧急处理。
3、如病情允许可使病人端坐，双腿下垂，以减少下肢静脉回流，减轻心脏负担。必要时进行四肢轮扎。用橡胶止血带或血压计袖带适当加压四肢，以阻断静脉血流，但动脉血仍可通过。每2510min 轮流放松一个肢体上的止血带，可有效地减少静脉回心血量。症状缓解后，逐渐解除止血带。（3）给予高流量氧气吸入，一般氧气流量为 68Lmin，以提高肺泡内氧分压，增加氧的弥散，改善低氧血症。最好用 50%-70%酒精湿化后吸入，酒精能降低泡沫表面张力，从而改善肺部气体交换，缓解缺氧症状。（4）遵医嘱给予镇静剂、平喘、强心、利尿和扩血管药物。（5）安慰病人，解除病人的紧张情绪。三、静脉炎1、原因：由于长期输注高浓度、刺激性较
4、强的药液，静脉内放置刺激性大的塑料管或静脉留置针放置时间过长，引起局部静脉壁发生化学性反应；也可因输液过程中未严格执行无菌操作，导致局部静脉感染。2、症状：沿静脉走向出现条索状红线，局部组织发红、肿胀、灼热、疼痛，有时伴有畏寒、发热等全身症状。3、预防及处理：（1）严格执行无菌操作。对血管壁有刺激性的药物应充分稀释后再应用。点滴速度宜慢，防止药物漏出血管外。同时，要有计划地更换输液部位，以保护静脉。（2）停止在此部位输液，并将患肢抬高、制动。局部用 50硫酸镁溶液湿敷（早期冷敷，晚期热敷） ，每日 2 次，每次 20min。（3）超短波理疗，每日 l 次，每次 1520min。（4）中药治疗，
5、将如意金黄散加醋调成糊状，局部外敷，每日 2 次，具有清热、止痛、消肿的作用。（5）如合并感染，遵医嘱给予抗生素治疗。四、空气栓塞l、原因：（1）输液导管内空气未排尽，导管连接不紧，有漏气。（2）加压输液、输血时无人守护，液体输完未及时更换药液或拔针。发生空气栓塞是由于进人静脉的空气形成的气栓，随血流首先被带到右心房，然后进入右心室。如空气量少，则被右心室随血液压入肺动脉并分散到肺小动脉内。最后经毛细血管吸收，损害较小；如空气量大，空气在右心室内阻塞肺动脉入口，使血液不能进入肺内，气体交换发生障碍，引起机体严重缺氧而立即死亡。2、症状：病人感到不适或胸骨后疼痛，随之出现呼吸困难和严重发绀，有濒
6、死感。听3诊前区可闻及响亮的、持续的“水泡声” ，心电图呈现心肌缺血和急性肺源性心脏病的改变。3、预防及处理：（1）输液前认真检查输液器的质量，排尽输液导管内的空气。（2）输液过程中加强巡视，输液中及时更换输液瓶或添加药物；输液完毕及时拔针；加压输液时应有专人在旁守护。（3）立即让病人取左侧卧位并头低脚高，以便气体能浮向右心室尖部。避开肺动脉入口，随着心脏舒缩，将空气混成泡沫，分次小量进入肺动脉内，逐渐被吸收。（4）立即绐予高流量氧气吸入，提高病人的血氧浓度，纠正缺氧状态；有条件者可通过中心静脉导管抽出空气；严密观察病人病情变化：如有异常及时对症处理。五、液体外渗1原因：穿剌时刺破血管或输液过
7、程中针头或留置导管滑出血管外，使液体进入穿刺部位的血管外组织而引起。2症状：局部组织肿胀、苍白、疼痛，输液不畅，如药物有刺激性或毒性，可引起严重的组织坏死。3预防及处理：（1）牢固固定针头，避免移动；减少输液肢体的活动。（2）经常检查输液管是否通畅，特别是在加药之前。（3）发生液体外渗时，应立即停止输液，更换肢体和针头重新穿刺。（4）抬高患肢以减轻水肿，可局部热敷 20 分钟，促使静脉回流和渗出液的吸收，减轻疼痛和水肿。 六、过敏性休克的急救一旦发生过敏性休克必须争分夺秒、迅速及时、就地急救。1立即停药，患者就地平卧，进行抢救。2. 立即皮下注射 0.1盐酸肾上腺素 0.5-1ml，病儿酌减，
8、此药是抢救过敏性休克的首选药物，具有收缩血管、增加外周阻力，提升血压，兴奋心肌、增加心输出量及松弛支气管平滑肌的作用。如症状不缓解，可每隔 30min 皮下或静脉注射给药 0.5ml，直至脱离危险。如发生心脏骤停立即行胸外心脏按压术。3维持呼吸：给予氧气吸入。呼吸受抑制时肌内注射尼可刹米（可拉明）或络贝林等呼吸兴奋剂。喉头水肿影响呼吸时，可行气管插管或气管切开术。4抗过敏：根据医嘱，立即给予地塞米松 5-10mg 静脉注射或氢化可的松 200400mg4加人 510的葡萄糖液 500ml，静脉滴注。应用抗组胺类药，如肌内注射异丙嗪（非那根）2540mg 或苯海拉明 20mg。5补充血容量：静脉
9、滴注 10葡萄糖溶液或平衡液扩充血容量。如血压下降不回升，可用低分子右旋糖酐，必要时可用多巴胺、阿拉明等升压药物。6纠正酸中毒。7密切观察患者体温、脉搏、呼吸、血压、尿量及其他病情变化，并做好病情动态记录。Prevention and management of complications of intravenous infusionFebrile reactions1, reason: as a result of input heating material. Because the infusion bottle is not clean and sterilized, the sol
10、ution 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 presented with chills, chills, and high fever. The ligh
11、t 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 and other symptoms, pulse rate.3, prevention and trea
12、tment:(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 intravenous drip or stop the infusion, notify the doctor and
13、 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 reaction, the infusion should be stopped immediately, a
14、nd 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 the circulating blood volume increase rapidly and th
15、e 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 the mouth and nose when serious, auscultation, lung
16、s 5filled 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, especially need to pay attention to control the spee
17、d 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 upright, the legs hang down, reduces the vein of
18、the lower limb to return, reduces the heart burden. If necessary, the limbs are tied. The appropriate pressure rubber tourniquet or limbs blood pressure cuffs, to prevent venous blood flow, but still through the arterial blood. Each 5 to 10min relaxation of a tourniquet on the limb can effectively r
19、educe 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 oxygen dispersion, improve hypoxemia. It is best
20、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 drugs.(5) comfort the patient and relieve the pati
21、ents 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; as a result of aseptic operation is not strict
22、ly 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 treatment:(1) strictly implement aseptic operat
23、ion. 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 vein.(2) stop the infusion at this site, and raise
24、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 Chinese medicine treatment, the powder of Ruyijinhu
25、ang 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 catheter is not exhausted, the connecting of the cat
26、heter is not 6tight, 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 first taken to the right atrium with the blood str
27、eam, 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 blocking pulmonary artery at the entrance to the ri
28、ght 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, persistent, “bubbling“ sound in the pre - auscultat
29、ion 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 inspection during the infusion process, change
30、 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 float to the right ventricular apex. Avoid th
31、e 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 oxygen concentration in patients with the corr
32、ect 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 process, needle or indwelling catheter slide out
33、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:(1) firmly fixing the needle head, avoiding m
34、ovement; 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 needles, and re puncture.(4) lift affected limbs to
35、 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.71. immediately stop the drug, the patient on the h
36、orizon, for rescue.2. immediately subcutaneous injection 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 incr
37、eased cardiac output and bronchial smooth muscle relaxation. If symptoms are not relieved, 0.5ml or 30min can be administered subcutaneously or intravenously every day until it is out of danger. In case of cardiac arrest, erect chest compressions should be performed.3. maintain breathing: oxygen inh
38、alation. Breathing by inhibition of intramuscular injection of Nikethamide (Coramine) or complex respiratory stimulant bailyn. When laryngeal edema affects respiration, endotracheal intubation or tracheotomy can be performed.4., anti allergy: according to the doctors advice, immediately give dexamet
39、hasone 5-10mg intravenous injection or hydrocortisone 200 - 400mg, add 5% - 10% glucose solution 500ml, intravenous drip. The application of anti histamine drugs, such as intramuscular injection of promethazine (phenergan) 2540mg diphenhydramine or 20mg.5. add blood volume: intravenous infusion of 1
40、0% glucose solution or balanced solution to expand the volume of blood. If the blood pressure does not rise, available in low molecular dextran, dopamine and metaraminol etc. can be used when necessary pressor agents.6. correct acidosis.7. to observe the patients body temperature, pulse, respiration, blood pressure, urine volume and other changes, and make a dynamic record of the disease.
