PICC导管标准维护流程.ppt

Affiliated Affiliated Hospital Hospital Of Bei-hua Of Bei-hua UniversityUniversityPICC导管标准维护流程 Affiliated Affiliated Hospital Hospital Of Bei-hua Of Bei-hua UniversityUniversity一、PICC维护的目的1、确保PICC穿刺点的无菌状态2、预防导管相关性血流感染3、确保PICC导管通畅4、维持导管的正常功能5、体现护理专业价值，提升医院的社会效益Affiliated Affiliated Hospital Hospital Of Bei-hua Of Bei-hua UniversityUniversity物品准备2注意事项4操作程序3 3评 估3 1Affiliated Affiliated Hospital Hospital Of Bei-hua Of Bei-hua UniversityUniversity 穿刺点导 管敷 料发红肿胀渗血渗液移位潮湿脱落污染是否到期一、评 估Affiliated Affiliated Hospital Hospital Of Bei-hua Of Bei-hua UniversityUniversity 物品名称数量 物品名称数量 一次性中心静脉导管换药包1个无菌棉签1包10ml(20ml)注射器2个污物桶1个生理盐水100ml或10ml预冲1袋锐器盒1个肝素盐水（0-10U/ml）1袋手部消毒液1瓶思乐扣1个油性签字笔1支MC100输液接头1个治疗盘1个75%酒精1瓶二、物品准备Affiliated Affiliated Hospital Hospital Of Bei-hua Of Bei-hua UniversityUniversity1 1更换输液接头三、操作程序2 2冲洗导管并封管3 3更换思乐扣、透明敷料Affiliated Affiliated Hospital Hospital Of Bei-hua Of Bei-hua UniversityUniversity1目的：预防感染2更换频率：1)建议至少每7天更换一次 2)有血液残留、完整性受损或取下，应立即更换静脉治疗护理技术操作规范 第一步:更换输液接头Affiliated Affiliated Hospital Hospital Of Bei-hua Of Bei-hua UniversityUniversity2011版CDC指南：-使用无针连接系统时，分隔膜式输液接头要优于机械阀输液接头，因为机械阀接头可增加感染风险。（II类）2011版INS指南：-所有的附加装置应该使用螺口连接，以保证安全连接2013卫计委静脉治疗护理技术操作规范-6.6.6所有附加装置宜选用螺旋接口Affiliated Affiliated Hospital Hospital Of Bei-hua Of Bei-hua UniversityUniversity34.无针输液接头标准34.1 利用螺口连接可保证血管通路装置（VAD）导管座或穿刺部位上无针输液接头的安全连接。34.2 在每次连接装置前对无针输液接头进行消毒。34.3 使用无菌非接触技术更换无针输液接头。34.4 无针输液接头只可与无菌装置连接。2016 INSAffiliated Affiliated Hospital Hospital Of Bei-hua Of Bei-hua UniversityUniversity1洗手、戴口罩，查对医嘱执行单并打铅笔勾。检查无菌物品2携用物至病人床旁，进行查对，向病人解释操作目的，以取得合作3评估（输液接头、穿刺点、敷料）更换输液接头-准备Affiliated Affiliated Hospital Hospital Of Bei-hua Of Bei-hua UniversityUniversity打开换药包，将思乐扣投入换药包内，在穿刺肢体下铺垫巾 更换输液接头-步骤用皮尺测量肘正中上方10cm处臂围揭开固定输液接头的胶布，如有胶痕给予清除123Affiliated Affiliated Hospital Hospital Of Bei-hua Of Bei-hua UniversityUniversity 更换输液接头-步骤洗消手，抽取10ml生理盐水待用4打开输液接头包装；预冲输液接头待用5卸下旧的输液接头(确保拇指夹处于夹闭状态)6Affiliated Affiliated Hospital Hospital Of Bei-hua Of Bei-hua UniversityUniversity 更换输液接头-步骤带手套，并摆放用物7打开酒精棉片包，用酒精棉片消毒路厄氏接口，用力多方位擦拭15秒用无菌生理盐水预冲输液接头，连接新的输液接头 89Affiliated Affiliated Hospital Hospital Of Bei-hua Of Bei-hua UniversityUniversity1 定义：用等渗盐水将导管内残留的药液冲入血管，应用于输液前或两种药物之间:避免残留药液刺激局部血管减少药物之间的配伍禁忌 第二步:冲洗导管2 目的:保持导管通畅,输液遇到阻力或抽吸无回血应进一步确认导管的通畅性,不要强行冲管Affiliated Affiliated Hospital Hospital Of Bei-hua Of Bei-hua UniversityUniversity3冲洗方法:冲管液通常为生理盐水，采用 脉冲式 冲洗方法，使生理盐水在导管内形成小旋涡，有利于把导管内的残留药物冲洗干净4 冲洗频率：1、输注的两种不同药物间有配伍禁忌时，在前一种药物输注结束后，应冲洗或更换输液器并冲洗导管2、使用输血器时，输血前后应用生理盐水冲洗输血管道3、PICC导管在治疗间歇期间应至少每周维护一次 第二步:冲洗导管2013卫计委静脉治疗护理技术操作规范Affiliated Affiliated Hospital Hospital Of Bei-hua Of Bei-hua UniversityUniversity脉冲与直冲比较脉冲：产生正、负压形成涡流，可有力地将粘在导管壁上的内容物冲洗干净直推：水注只能在导管中心流动无法冲洗导管壁，容易造成导管腔狭窄而堵塞导管Affiliated Affiliated Hospital Hospital Of Bei-hua Of Bei-hua UniversityUniversity1、打开拇指夹2、用10ml生理盐水注射器连接输液接头3、脉冲方式冲洗导管 双腔两个腔都要冲冲洗导管步骤勿使用小于10ml的注射器冲管、给药Affiliated Affiliated Hospital Hospital Of Bei-hua Of Bei-hua UniversityUniversity静脉治疗护理技术操作规范冲洗导管步骤6.5.1.5 肝素盐水的浓度：PICC及CVC可用0-10U/ml 6.5.1.4 输液完毕应用导管容积加延长管容积2倍的生理盐水或肝素盐水正压封管 4F 0.67ml(包括延长管）延长管 0.14mlAffiliated Affiliated Hospital Hospital Of Bei-hua Of Bei-hua UniversityUniversity注:注射器内要有剩余液体正压封管步骤方法1（连接肝素帽）：将针尖留在肝素帽内少许，正压推注封管液，一边推一边拔针头,推液速度大于拔针速度,夹闭拇指夹方法2（连接MC100）：先去除注射器后夹拇指夹12Affiliated Affiliated Hospital Hospital Of Bei-hua Of Bei-hua UniversityUniversity正压达标效果图Affiliated Affiliated Hospital Hospital Of Bei-hua Of Bei-hua UniversityUniversity40.冲管和封管A.所有血管通路装置的冲管和封管应该使用单剂量系统（例如单剂量小瓶或有标签的预充式冲洗器）。1.市场上销售的预充式冲洗器可降低导管相关性血流感染的风险，并节省手工配制的时间。2.如果必须使用多次剂量药瓶，则一个药瓶只用于一个患者（参考标准49，感染）。3.不可将静脉输注溶液（例如输液袋或输液瓶）作为冲管液的来源。4.告知患者预充式冲洗器可能会干扰味觉和嗅觉，其相关的原因包括免疫系统疾病（如糖尿病、克隆氏病）、用药情况（如抗肿瘤药）以及放射治疗。已有报道称塑料材质冲洗器中的物质会溶入盐水，但对健康并无伤害。2016 INSAffiliated Affiliated Hospital Hospital Of Bei-hua Of Bei-hua UniversityUniversity1 1更换输液接头2 2冲洗导管并封管3 3更换思乐扣、透明敷料Affiliated Affiliated Hospital Hospital Of Bei-hua Of Bei-hua UniversityUniversity目的：预防感染 第三步:更换思乐扣、透明敷料 6.5、2.1 应每日观察穿刺点及周围皮肤的完整性.6.5、2.2 无菌透明敷料应至少7d更换一次，无菌纱布敷料应至少2d更换一次：若穿刺部位发生渗液渗血时应及时更换敷料：穿刺部位的敷料发生松动、污染等完整性受损时应立即更换 -静脉治疗护理技术操作规范Affiliated Affiliated Hospital Hospital Of Bei-hua Of Bei-hua UniversityUniversity1、去除透明敷料外胶带2、“0”度角平行撕拉，自下而上 去除原有透明敷料3、手消后再戴手套第三步:更换思乐扣、透明敷料Affiliated Affiliated Hospital Hospital Of Bei-hua Of Bei-hua UniversityUniversity4、除拆旧思乐扣：脱离：轻轻打开锁扣，小心从锁扣上移开导管卸除：用酒精浸润、溶解思乐扣固定装置下方的粘合剂，直至将Statlock固定装置从皮肤上移开第三步:更换思乐扣、透明敷料打开思乐扣移除导管酒精浸润Affiliated Affiliated Hospital Hospital Of Bei-hua Of Bei-hua UniversityUniversity5、左手持纱布包裹输液接头，提起导管，右手持酒精棉棒一根，避开穿刺点直径1cm处，顺时针去脂、消毒，范围：至少大于贴膜的面积。再取第二根酒精棉棒，同样的方法逆时针脱脂并消毒皮肤待干第三步:更换思乐扣、透明敷料Affiliated Affiliated Hospital Hospital Of Bei-hua Of Bei-hua UniversityUniversity6、再取碘伏棉棒一根顺时针消毒皮肤、取第二根碘伏棉棒同样的方法逆时针消毒皮肤。*注：酒精、碘伏消毒方法参照中华人民共和国卫生部医疗机构消毒技术规范，2012版第三步:更换思乐扣、透明敷料Affiliated Affiliated Hospital Hospital Of Bei-hua Of Bei-hua UniversityUniversity7、安装思乐扣（使用思乐扣固定法)第三步:更换思乐扣在摆放思乐扣处均匀涂抹一层皮肤保护剂，待干15秒或至不粘手套为止按思乐扣上箭头所示方向（箭头指向穿刺点）将导管装在思乐扣立柱上，锁定纽扣导管出皮肤处逆血管方向摆放弧形（“L”或“U”型）依次撕除思乐扣的背胶纸，将思乐扣贴在皮肤上涂皮肤保护剂 按压 撕 开 贴 放Affiliated Affiliated Hospital Hospital Of Bei-hua Of Bei-hua UniversityUniversity第三步:更换透明敷料10*12cm透明敷料无张力粘贴，透明敷料应完全覆盖住思乐扣1胶带蝶型交叉固定贴膜下缘，再以胶带横向固定胶带横向固定延长管在记录胶带上标注操作者姓名及日期，贴于透明敷料23Affiliated Affiliated Hospital Hospital Of Bei-hua Of Bei-hua UniversityUniversity整理用物，脱无菌手套向病人交待注意事项手消毒在执行单上签名及时间填写PICC维护记录单整理用物Affiliated Affiliated Hospital Hospital Of Bei-hua Of Bei-hua UniversityUniversity严格无菌操作，敷料要完全覆盖体外导管，以免引起感染如发现污染、患者出汗多及敷料卷边时，应及时更换透明敷料 当体外导管被污染时，可用碘伏消毒，一定完全待干后再覆盖敷料四、注意事项Affiliated Affiliated Hospital Hospital Of Bei-hua Of Bei-hua UniversityUniversity感谢聆听！Affiliated Affiliated Hospital Hospital Of Bei-hua Of Bei-hua UniversityUniversity2、穿刺部位感染：案例二、静脉导管维护常见并发症预防措施Affiliated Affiliated Hospital Hospital Of Bei-hua Of Bei-hua UniversityUniversity二、静脉导管维护常见并发症预防措施Affiliated Affiliated Hospital Hospital Of Bei-hua Of Bei-hua UniversityUniversity二、静脉导管维护常见并发症预防措施Affiliated Affiliated Hospital Hospital Of Bei-hua Of Bei-hua UniversityUniversity二、静脉导管维护常见并发症预防措施