a-c-l導(dǎo)管維護(hù)

1、,,,A-C-L導(dǎo)管程序化維護(hù)最佳實(shí)踐標(biāo)準(zhǔn),工作中是否遇到……,,,?,,Lynn Hadaway A-C-L導(dǎo)管維護(hù)程序系列課程的創(chuàng)始者及提倡者。林恩.哈達(dá)維在靜療護(hù)理和成人繼續(xù)教育領(lǐng)域有著30多年的豐富經(jīng)驗(yàn)。具有靜療護(hù)士證書協(xié)會(huì)頒發(fā)的《靜療護(hù)士證書》和美國護(hù)理協(xié)會(huì)頒發(fā)的《專業(yè)護(hù)理指導(dǎo)教育證書》。她曾就職于美國血管通路協(xié)會(huì)，先后擔(dān)任輪值總監(jiān)和主席；后又兩次就任美國靜療護(hù)士協(xié)會(huì)東南部的主席，目前為美國INS學(xué)會(huì)高級(jí)顧問及《美國IN

2、S輸液治療護(hù)理實(shí)踐標(biāo)準(zhǔn)》等教材的編委。,A- Assess導(dǎo)管功能評(píng)估C- Clear 沖管L– Lock 封管,常見靜脈輸液工具的種類,,,,,以導(dǎo)管尖端是否達(dá)到腔靜脈為標(biāo)準(zhǔn)外周靜脈導(dǎo)管和中心靜脈導(dǎo)管,A-C-L導(dǎo)管維護(hù)最佳實(shí)踐標(biāo)準(zhǔn),A- Assess the function of the catheter 導(dǎo)管功能評(píng)估（抽回血）導(dǎo)管穿刺期間導(dǎo)管留置期間C- Clear 沖管L – Lock 封管,Blo

3、od Return is Mandatory!通過抽回血判斷導(dǎo)管通暢是必須的!,All catheters should yield a brisk blood return prior to infusion of each dose of medication. 所有的導(dǎo)管在輸液前都會(huì)有一些回血Lack of blood return means a non-functioning catheter 無回血意味著導(dǎo)管功能下降R

4、elated to how or where the catheter was placed 與導(dǎo)管留置的過程和部位等因素相關(guān),Catheter Lumen Occlusion導(dǎo)管腔內(nèi)堵塞,Causes原因Thrombotic血栓性Drug precipitate藥物沉淀Mechanical 機(jī)械性Proper flushing and locking catheters will either prevent or

5、 identify these problems正確沖封管能預(yù)防此類問題,Precipitate Causes藥物沉淀因素,Contact between two or more incompatible drugs or fluids 兩種或多種不相容藥物/液體Alteration in drug pH 藥物PH值變化Precipitate forms inside catheter lumen 管內(nèi)沉淀形成Lipid slu

6、dge from fat emulsion 脂肪乳沉積Waxy coating on internal catheter walls 管壁內(nèi)蠟狀沉淀,Catheter Flushing導(dǎo)管沖封管,Standards and Guidelines標(biāo)準(zhǔn)和指南INS Standard #56 INS標(biāo)準(zhǔn)第56條If resistance is met or an absent blood aspirate noted, th

7、e nurse should take further steps to assess patency of the catheter prior to administration of medications and solutions. The catheter should not be forcibly flushed.給藥和輸液前，如果遇到阻力或者抽吸無回血，護(hù)士應(yīng)進(jìn)一步確認(rèn)導(dǎo)管的通暢性。不應(yīng)強(qiáng)行沖洗導(dǎo)管。The nurs

8、e should aspirate the catheter for positive blood return to confirm patency prior to administration of medications and solutions. 給藥和輸液前，護(hù)士應(yīng)抽回血以確認(rèn)導(dǎo)管是否通暢。,A- Assess導(dǎo)管功能評(píng)估C- Clear 沖管：將導(dǎo)管內(nèi)殘留的藥液和血液沖入血管L– Lock 封管,A-C-L導(dǎo)管維護(hù)最

9、佳實(shí)踐標(biāo)準(zhǔn),Purposes of Catheter Flushing導(dǎo)管沖管的目的,Infusion Nursing Standards of Practice, Infusion Nurses Society 美國INS指南To promote and maintain catheter patency 維持通暢To prevent contact between incompatible medications and so

10、lutions 避免藥物間反應(yīng)Many medications are incompatible 很多藥物間都有配伍禁忌Contact in the catheter lumen causes drug precipitate that occludes the lumen 藥物沉淀在導(dǎo)管內(nèi)形成堵塞,沒有足夠沖管會(huì)造成：,并發(fā)癥管腔阻塞血液凝結(jié)藥物沉積,Flush Solution Containers沖管液容器的選擇,Si

11、ngle dose containers are preferred Single dose vials, e.g. 10 mL vial of preservative-free normal saline 獨(dú)立包裝容器，例如10ml不含防腐劑的生理鹽水Prefilled syringes 預(yù)沖式注射裝置,采用推一下停一下的沖洗方法，使等滲鹽水在導(dǎo)管內(nèi)形成小旋渦，有利于把附著在導(dǎo)管和血管壁的殘留藥液沖洗干凈。,沖管方法,不間斷的沖

12、洗方法,脈沖式的沖洗方法,Catheter Flushing導(dǎo)管沖封管,Standards and Guidelines標(biāo)準(zhǔn)和指南INS Standard #56 INS標(biāo)準(zhǔn)第56條 The minimum volume of the flush solution should be equal to at least twice the volume capacity of the catheter and add-o

13、n devices.沖洗液的最少量應(yīng)為導(dǎo)管和附加裝置容量的2倍。The nurse should be knowledgeable about medication and solution incompatibilities. 護(hù)士應(yīng)具備有關(guān)藥物和/或液體不相容性的知識(shí)。,Catheter Flushing導(dǎo)管沖封管,Standards and Guidelines標(biāo)準(zhǔn)和指南INS Standard #56 INS標(biāo)準(zhǔn)

14、第56條Positive-end pressure shall be used 脈沖式的沖管手法Syringe size should be in accordance with manufacturer recommendations 注射器規(guī)格與廠家一致Consideration should be given to single-use flushing systems 使用一次性沖管裝置,Standards and Gu

15、idelines標(biāo)準(zhǔn)和指南?CDCBased on recent HCV outbreak, CDC “strongly encourages” use of pre-fills or SDV’sCDC強(qiáng)烈鼓勵(lì)使用預(yù)充式導(dǎo)管沖洗器?JCAHOSentinel Event Alert identifies “single-use IV flush vials” as important strategy to reduce

16、the risk of nosocomial infections. 一次性使用的導(dǎo)管沖洗器是減少院內(nèi)感染最重要的策略,Catheter Flushing導(dǎo)管沖封管,A- Assess導(dǎo)管功能評(píng)估C- Clear 沖管L- Lock 封管：輸液完畢或在兩次間斷的輸液之間，需用封管液封管，維持導(dǎo)管通暢。,A-C-L導(dǎo)管維護(hù)最佳實(shí)踐標(biāo)準(zhǔn),常用封管液,0.9%生理鹽水 適用于所有短導(dǎo)管 稀釋的肝素溶液管內(nèi)保留沖管液肝素稀

17、釋濃度10或者100單位/mlINS推薦 - 10 單位/ml適用于所有類型靜脈導(dǎo)管的封管操作,封管方法,方法推封管液至剩余0.5ml夾輸液夾：一手持小夾子，一手快速將延長管（拿捏輸液接頭一端）推至輸液夾底部 。,沖封管護(hù)理的正確步驟,SASH procedureS = 生理鹽水(A/C)A= 給藥S=生理鹽水(L)H= 肝素(L),SAS procedureS=生理鹽水(A/C)A= 給藥S=生理鹽水(L),何謂A