catheter care. How to flush a catheter Heparin plug dilution

3. Prepare a tray with dressing material and tweezers.

4. Prepare drugs for treating the skin around the catheter: alcohol 70 °, 1% brilliant green solution.

5. Explain to the patient the meaning of the manipulation.

6. Position the patient facing you, in a position that is comfortable for him.

7. Remove the old bandage

8. Carefully inspect the catheter puncture site and, in the absence of edema, hyperemia and purulent discharge, treat the skin with alcohol 70 ° and 1% brilliant green solution

9. Apply sterile gauze panties around the catheter.

10.Fix the catheter to the skin with adhesive tape

11. Throw the used dressing material into a container with a disinfectant solution.

12. Throw used tools and rubber gloves into a container with a disinfectant solution.

1. To prevent blockage of the catheter by a thrombus, after the end of infusions or in the intervals between infusions (4 times a day), it is necessary to rinse the catheter with 0.9% saline and install a “heparin lock”.

Preparation of "heparin castle":

100 ml. physiological solution+ 5000 IU of heparin (5000 IU - 1 ml.) - administered in 2 - 3 ml.

2. If the catheter plug is depressurized, it must be replaced.

Before opening or closing the catheter plug, ask the patient to hold their breath.

3. In case of violation of the catheter patency, immediately call a doctor!

Caring for a central venous catheter

1. Apron, goggles, mask, rubber gloves.
2. Prepare on the mobile table: Adhesive plaster, scissors, 5000 units. heparin / 5% sodium citrate /, 100 ml of 0.9% sodium chloride solution, 1% iodonate solution, 0.25% novocaine solution, 70% alcohol solution. Fill the system with an indifferent solution.
3. Prepare on a sterile table: a s / c catheter with a mandrin and a stopper, a long needle, a diameter of 2 mm, sterile balls, napkins, two syringes, two needles for intravenous administration, tweezers.

Treatment of the skin in the area of ​​​​the catheter: the treatment of the catheter with a toilet of the skin around it is carried out daily or as it becomes dirty. It includes: removal of the old bandage / adhesive plaster /, examination and palpation in the catheter area, treatment of the hole and the skin around the catheter with a swab moistened with alcohol, application of gauze “panties”, dry or moistened with alcohol, followed by fixation with adhesive plaster “panties”.

Changing the heparin "lock": this is the introduction of a heparin solution into the catheter at a dilution of 1:10, and 1:100 saline ml. A heparin "lock" is made after each injection of a medicinal substance into the catheter, as well as washing the catheter with this heparin solution 3 times a day, if the catheter is functioning (drip injection is carried out through it). In the absence of heparin, a 5% sodium citrate solution can be used.

The introduction of drugs into the catheter:

1. Introduction medicines, infusions are carried out only through a rubber stopper.

2. Before the introduction of the drug, the patency of the catheter is checked by pulling the plunger of the syringe towards itself.

3. The system is connected on exhalation.

4. After the end of the administration of drugs - washing the catheter with saline.

5. According to the schedule, prevent thrombosis in the catheter (heparin lock) and around it (the schedule is available at the nurse's post):

The rubber plug is treated with a 70% alcohol solution. 5-10 ml of heparinized solution (5000 IU - 1 ml of heparin per 100 ml of isotonic sodium chloride solution) is drawn into the syringe and slowly injected through the puncture of the rubber plug. With a difficult introduction, a doctor is called who will remove the blood clot, since it is strictly forbidden to push it.

6. All medications injected very slowly.

7. If there is no patency of the catheter, redness in the area of ​​the catheter insertion, the presence of pain, it is necessary to inform the doctor about this.

8. The catheter is removed as prescribed by the doctor.

9. Aseptic dressings are applied to the wound.

Heparin lock technique

The method of performing a heparin lock in children:

1. Wash hands and put on gloves.

2. Treat the connection of the system for intravenous administration of solutions and the catheter with an antiseptic solution.

3. Stop intravenous administration and disconnect the system from the pavilion of the needle or catheter located in the lumen of the vein.

4. Close the catheter pavilion with a sterile plug or T-piece [eg, an Argyle intermittent infusion plug (Consolidated Medical Equipment, Utica, NY, USA; Sherwood Medical Co., St. Louis, MO, USA) or a Barron port interlock dilator ( Burron Medical, Bethlehem, PA, USA), which are already supplied with the required amount of heparinized saline].

Alternatively, a stopcock with two non-functioning heads can be used. However, a minimum of 3 ml of lavage solution is required to flush all parts of the stopcock, which increases the potential for fluid overload error in extremely low birth weight preterm infants.

5. The cork is treated with an antiseptic and 0.4-0.8 ml of heparinized saline is injected through the cork, washing out the blood from the needle or catheter.

6. Before each use, the cork is treated with an antiseptic.

7. Re-produce the heparin block with heparinized flushing solution after each intravenous infusion. (Routine flushing is done every 6-12 hours depending on frequency of use.)

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Caring for your subclavian (venous) catheter

Target: prevention of complications: air embolism, infection of the vein and skin at the site of catheter insertion.

Indications: a subclavian catheter is inserted for the purpose of long-term infusion therapy.

Equipment: sterile dressing material, skin antiseptic, sterile syringe, heparin, isotonic solution.

You- nurse admission department. A patient was admitted with arterial bleeding from the middle third of the right leg. You need to apply a tourniquet.

The imposition of a hemostatic tourniquet for arterial bleeding.

Target: temporary stop of bleeding.

Indications: arterial bleeding.

Equipment: hemostatic tourniquet, napkin, paper, pencil, IPP, Cramer's splint.

You are a nurse in the Department of Purulent Surgery. The patient applied on the 3rd day after the opening of the boil on the left cheek. You need to bandage a purulent wound.

Target: removal of purulent contents from the wound, prevention of secondary

infection, creating conditions for wound healing.

Indications: the presence of a purulent wound.

Equipment: goggles, mask, oilcloth apron, gloves, leather

antiseptic, sterile tweezers - 3, bellied probe, rubber drains.

sterile dressings, antiseptic solutions, ointments,

hypertonic solution, container with disinfectant.

You are a trauma nurse. A patient was brought to you with a closed fracture of the middle third of the right ulna. It is necessary to carry out therapeutic immobilization.

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Peripheral venous catheter

Peripheral venous catheter When performing intravenous therapy through a peripheral venous catheter (PVC), complications are excluded if the following basic conditions are met: the method should not be used occasionally (become permanent and habitual in practice), the catheter should be provided with impeccable care. A well-chosen venous access is essential for successful intravenous therapy.

STEP 1. Choosing a puncture site

When choosing a catheterization site, consideration should be given to patient preference, ease of access to the puncture site, and suitability of the vessel for catheterization.

Peripheral venous cannulas are intended for insertion into peripheral veins only. Priorities for choosing a vein for puncture:

1. Well visualized veins with well developed collaterals.
2. Veins on the non-dominant side of the body (for right-handers - left, for left-handers - right).
3. Use distal veins first
4. Use veins soft and elastic to the touch
5. Veins from the side opposite to surgical intervention.
6. Veins with the largest diameter.
7. The presence of a straight section of the vein along the length corresponding to the length of the cannula.

The most suitable veins and zones for the installation of PVK (the back of the hand, the inner surface of the forearm).

The following veins are considered unsuitable for cannulation:

1. Vienna lower extremities(low blood flow in the veins of the lower extremities leads to an increased risk of thrombosis).
2. Places of bends of the limbs (periarticular areas).
3. Previously catheterized veins (possibly damage to the inner wall of the vessel).
4. Veins located close to arteries (possibility of arterial puncture).
5. Median cubital vein (Vena mediana cubiti). Puncture of this vein according to the protocols is permissible in 2 cases - blood sampling for analysis, when rendering emergency assistance and poor expression of other veins.
6. Veins of the palmar surface of the hands (risk of damage to blood vessels).
7. Veins in the limb on which the surgical interventions or chemotherapy.
8. Veins of the injured limb.
9. Poorly visualized superficial veins.
10. Fragile and sclerosed veins.
11. Areas of lymphadenopathy.
12. Infected areas and areas of skin damage.
13. Deep veins.

PVC throughput

Rapid transfusion of large volumes of fluid or blood products.

Transfusion of large volumes of fluid and blood products.

Patients who undergo transfusion of blood products (erythrocyte mass) in a planned manner.

Patients on long-term intravenous therapy (from 2-3 liters per day).

Patients on long-term intravenous therapy, pediatrics, oncology.

Oncology, pediatrics, thin sclerosed veins.

STEP 2. Choosing the type and size of the catheter

When choosing a catheter, it is necessary to focus on the following criteria:

1. vein diameter;
2. the required rate of introduction of the solution;
3. potential time of the catheter in the vein;
4. properties of the injected solution;
5. The cannula should never completely block the vein.

The main principle for choosing a catheter is to use the smallest size that provides the required insertion rate in the largest available peripheral vein.

All PVCs are divided into ported (with an additional injection port) and non-ported (without a port). Ported PVCs have an additional injection port for the introduction of drugs without additional puncture. With its help, needle-free bolus (intermittent) administration of drugs without interrupting intravenous infusion is possible.

In their structure, there are always such basic elements as a catheter, a guide needle, a plug and a protective cap. With the help of a needle, a venesection is performed, at the same time a catheter is inserted. The plug serves to close the catheter opening when infusion therapy is not performed (in order to avoid contamination), the protective cap protects the needle and catheter and is removed immediately before manipulation. For easy introduction of the catheter (cannula) into the vein, the tip of the catheter has the form of a cone.

In addition, catheters can be accompanied by an additional structural element - "wings". With their help, PVCs are not only firmly fixed on the skin, but also reduce the risk of bacterial contamination, since they do not allow direct contact of the back of the catheter plug and the skin.

STEP 3. Placement of a peripheral venous catheter

1. wash your hands;
2. Assemble a standard venous catheter kit, including several catheters of various diameters;
3. check the integrity of the packaging and the shelf life of the equipment;
4. make sure that in front of you is the patient who is scheduled for vein catheterization;
5. provide good lighting, help the patient find a comfortable position;
6. explain to the patient the essence of the upcoming procedure, create an atmosphere of trust, provide an opportunity to ask questions, determine the patient's preferences for the place where the catheter is placed;
7. prepare a sharps disposal container within easy reach;
8. wash your hands thoroughly and dry them;
9. apply a tourniquet above the proposed catheterization zone;
10. ask the patient to squeeze and unclench the fingers of the hand to improve the filling of the veins with blood;
11. select a vein by palpation;
12. remove the tourniquet;
13. select the smallest catheter considering: vein size, desired infusion rate, intravenous therapy schedule, infusate viscosity;
14. re-treat your hands using an antiseptic and put on gloves;
15. apply a tourniquet above the selected zone;
16. treat the catheterization site with a skin antiseptic for seconds without touching untreated skin areas, let it dry on its own; DO NOT palpate the vein again;
17. fix the vein by pressing it with your finger below the intended insertion site of the catheter;
18. take the catheter of the selected diameter using one of the grip options (longitudinal or transverse) and remove the protective cover. If there is an additional plug on the case, do not throw the case away, but hold it between the fingers of your free hand;
19. make sure that the cut of the PVC needle is in the upper position;
20. insert the catheter on the needle at an angle of 15 degrees to the skin, observing the appearance of blood in the indicator chamber;
21. when blood appears in the indicator chamber, further advancement of the needle must be stopped;
22. fix the stylet needle, and slowly move the cannula from the needle into the vein to the end (the stylet needle is not completely removed from the catheter yet);
23. remove the harness. DO NOT INSERT THE NEEDLE INTO THE CATHETER AFTER IT IS DISPLACED FROM THE NEEDLE INTO THE VEIN
24. clamp the vein throughout to reduce bleeding and finally remove the needle from the catheter;
25. dispose of the needle in accordance with safety rules;
26. if, after removing the needle, it turned out that the vein is lost, it is necessary to completely remove the catheter from under the surface of the skin, then, under visual control, collect the PVC (put the catheter on the needle), and then repeat the entire procedure for installing the PVC from the beginning;
27. remove the plug from the protective cover and close the catheter by placing a heparin plug through the port or attach the infusion set;
28. fix the catheter on the limb;
29. register the vein catheterization procedure according to the requirements of the medical institution;
30. dispose of waste in accordance with the safety regulations and the sanitary and epidemiological regime.

Standard kit for peripheral vein catheterization:

1. sterile tray
2. trash tray
3. syringe with heparinized solution 10 ml (1:100)
4. sterile cotton balls and wipes
5. adhesive tape and/or adhesive bandage
6. skin antiseptic
7. peripheral intravenous catheters of several sizes
8. adapter and/or connecting tube or obturator
9. sterile gloves
10. scissors
11. splint
12. bandage medium
13. 3% hydrogen peroxide solution

STEP 4. Removal of the venous catheter

1. wash your hands
2. stop infusion or remove protective bandage (if present)
3. sanitize your hands and put on gloves
4. from the periphery to the center, remove the fixing bandage without using scissors
5. slowly and carefully remove the catheter from the vein
6. gently press the catheterization site with a sterile gauze swab for 2-3 minutes
7. treat the catheterization site with a skin antiseptic, apply a sterile pressure bandage to the catheterization site and fix it with a bandage. Recommend not to remove the bandage and not to wet the catheterization site during the day
8. check the integrity of the catheter cannula. In the presence of a thrombus or suspected infection of the catheter, cut off the tip of the cannula with sterile scissors, place it in a sterile test tube and send it to a bacteriological laboratory for examination (as prescribed by a doctor)
9. Document the time, date, and reason for catheter removal
10. dispose of waste in accordance with the safety regulations and the sanitary and epidemiological regime

Venous catheter removal kit

1. sterile gloves
2. sterile gauze balls
3. adhesive plaster
4. scissors
5. skin antiseptic
6. trash tray
7. sterile tube, scissors and tray (used if the catheter is clotted or if infection of the catheter is suspected)

STEP 5. Subsequent venipunctures

If there is a need to make several settings of PVK, change them due to the end of the recommended period of PVK in the vein or the occurrence of complications, there are recommendations regarding the choice of the venipuncture site:

1. The catheterization site is recommended to be changed every hour.
2. Each subsequent venipuncture is performed on the opposite arm or proximal (higher along the vein) of the previous venipuncture.

STEP 6. Daily catheter care

1. Each connection of the catheter is a gateway for infection. Avoid repeatedly touching the equipment with your hands. Strictly observe asepsis, work only with sterile gloves.
2. Change sterile plugs frequently, never use plugs that may have been contaminated on the inside.
3. Immediately after the introduction of antibiotics, concentrated glucose solutions, blood products, flush the catheter with a small amount of saline.
4. Monitor the condition of the fixing bandage and change it if necessary or every three days.
5. Check the puncture site regularly to early detection complications. If swelling, redness, local fever, catheter obstruction, leakage, as well as pain during the administration of drugs, notify the doctor and remove the catheter.
6. When changing the adhesive bandage, it is forbidden to use scissors. There is a danger for the catheter to be cut off, which will cause the catheter to enter the circulatory system.
7. To prevent thrombophlebitis, apply a thin layer of thrombolytic ointments to the vein above the puncture site (for example, Traumeel, Heparin, Troxevasin).
8. The catheter should be flushed before and after each infusion session with heparinized solution (5 ml of isotonic sodium chloride solution + 2500 IU of heparin) through the port.

Despite the fact that peripheral vein catheterization is a significantly less dangerous procedure compared to central venous catheterization, it carries the potential for complications, like any procedure that violates the integrity of the skin. Most complications can be avoided with good nursing technique, strict adherence to asepsis and antisepsis, and proper care of the catheter.

It is necessary to completely remove the air from all plugs, additional elements and "droppers" before joining the PVVC, and also stop the infusion before the vial or bag with the drug solution is empty; use IV devices of appropriate length to allow the end to be lowered below the insertion site, thus preventing air from entering the infusion system. An important role is played by reliable sealing of the entire system. The risk of air embolism with peripheral cannulation is limited by positive peripheral venous pressure (3–5 mmH2O). Negative pressure in the peripheral veins can be formed when choosing a location for the installation of PVCs above the level of the heart.

Hematoma associated with catheter removal

Apply pressure to the venipuncture site after removal of the catheter

3–4 min. or raise a limb.

Hematoma associated with PVK placement

It is necessary to ensure adequate filling of the vein and carefully plan the venipuncture procedure, do not puncture poorly contoured vessels.

Venipuncture of the lower extremities should be avoided, and the smallest possible diameter of the PVVC should be used, which ensures continuous blood washing of the tip of the catheter located in the vessel.

It is necessary to use an aseptic technique for installing PVVC, choose the smallest possible size to achieve the volumes required for intravenous therapy; securely fix the catheter to prevent its movement in the vein; ensure adequate dissolution of drugs and their administration at an appropriate rate; Change PVHC every 48 to 72 hours or sooner (depending on conditions) and alternate body side for catheter site.

STEP 7. Caring for your central catheter

Puncture catheterization of the central vessels is a medical manipulation. The subclavian vein, jugular and femoral veins can be punctured, both on the left and on the right. A central venous catheter can function and be uninfected for many weeks. This is achieved by strict adherence to the rules of care of the catheter, including compliance with the rules of asepsis during its installation, precautions when performing infusion and injections.

With a long stay of the catheter in the PV, the following complications may occur:

Thrombo- and air embolism;

Infectious complications (5 - 40%) such as suppuration, sepsis, etc.

That is why central venous catheterization requires careful adherence to the rules of care and monitoring of the catheter:

1. Before all manipulations, wash your hands with soap and water, dry them and treat them with 70% alcohol, put on sterile rubber gloves.

2. The skin around the catheter is inspected daily and treated with 70% alcohol and 2% iodine solution or 1% brilliant green solution.

3. The bandage is changed daily and as it gets dirty.

4. Before starting infusion therapy, ask the patient to inhale and hold his breath. Remove the rubber plug, attach a syringe with 0.5 ml of saline to the catheter, pull the plunger towards you and make sure that blood flows freely into the syringe. Connect an intravenous infusion system to the catheter, allow the patient to breathe, adjust the frequency of drops. Pour the blood from the syringe into the tray.

5. After the end of infusion therapy, it is necessary to put a heparin lock as follows:

Ask the patient to inhale and hold the breath;

Plug the catheter with a rubber stopper and allow the patient to breathe;

Through a stopper pre-treated with alcohol, inject 5 ml of a solution with an intradermal needle: 2500 IU (0.5 ml) of heparin + 4.5 ml of saline;

Secure the stopper to the catheter with adhesive tape.

6. Be sure to flush the catheter with the same solution as when placing a heparin lock in the following cases:

After a jet injection of the drug through a catheter;

When blood appears in the catheter.

7. It is forbidden to kink the catheter, apply clamps that are not provided for by the design of the catheter, or allow air to enter the catheter.

8. In case of detecting problems associated with the catheter: pain, swelling of the arm, wetting of the bandage with blood, exudate or infusion medium, fever, kinks of the catheter, immediately inform the attending physician.

9. The catheter is removed by the attending physician or anesthesiology staff, followed by a note in the medical history.

10. It is forbidden to leave the territory of the hospital with a catheter! In case of direction to another medical institution the patient must be accompanied by a health worker; in the discharge summary, a note is made that the patient has a subclavian catheter.

V.L. GOLOVCHENKO, L.M. ROMANOV

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Basic rules for the care and monitoring of the catheter

The development of such complications as catheter prolapse, paravenous administration of solutions, catheter thrombosis, air embolism, catheter escape under the skin and even into a vein, etc., can be avoided with careful observation and punctual implementation by the staff of the rules for caring for the catheter.

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How to care for your central venous catheter

To prevent purulent complications, you should follow the rules of asepsis and antisepsis, at least 1 time in 3 days, if necessary more often, change the fixing bandage with the treatment of the puncture hole and the skin around it with an antiseptic; wrap a sterile napkin around the junction of the catheter with the system for intravenous drip infusions, and after infusion - the free end of the catheter. Repeated contact with the element of the infusion system should be avoided, access to it should be minimized. Carry out a change of infusion systems for intravenous infusion of solutions, antibiotics daily, replacement of tees and conductors - once every two days (for patients with a cytopenic state - daily). The use of a sterile fixing bandage provides protection against infection from the outer surface of the catheter.

To prevent thrombosis of the catheter blood clot it is preferable to use catheters with an anticoagulant coating. If the catheter is thrombosed, it is unacceptable to flush it to remove the thrombus.

To prevent bleeding from the catheter, the plug should be tightly closed, tightly fixed with a gauze cap, and the position of the plug should be constantly monitored.

In order to prevent air embolism, it is necessary to use catheters with a lumen diameter of less than 1 mm. Manipulations, which are accompanied by disconnection and attachment of syringes (droppers), are preferably carried out on exhalation, pre-blocking the catheter with a special plastic clamp, and if there is a tee, blocking its corresponding channel. Before connecting a new line, make sure it is completely filled with mortar. It is preferable to use small highways (the probability of an air embolism decreases).

To prevent spontaneous removal and migration, use only standard catheters with needle pavilions, fix the catheter with adhesive tape (a special fixing bandage). Before infusion, check the position of the catheter in the vein with a syringe. Do not use scissors to remove the adhesive tape, as the catheter may be accidentally cut off and migrate into the circulatory system.

Workplace equipment: 1) a bottle with a filled system for intravenous drip infusions of a single use, a tripod; 2) a bottle with heparin with a volume of 5 ml with an activity of 1 ml - 5000 IU, an ampoule (bottle) with a solution of sodium chloride 0.9% - 100 ml; 3) syringes with a capacity of 5 ml, single-use injection needles; 4) sterile catheter plugs; 5) sterile material (cotton balls, gauze triangles, napkins, diapers) in biks or packages; 6) tray for sterile material; 7) tray for used material; 8) caps in the package; 9) sterile tweezers; 10) tweezers in a disinfectant solution; 11) file, scissors; 12) a container-dispenser with an antiseptic agent for treating the skin of patients and the hands of staff; 13) a container with a disinfectant for processing ampoules and other injectable dosage forms; 14) plaster (regular or Tegoderm type) or other fixative bandage; 15) mask, medical gloves (single use), waterproof decontaminated apron, goggles (plastic screen); 16) tweezers for working with used tools; 17) containers with a disinfectant for disinfecting surfaces, washing used needles, syringes (systems), soaking used syringes (systems), soaking used needles, disinfecting cotton balls, gauze wipes, used rags; 18) clean rags; 19) tool table.

4. Put on an apron, mask, gloves.

5. Treat the surface of the manipulation table, tray, apron, bix with a disinfectant solution. Wash gloved hands with soap and running water, dry.

6. Put the necessary equipment on the tool table.

7. Cover the sterile tray, putting everything you need on it. There is another option for working with sterile material when it is in packages.

The main stage of the manipulation. Connecting the infusion system to the CVC. 8. Treat the vial with isotonic sodium chloride solution.

9. Draw 1 ml of solution into one syringe, 5 ml into the other.

11. Clamp the catheter with a plastic clamp. Clamping the catheter prevents bleeding from the vessel and air embolism.

12. Remove the "old" pear-shaped bandage from the catheter cannula.

13. Treat the catheter cannula and plug with an antiseptic, keeping the end of the catheter suspended at a certain distance from the cannula.

14. Put the treated part of the catheter on a sterile diaper, placing it on the baby's chest.

15. Treat gloved hands with an antiseptic.

16. Remove the cork from the cannula and discard. If there are no additional sterile plugs, then put it in an individual container with alcohol(used once).

17. Attach the syringe with sodium chloride solution 0.9%, open the clamp on the catheter, remove the contents of the catheter.

18. Using another syringe, flush the catheter in an amount of 5-10 ml.

To avoid air embolism and bleeding, it is necessary to pinch the catheter with a plastic clamp each time before disconnecting the syringe, system, plug from it.

19. Attach the system for intravenous drip infusion to the cannula of the jet-to-jet catheter.

20. Adjust the rate of introduction of drops.

21. Wrap a sterile cloth around the junction of the catheter with the system.

Disconnecting the infusion set from the CVC. Heparin "lock". 22. Check the stickers on the bottles with heparin and sodium chloride solution 0.9%(name of the drug, quantity, concentration).

23. Prepare vials for manipulation.

24. Draw 1 ml of heparin into the syringe. Introduce 1 ml of heparin into a vial with a solution of sodium chloride 0.9% (100 ml).

25. Draw 2 - 3 ml of the resulting solution into a syringe.

26. Close the dropper, pinch the catheter with a plastic clamp.

27. Remove the gauze covering the joint between the catheter cannula and the system cannula. Transfer the catheter to another sterile napkin (diaper) or to the inner surface of any sterile package.

28. Treat your hands with an antiseptic solution.

29. Disconnect the dropper and attach a syringe with diluted heparin to the cannula, remove the clamp and inject 1.5 ml of the solution into the catheter.

30. Clamp the catheter with a plastic clamp, disconnect the syringe.

31. Process the catheter cannula ethyl alcohol, to remove traces of blood, another protein preparation, glucose from its surface.

32. Put a sterile cork on a sterile napkin with sterile tweezers and close the catheter cannula with it.

33. Wrap the catheter cannula with sterile gauze and secure with a rubber band or adhesive tape.

Changing the bandage that fixes the CVC. 34. Remove the old fixing bandage.

35. Treat gloved hands with an antiseptic solution (put on sterile gloves).

36. Treat the skin around the catheter insertion site first 70% alcohol, then antiseptic iodobac (betadine etc.) in the direction from the center to the periphery.

37. Cover with a sterile napkin, withstand exposure for 3-5 minutes.

38. Dry with a sterile cloth.

39. Apply to the catheter entry site sterile dressing.

40. Fix the bandage with a Tegoderm plaster (Mefix, etc.), completely covering the sterile material.

41. Indicate on the top layer of the patch the date of applying the bandage.

Note. If an inflammatory process occurs around the site of catheter insertion (redness, induration), after consultation with the attending physician, it is advisable to use ointments (betadine, seen, ointment with antibiotics). In this case, the dressing is changed daily, and on the patch, in addition to the date, it is indicated - "ointment".

The final stage of the manipulation.42. Disinfect used medical instruments, catheters, infusion systems, apron in appropriate containers with a disinfectant solution. Treat work surfaces with a disinfectant solution. Remove gloves and decontaminate them. Wash hands under running water with soap, dry, treat with cream.

43. Provide a protective regime for the child.

44. Record in medical records indicating the date, time of infusion, the solution used, its amount.

Possible Complications: 1) purulent complications (suppuration of the puncture channel, thrombophlebitis, phlegmon, sepsis); 2) thrombosis of the catheter with a blood clot; 3) bleeding from the catheter; 4) air embolism, thromboembolism; 5) spontaneous removal and migration of the catheter; 6) sclerosis of the central vein in case of frequent change of the catheter; 7) infiltration; eight) allergic reaction for medicines, etc.

PUNCTION AND CATHETERIZATION OF PERIPHERAL VEINS

General information. The use of a peripheral venous catheter (PVC) enables long-term infusion therapy, makes the catheterization procedure painless, and reduces the frequency of psychological trauma associated with numerous punctures of peripheral veins. The catheter can be inserted into the superficial veins of the head, upper and lower extremities.

The duration of operation of one catheter is 3-4 days. Patients receiving long-term treatment, it is advisable to start catheterization of veins with a peripheral catheter from the veins of the hand or foot. In this case, during their obliteration, the possibility of using higher-lying veins remains. When operating a peripheral venous catheter, the rules of asepsis and antisepsis should be strictly observed. Thoroughly clean the connection points of the catheter with the system for intravenous drip infusions, connector, cork from blood residues, cover with a sterile napkin. Monitor the condition of the vein and skin in the puncture area. To prevent bleeding from the catheter, air embolism, firmly fix the plug on the catheter cannula, press the vein to the top of the catheter each time before removing the plug, turning off the system, syringe. If a connector (wire) with a tee is attached to the catheter, block the corresponding channel of the tee. To avoid thrombosis of the catheter with a blood clot, the catheter temporarily not used for infusion must be filled with a heparin solution (see paragraphs "Care of the central venous catheter"). To prevent external migration of the catheter with the formation of a subcutaneous hematoma and (and) paravasal administration of a medicinal substance, constantly monitor the reliability of fixation of the catheter, check its position in the vein with a syringe. When placing a catheter in the joint area, use a splint.

Workplace equipment: 1) vial (ampoule) with sodium chloride solution 0.9%; 2) peripheral venous catheter, plugs for the catheter; 3) syringes with a capacity of 5 ml, single-use injection needles; 4) sterile material (cotton balls, gauze wipes, diapers) in bixes or packages; 5) tray for sterile material; 6) tray for used material; 7) hoes in packages; 8) sterile tweezers; 9) tweezers in a disinfectant solution; 10) nail file, scissors; 11) tourniquet; 12) a container-dispenser with an antiseptic agent for treating the skin of patients and the hands of staff; 13) a container with a disinfectant solution for processing ampoules and other injectable dosage forms; 14) plaster (regular or Tegoderm type) or other fixative bandage; 15) mask, medical gloves (single use), waterproof apron, goggles (plastic screen); 16) tool table; 17) tweezers for working with used tools; 18) containers with a disinfectant for disinfecting surfaces, washing used syringes (systems), soaking used syringes (systems), soaking used needles, disinfecting cotton and gauze balls, used rags; 19) clean rags.

Preparatory stage of the manipulation. 1.Inform the patient (close relatives) about the need to perform and the essence of the procedure.

2. Obtain the consent of the patient (close relatives) to perform the procedure.

3. Wash hands with running water, lathering twice. Dry them with a disposable napkin (individual towel). Treat your hands with an antiseptic.

4. Put on an apron, mask, gloves.

5. Treat the surface of the manipulation table, tray, apron, bix with a disinfectant solution. Wash gloved hands with running water and soap, dry, treat with an antiseptic.

6. Put the necessary equipment on the tool table. Check the expiration dates, the integrity of the packages.

7. Cover the sterile tray, putting everything you need on it. There is another option for working with sterile material when it is in packages.

8. Treat the vial with sodium chloride solution 0.9%.

9. Draw 5 ml of the solution into the syringe.

10. Put on safety goggles (plastic shield).

The main stage of the manipulation. 11. Apply a tourniquet above the intended site of the catheter. children early age it is better to use finger pressure on the vein (performed by a nurse assistant). 12. Treat the skin in the area of ​​the veins of the back of the hand or the inner surface of the child's forearm with an antiseptic agent (two balls, wide and narrow).

13. Treat hands with an antiseptic.

14. Take the catheter in your hand with three fingers and, pulling the skin in the vein area with the other hand, puncture it at an angle of 15-20.

15. When blood appears in the indicator chamber, slightly pull the needle while pushing the catheter into the vein.

17. Press the vein to the top of the catheter (through the skin), remove the needle completely.

18. Connect a syringe with isotonic sodium chloride solution to the catheter, rinse the catheter with the solution.

19. In the same way, pressing the vein with one hand, disconnect the syringe with the other hand and close the catheter with a sterile stopper.

20. Clean the outer part of the catheter and the skin under it from traces of blood.

21. Fix the catheter with a plaster.

22. Wrap the cannula of the catheter with a sterile gauze, fix it with adhesive plaster, bandage it.

23. Transfer (transport) the child to the ward, connect the dropper (syringe pump). If intravenous infusions through a peripheral venous catheter will not be carried out in the near future, fill it with a solution of heparin (see paragraph "Care of the central venous catheter").

The final stage of the manipulation. 24. Disinfect used medical instruments, catheters, infusion systems, apron in appropriate containers with a disinfectant solution. Treat work surfaces with a disinfectant solution. Remove gloves and decontaminate them. Wash hands under running water with soap, dry, treat with cream.

25. Provide a protective regime for the child.

26. Make an entry in the medical records indicating the date, time of infusion, the solution used, its amount.

Puncture of the veins of the calvarium

BUTTERFLY NEEDLE WITH CATHETER

General information. For young children, drugs can be injected into the superficial veins of the head. During the procedure, the child is fixed. His head is held by a nurse assistant, hands to the body and legs are fixed with a diaper (sheet). If there is hairline at the site of the intended puncture, the hair is shaved off.

Workplace equipment: 1) “butterfly” needle with a single-use catheter; 2) a bottle with a filled system for intravenous drip infusions of a single use, a tripod; 3) an ampoule (bottle) with a solution of sodium chloride 0.9%; 4) a single-use syringe with a volume of 5 ml, injection needles; 5) sterile material (cotton balls, gauze triangles, napkins, diapers) in packages or bixes; 6) tray for sterile material; 7) tray for used material; 8) caps in the package; 9) sterile tweezers; 10) tweezers in a disinfectant solution; 11) file, scissors; 12) a container-dispenser with an antiseptic agent for treating the skin of patients and the hands of staff; 13) a container with a disinfectant solution for processing ampoules and other injectable dosage forms; 14) plaster (regular or Tegoderm type) or other fixative bandage; 15) medical gloves (single use); mask, goggles (plastic screen), waterproof decontaminated apron; 16) tweezers for working with used tools; 17) containers with a disinfectant for treating surfaces, washing used needles, syringes (systems), soaking used syringes (systems), needles, disinfecting cotton balls and gauze wipes, used rags; 18) clean rags; 19) tool table.

Preparatory stage of the manipulation. 1. Inform the patient (close relatives) about the need to perform and the essence of the procedure.

2. Obtain the consent of the patient (close relatives) to perform the procedure.

3. Wash hands under running water, lathering twice. Dry hands with a disposable napkin (individual towel). Treat your hands with an antiseptic. Wear an apron, gloves, mask.

4. Treat the surface of the manipulation table, tray, apron, stand for the system with a disinfectant solution. Wash gloved hands under running water with soap, dry, treat with an antiseptic.

5. Put the necessary equipment on the tool table.

6. Cover the sterile tray.

7. Print the packages with the butterfly catheter, syringes, put them on the tray. There is another option for working with sterile material when it is in packages.

8. Treat the ampoule (vial) with sodium chloride solution 0.9%.

9. Draw 2 ml into the syringe connect to the catheter, fill it and put it on the tray.

10. Fix the child (performed by a nurse assistant). Put a sterile diaper next to the baby's head.

11. Put on safety goggles (plastic shield).

The main stage of the manipulation.12. Select a vessel for puncture and treat the injection site with two balls with an antiseptic (one wide, the other narrow) in the direction from the parietal to the frontal region. For better blood supply to the vein, it is convenient to use a special elastic band applied around the head below the punctured area (above the eyebrows). Local digital vein clamping is ineffective due to the abundance of venous anastomoses of the cranial vault. The crying of the child also contributes to the swelling of the veins of the head.

13. Treat gloved hands with an antiseptic.

14. Stretch the skin in the area of ​​the proposed puncture to fix the vein.

15. Puncture a vein with a butterfly needle with a catheter in three stages . To do this, direct the needle along the blood flow at an acute angle to the surface of the skin and puncture it. Then advance the needle approximately 0.5 cm, pierce the vein and direct it along its course. If the needle is not in the vein, return it without removing it from under the skin and re-puncture the vein.

Insertion of a needle into a vessel immediately after skin puncture may result in puncture of both walls of the vessel.

16. Pull the plunger of the syringe connected to the catheter. The appearance of blood indicates the correct position of the needle. If an elastic band was used to increase blood supply to the vein, remove it.

17. Inject 1 - 1.5 ml sodium chloride solution 0.9%, to avoid thrombosis of the needle with a blood clot and to exclude the possibility of extravasal administration of the drug.

18. Fix the needle with three strips of adhesive tape: 1st - across the needle to the skin. 2nd - under the "wings" of the "butterfly" needle with a cross over them and fixation to the skin, 3rd - across the wings of the "butterfly" needle to the skin.

19. Roll up the catheter and fix it with adhesive tape on the scalp to prevent its displacement.

20. If necessary, if the angle of the needle with respect to the curve of the skull is large, place a gauze (cotton) ball under the cannula of the needle.

21. Pull the plunger of the syringe connected to the catheter to recheck the position of the needle in the vein.

22. Disconnect the syringe, connect the dropper on the solution jet.

23. Use the clamp to adjust the rate of drug administration.

24. Cover the junction of the cannulae of the catheter and dropper with a sterile gauze.

The final stage of the manipulation.25. After completion of the infusion, clamp the dropper tube with a clamp. Carefully peel off the adhesive tape from the skin. Press the ball with an antiseptic into the place where the needle enters the vein. Remove the needle (catheter) along with the adhesive tape.

26. Apply a sterile napkin to the puncture site, a pressure bandage on top.

27. Disinfect used medical instruments, catheters, infusion systems, apron in appropriate containers with a disinfectant solution. Treat work surfaces with a disinfectant solution. Remove gloves and decontaminate them. Wash hands under running water with soap, dry, treat with cream.

28. Provide a protective regime for the child.

29. Make an entry in the medical records indicating the date, time of infusion, the solution used, its amount.

Possible complications: 1) purulent complications (suppuration of the puncture channel, thrombophlebitis, phlegmon, sepsis); 2) thrombosis of the catheter with a blood clot; 3) bleeding from the catheter; 4) air embolism; 5) spontaneous removal and migration of the catheter; 6) vein sclerosis in case of frequent catheter change; 7) infiltration; 8) an allergic reaction to drugs, etc.

to the Instructions for the execution technique

medical and diagnostic procedures and manipulations in the disciplines "Nursing in Pediatrics", "Pediatrics" in the specialties 1 "Nursing", 1 "General Medicine"

General information. Preventive vaccinations are effective tool fight against children infectious diseases. The vaccination preparations used contribute to the development of immunity, immunity to a particular infection.

Vaccinations are carried out in specially equipped vaccination rooms of medical institutions, medical offices schools and other educational institutions. The vaccination room must be equipped to provide emergency care. In order to avoid inactivation of vaccine preparations, a "cold chain" must be observed all the way from the manufacturing institute until the moment of vaccination.

Immediately before vaccination, the child should be examined by a doctor (paramedic). Without written permission to vaccinate, a nurse is not authorized to administer it. In the first 30-60 minutes after vaccination, the child should be under medical supervision in a clinic (school, preschool institution).

Workplace equipment: 1) vaccination preparations: vaccine against viral hepatitis B ("Angerix-B", Euvax-B, Eberbiovak NV, Shenvak-B, etc.), BCG, BCG-M, DTP, DTP-M, ADS, ADS-M, AD-M, OPV, IPV, ZhKV, ZHPV, "Rudivax", "Trimovax"; 2) solvents for BCG, ZhKV, ZHPV, Trimovax, Ruvaks vaccines; 3) single use syringes with a capacity of 1-2 ml, injection needles for subcutaneous and intramuscular injections; 4) tuberculin (insulin) syringes, injection needles for intradermal injections; 5) droppers for polio vaccine; 6) file; 7) tweezers in a disinfectant solution; 8) sterile material (cotton balls and gauze pads) in a package; 9) cold element with cells; 10) light-protective cone for vaccines BCG, ZhKV, "Trimovax"; 11) 70% ethyl alcohol or other antiseptic agent for disinfecting the patient's skin and personnel's hands (dispensing container); 12) a container with a disinfectant for processing ampoules (vials); 12) a tray for placing the inoculum on the instrument table; 13) a tray for used material (without live vaccine residues or traces of blood); 14) mask; 15) medical gloves (disposable or disinfected); 16) tweezers for working with used tools; 17) containers with disinfectants: a) for surface treatment, b) for washing and soaking used syringes and needles, c) for disinfecting used ampoules (vials) and cotton balls (napkins) with live vaccine residues, d) for disinfecting used rags ; 18) clean rags; 19) tool table.

Note. When working with the BCG vaccine (BCG-M), use disinfectant solutions of high activity.

Preparatory stage of the manipulation. 1. Inform the patient (close relatives) about the need to perform and the essence of the procedure.

2. Obtain the consent of the patient (close relatives) to perform the procedure.

3. Wash and dry your hands. Treat your hands with an antiseptic.

4. Put on gloves.

5. Treat the tray, instrument table, apron with a disinfectant solution. Wash and dry hands.

6. Place the tweezers in a container with a disinfectant solution on the top shelf of the instrument table, ethyl alcohol 70%, lay out sterile material in packages, single-use syringes and needles, when performing OPV vaccinations - a package of droppers; when working with BCG, ZhIV, Trimovax vaccines- a light-protective cone, a tray for placing grafting material, a file.

7. On the bottom shelf, place containers with a disinfectant solution, tweezers for removing needles, a tray for used material.

8. Remove from the refrigerator, disinfect with a disinfectant solution and place the cold element on the tray. Cover the cold element with a two-three-layer gauze napkin.

9. Check the availability of a written permission for vaccination and compliance with its acceptable deadlines.

10. Take out the appropriate vaccine preparation (if necessary, and solvent) from the refrigerator (refrigerator bag), check the presence of the label, expiration date, integrity of the ampoule (vial), appearance of the preparation (and solvent).

11. Install the grafting preparation in the cell of the cold element.

12. Ampoules (vials) with live vaccine (ZhKV, BCG, Trimovax) cover with a light shield.

13. Wash and dry your hands, treat with an antiseptic. Wear a mask when handling live vaccines.

AGAINST VIRAL HEPATITIS B

vaccination dose . The dose is for newborns and children under 10 years old - 10 mcg (0.5 ml), for older children and adults - 20 mcg (1 ml).

Method and place of administration. The vaccine is administered intramuscularly. Newborns and young children in the anterolateral region of the thigh, older children and adults - in the deltoid muscle.

Workplace equipment and preparatory stage.P. 1 - 13 - see Vaccinations.

The main stage of the manipulation.14. Shake the vial with the vaccine until a homogeneous suspension is obtained.

15. Treat the metal cap of the bottle with a ball of alcohol, remove its central part, treat the rubber stopper with a second ball of alcohol, leave it on the bottle. Return vial to cold cell.

16. Open the syringe package, fix the needle on the cannula.

17. Draw the vaccine into the syringe: for newborns and children under 10 years old - 0.5 ml (10 mcg), for children over 10 years old - 1 ml (20 mcg).

18. Change the needle. Before changing the needle, use the plunger to draw the vaccine from the needle into the syringe.

19. Expel the air from the syringe. Throw the used ball into a container with a disinfectant solution. Treat your hands with an antiseptic.

20. Treat the skin of newborns and young children - the anterolateral surface of the thigh, for older children - the area of ​​​​the deltoid muscle with two balls with alcohol (wide and narrow).

21. Remove the cap from the needle and inject the vaccination dose of the vaccine intramuscularly.

22. Treat the skin after the injection with alcohol.

The final stage of the manipulation.23. Rinse the used syringe and needle in the first container with a disinfectant solution and, removing the needle with tweezers, immerse it disassembled in the appropriate containers with the same solution.

24. Discard the used vial into the waste tray.

25. Treat gloved hands with an antiseptic solution, remove and disinfect gloves. Wash and dry hands, treat with cream if necessary.

26. Register the vaccination, and later information about the reaction to it in the relevant documents: in the maternity hospital - in the history of the development of the newborn (recording form No. 97 / y), exchange card (recording form No. 113 / y), preventive vaccination journal (recording form No. 64/y); in the clinic - in the preventive vaccination card (recording form No. 63 / y), in the history of the child's development (recording form No. 112 / y), in the register of preventive vaccinations (recording form No. 64 / y, Fig. 59); at school - in the individual card of the child (recording form No. 26 / y) and the journal (recording form No. 64 / y). At the same time, indicate the date of vaccination, dose, control number, batch number of the drug, manufacturer.

Possible vaccination reaction: 1) pain, erythema and hardening of soft tissues at the injection site in the first 5 days after the introduction of the vaccine.

Possible unusual reactions and complications: 1) fever; 2) joint pain, myalgia, headache; 3) nausea, vomiting, diarrhea; 4) lymphadenopathy; 5) isolated cases of anaphylactic shock; 6) phlegmon, abscess; 7) tissue infiltration and necrosis, hematoma, damage to the periosteum and joint.

AGAINST TUBERCULOSIS WITH BCG VACCINE (BCG-M)

Inoculation dose. It is 0.05 mg of BCG vaccine or 0.025 mg of BCG-M vaccine. The dry vaccine is diluted in saline: 0.1 ml per vaccination dose.

Method and place of administration. The vaccine is administered strictly intradermally at the border of the upper and middle thirds of the outer surface of the left shoulder.

Equipment of the workplace and the preparatory stage, P. 1 - 13 - see Vaccinations.

The main stage of the manipulation.14. Remove two sterile balls from the kraft bag with tweezers, moisten them alcohol. Treat the neck of the ampoule with the vaccine with alcohol, file, re-treat with another ball, carefully squeezed out of alcohol (alcohol inactivates the vaccine).

15. Cover the filed end of the ampoule with a sterile gauze cap and open it. Throw the top of the ampoule with a gauze cap into a container with a disinfectant solution. Place the opened ampoule in the cell of the cold element. Cover with another gauze cap and light protection cone.

16. Treat the solvent ampoule with alcohol, file, re-process and open.

17. Open the package of the syringe with a capacity of 2 ml, fix the needle on the cannula. Draw solvent into the syringe. The amount of solvent should correspond to the number of doses of dry vaccine in the ampoule (for 20 doses - 2 ml of solvent, for 10 doses - 1 ml).

18. Remove the light-protective cone and gauze cap from the dry vaccine, slowly introduce the solvent, thoroughly washing off the particles of the sprayed vaccine from the walls of the ampoule. Mix the dissolved vaccine by reciprocating the plunger in the syringe. If the needle protrudes above the cut of the ampoule and can be hermetically connected to the tuberculin syringe, leave it in the ampoule. When using a tuberculin syringe with a cannula soldered to the needle cone, do not leave the needle in the vaccine.

19. Cover the ampoule with a sterile gauze cap and a light-protective cone.

20. Rinse the syringe and needle in containers with a disinfectant solution and immerse them disassembled in the appropriate containers with the same solution. Clean your hands with alcohol.

21. Treat with two cotton balls with alcohol skin of the outer surface of the left shoulder of the child (on the border of the upper and middle thirds).

The skin in the area of ​​the upcoming injection can be treated immediately before the administration of the drug, but in this case it is necessary to thoroughly blot the remaining alcohol on the skin with a sterile dry ball (napkin).

22. Fix the needle on the tuberculin (insulin) syringe to take the vaccine. Draw 0.2 ml of the vaccine into the syringe, after mixing the vaccine with reciprocating movements of the piston in the syringe (mycobacteria are absorbed on the walls of the ampoule). Move the piston to draw the vaccine from the needle into the syringe. Throw the used needle into a container with a disinfectant solution.

23. Close the ampoule with the vaccine with a gauze cloth and a light-protective cone.

24. Fix a thin short needle with a cap on the cannula of the syringe. Expel the air and excess vaccine from the syringe onto a cotton ball tightly pressed against the cannula of the needle.

25. Throw the used ball into a container with a disinfectant solution.

27. Treat your hands with an antiseptic.

28. Remove the cap from the needle and discard it in a container with a disinfectant solution.

29. Grasp the left shoulder of the child with your hand, pulling the skin of the previously treated area (the skin must be dry).

30. Direct the needle of the tuberculin syringe with the cut up into the surface layer of the skin and, making sure that it is in the intradermal position, press the cannula of the needle with your thumb. Inject 0.1 ml of vaccine .

With proper administration, a whitish papule with a diameter of about 8 mm is formed on the skin, usually disappearing after 15-20 minutes. Do not treat the injection site with alcohol or other antiseptic (alcohol will inactivate the vaccine).

The final stage of the manipulation.31. Rinse the tuberculin syringe and needle in the first container with a disinfectant solution, remove the needle with tweezers (if it is not soldered), immerse the disassembled syringe and the needle in the appropriate containers with the same solution.

32. Discard the used ampoule of solvent into the waste tray. An ampoule with vaccine residues insufficient to vaccinate another child or with expired storage, discard in a container with a disinfectant solution.

33. Treat gloved hands with an antiseptic solution, remove and disinfect gloves. Wash and dry hands, treat with cream if necessary.

34. Register the vaccination, and later information about the reaction to it in the relevant documents (see. item 26).

Vaccination reaction: 1) After 4-6 weeks (after revaccination 1-2 weeks) - a spot, infiltrate, later a vesicle (pustule), a sore or without it, a scar from 2 to 10 mm in diameter.

Possible complications: 1) increased local reaction (ulcer more than 10 mm); 2) regional lymphadenitis; 3) cold abscess; 4) keloid scar; 5) generalized BCG infection; 6) damage to the eyes, bones, the occurrence of lupus at the site of vaccination.

AGAINST whooping cough, diphtheria, tetanus

(AKDS, AKDS-M, ADS, ADS-M, AD-M)

vaccination dose . Makes 0.5 ml of vaccine or toxoid.

Method and site of administration . DTP vaccine injected intramuscularly into the anteroexternal area of ​​the thigh, toxoids - up to 6 years of age intramuscularly, then - subcutaneously into the subscapular region.

Equipment of the workplace and the preparatory stage of the manipulation.P. 1 - 13 - see Vaccinations.

The main stage of the manipulation.14. Shake the ampoule with the vaccine until a homogeneous suspension is obtained.

15. Process alcohol, file, reprocess and open the vaccine vial. If the vaccine is in a vial, treat the metal cap, remove its central part, treat the rubber stopper with a ball of alcohol, leave it on the vial.

16. Return the ampoule (vial) to the cell of the cold element.

17. Open the syringe package, fix the needle on the cannula.

18. Draw the vaccine into the syringe.

19. If one or more doses of the vaccine remain in the ampoule (vial), cover the ampoule or vial with a needle with a sterile gauze cap and return it to the cold element cell.

20. Change the needle on the syringe with the vaccine. Before changing the needle, use the plunger to draw the vaccine from the needle into the syringe.

21. Press a dry cotton ball to the cannula of the needle and, without removing the cap, expel the air from the syringe, leaving 0.5 ml of vaccine in it.

22. Discard the cotton ball in the waste tray. Clean your hands with alcohol or other antiseptic.

23. Treat the skin in the area of ​​the anterior outer surface of the thigh or the skin of the subscapular region with two balls with alcohol - when administered subcutaneously to schoolchildren ADS, ADS-M, AD-M-anatoxins.

24. Remove the cap from the needle and inject 0.5 ml of the vaccine AKDS, AKDS-M intramuscularly, ADS, ADS-M, AD-M schoolchildren - subcutaneously.

25. Treat the skin in the injection area with a ball of alcohol.

The final stage of the manipulation.26. Rinse the used syringe and needle in the first container with a disinfectant solution and, removing the needle with tweezers, immerse it disassembled in the appropriate containers with the same solution.

27. Discard the ampoule (vial) with the remnants of the vaccine preparation, insufficient for vaccinating the next child, into the waste material tray.

28. Treat gloved hands with an antiseptic solution, remove and disinfect gloves. Wash and dry hands, treat with cream if necessary.

29. Register the vaccination, and later information about the reaction to it in the relevant documents (see. Vaccination against viral hepatitis B, item 26).

Vaccination reaction: 1) hyperemia skin, swelling of soft tissues up to 5 cm in diameter, no more than 2 cm infiltrate at the injection site; 2) short-term fever, weakness, headache in the first 2-3 days after the introduction of the vaccine

Possible complications: 1) edema and soft tissue infiltrate more than 8 cm in diameter, phlegmon, abscess; 2) excessively strong over 3 days of fever and intoxication; 3) encephalopathy, encephalitis; four) anaphylactic shock; 5) asthmatic syndrome, croup; 6) neuritis of the brachial nerve; 7) damage to the periosteum and joint.

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Indication: the introduction of drugs through a catheter.

Sterile dressing material;

1% brilliant green solution;

Sodium chloride solution 0.9%.

2. Put on gloves.

4. Prepare drugs for treating the skin around the catheter: alcohol 70 °, 1% brilliant green solution.

5. Explain to the patient the meaning of the manipulation.

6. Position the patient facing you, in a position that is comfortable for him.

7. Remove the old bandage

8. Carefully inspect the catheter puncture site and, in the absence of edema, hyperemia and purulent discharge, treat the skin with alcohol 70 ° and 1% brilliant green solution

9. Apply sterile gauze panties around the catheter.

10.Fix the catheter to the skin with adhesive tape

11. Throw the used dressing material into a container with a disinfectant solution.

12. Throw used tools and rubber gloves into a container with a disinfectant solution.

1. To prevent blockage of the catheter by a thrombus, after the end of infusions or in the intervals between infusions (4 times a day), it is necessary to rinse the catheter with 0.9% saline and install a “heparin lock”.

Preparation of "heparin castle":

100 ml. physiological solution + 5000 IU of heparin (5000 IU - 1 ml.) - administered in 2 - 3 ml.

2. If the catheter plug is depressurized, it must be replaced.

Before opening or closing the catheter plug, ask the patient to hold their breath.

3. In case of violation of the catheter patency, immediately call a doctor!

Heparin plug

Thrombi and fibrin overlays on catheters can cause occlusion and serve as a focus for microbial contamination of PVCs. For the purpose of prevention, a number of the following measures should be taken:

Heparin plug - the introduction of a solution of heparin / ml into the catheter when closing the PVC

Heparin

Heparin - (from other Greek ?rbs - liver) is known as a direct anticoagulant, a substance that prevents blood clotting. It is used for the prevention and treatment of thromboembolic diseases, operations on the heart and blood vessels. It is also used in hemodialysis machines to maintain it in a liquid state. Synthesized in mast cells, the accumulation of which is in the liver, lungs, walls of blood vessels. The effect after seeing heparin develops quickly, but lasts for a short time. With a single injection, clotting inhibition occurs instantly and lasts for 4-5 hours, with intramuscular injection the action appears after a minute and within 6 hours, when administered in subcutaneous tissue The effect appears in a minute and within 8 hours.

The anticoagulant effect is enhanced by: other anticoagulants, antiplatelet agents, NSAIDs.

Caring for a central venous catheter

1. Apron, goggles, mask, rubber gloves.
2. Prepare on the mobile table: Adhesive plaster, scissors, 5000 units. heparin / 5% sodium citrate /, 100 ml of 0.9% sodium chloride solution, 1% iodonate solution, 0.25% novocaine solution, 70% alcohol solution. Fill the system with an indifferent solution.
3. Prepare on a sterile table: a s / c catheter with a mandrin and a stopper, a long needle, a diameter of 2 mm, sterile balls, napkins, two syringes, two needles for intravenous administration, tweezers.

Treatment of the skin in the area of ​​​​the catheter: the treatment of the catheter with a toilet of the skin around it is carried out daily or as it becomes dirty. It includes: removal of the old bandage / adhesive plaster /, examination and palpation in the catheter area, treatment of the hole and the skin around the catheter with a swab moistened with alcohol, application of gauze “panties”, dry or moistened with alcohol, followed by fixation with adhesive plaster “panties”.

Changing the heparin "lock": this is the introduction of a heparin solution into the catheter at a dilution of 1:10, and 1:100 saline ml. A heparin "lock" is made after each injection of a medicinal substance into the catheter, as well as washing the catheter with this heparin solution 3 times a day, if the catheter is functioning (drip injection is carried out through it). In the absence of heparin, a 5% sodium citrate solution can be used.

The introduction of drugs into the catheter:

1. The introduction of drugs, infusions are carried out only through a rubber plug.

2. Before the introduction of the drug, the patency of the catheter is checked by pulling the plunger of the syringe towards itself.

3. The system is connected on exhalation.

4. After the end of the administration of drugs - washing the catheter with saline.

5. According to the schedule, prevent thrombosis in the catheter (heparin lock) and around it (the schedule is available at the nurse's post):

The rubber plug is treated with a 70% alcohol solution. 5-10 ml of heparinized solution (5000 IU - 1 ml of heparin per 100 ml of isotonic sodium chloride solution) is drawn into the syringe and slowly injected through the puncture of the rubber plug. With a difficult introduction, a doctor is called who will remove the blood clot, since it is strictly forbidden to push it.

6. All drugs are administered very slowly.

7. If there is no patency of the catheter, redness in the area of ​​the catheter insertion, the presence of pain, it is necessary to inform the doctor about this.

8. The catheter is removed as prescribed by the doctor.

9. Aseptic dressings are applied to the wound.

How to flush a catheter

With the help of an intravenous catheter, injections into the venous bed, long-term administration of drugs and medical solutions, blood sampling for analysis and other procedures are performed. Such a catheter requires careful care to avoid infection and other complications. An important rule maintenance of a catheter or implanted port system is regular flushing.

Why flush the catheter

After each injection of medication through a port or catheter, the healthcare provider performs a saline flush to reduce drug interactions. At the end of each use, the catheter is flushed to prevent blockages that can be caused by:

• sediment of drugs;
• ingestion of blood and the formation of blood clots.

Depending on the type and purpose, catheters can be washed regularly, several times a day.

How to flush central and peripheral catheters

Depending on the type of access, there are:

• central venous catheter (serves to provide access to the central vein);
• peripheral venous catheter (provides access to the patient's venous bed).

How to flush the catheter? Care of any intravenous catheter involves flushing with saline 0.9% or a mixture with heparin: 100 IU (0.02 ml) of heparin per 1 ml of sodium chloride. This flushing is performed before and after each use of the catheter. Saline clears the inside of the catheter of drug residues, and the introduction of heparin prevents blockage.

The catheter is washed regularly, 1-3 times every day. If the patient is receiving long-term infusions, then there is no need to flush the catheter frequently.

How to flush the port system

The U-PORT port system provides long-term access to the patient's central vein, simplifies the injection procedure, and makes it less painful. At proper care U-PORT can be used for several years without the need for replacement. One of the rules for such care is regular flushing of the system. As in the case of an intravenous catheter, the system should be flushed with a solution of sodium chloride 0.9% each time before and after drug administration. A heparin lock is placed after a session of using the port system. The concentration of heparin in this case is selected in the range from 100 to 500 units/ml.

How to flush the catheter if the port system is rarely used? In such a situation, it is recommended to flush it every 4-5 weeks to avoid clogging.

Basic rules for the care and monitoring of the catheter

The development of such complications as catheter prolapse, paravenous administration of solutions, catheter thrombosis, air embolism, catheter escape under the skin and even into a vein, etc., can be avoided with careful observation and punctual implementation by the staff of the rules for caring for the catheter.

"Infusion-transfusion therapy of acute blood loss",

E.A. Wagner, V.S. corners

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Discussions

Consultation on setting up and caring for a peripheral catheter.

16 messages

Indications for central venous catheterization and a relative contraindication for the use of peripheral access are:

1. large infusion volume;

2. duration of infusion therapy;

3. "aggressive" drugs (meaning a high concentration. For example, infusion forms of antibiotics)

4. critical conditions, etc.

2. phlebitis and thrombosis;

3. infection of the catheter;

4. prolizhenie walls of the vessel and, as a consequence, perforation.

the answer is actually simple - the placement of the central catheter is complicated, it must be carried out under X-ray control, the patient must lie in the HOSPITAL, certain care is needed for the catheter and the patient himself cannot cope with this, because. the risk of infection is much higher, and, in addition to everything else, the anatomical features of patients with such a disease are complex and the risk of "piercing" the lung during catheterization is very high, thus arranging hydro-, hemo-, pneumotorex is very simple. And such complications are much more dangerous than peripheral vein phlebitis.

Therefore - of the two evils, we choose the lesser and least dangerous.

In fact, if you properly care for the periphery catheter and, if problems arise, immediately monitor and resolve them in a short time, you can do without complications.

1. brought an infection during staging, or poorly treated skin before staging;

2. incorrectly selected vein (for example, superficial veins quickly fail and become inflamed with prolonged use of the catheter and a large volume of infusion);

3. aggressive drugs administered in / in, or in a small dilution.

The superficial veins of the hand do not withstand those volumes and "aggressiveness" of medicinal media, which, as a rule, are prescribed to patients suffering from cystic fibrosis.

It is possible to bend the arm after placement in the cubital space, only v. mediana cubiti et v. basilica and catheter not less than G 20.

Not many authors recommend changing the dressing more than once every 24 hours, sometimes even once every 48 hours is enough, provided that the dressing is partially sealed, clean and “not stained” with blood or solution (under the Tegaderm dressing these conditions are created), otherwise the bandage is to be changed, the site of catheter insertion is treated with an antiseptic, dried and, if possible, a sterile bandage is applied. When changing the bandage, pay attention to redness, rash, maceration (skin irritation due to moisture), seals, soreness, correct placement of the catheter (it can move when moving, rest against the wall of the vessel, or go completely into the vein - it must not be in the vein more than 2/3 of its length).

Frequent change of catheter is an increased risk of thrombus formation as a result of repeated punctures. Additional entry gate for infection. In some patients, regular catheter changes are virtually unrealistic due to the lack of suitable veins.

Heparinization (heparin plug, heparin plug, etc.) - to prevent the formation of a blood clot at the end of the catheter and the formation of a fibrin film on the walls of the catheter and, as a result, obstruct the conditions for bacterial growth -, small doses of heparin are used at the rate of 1 unit per 1 ml of infused solution (in our case, saline solution of 0.9% sodium chloride).

A bandage closes the catheter in children so that the child does not accidentally touch it and damage it.

Often there are allergies to domestic plaster. In any pharmacy, you can buy a hypoallergenic patch from Hartman Paul. With any skin irritation, the allergen (patch) must be removed. There are also special sterile patches for fixing the catheter. Unfortunately, there may not be such luxury in the hospital. You will have to buy and ask the staff to use your patch.

Heparin plug for catheter

The method of performing a heparin lock in children:

1. Wash hands and put on gloves.

2. Treat the connection of the system for intravenous administration of solutions and the catheter with an antiseptic solution.

3. Stop intravenous administration and disconnect the system from the pavilion of the needle or catheter located in the lumen of the vein.

4. Close the catheter pavilion with a sterile plug or T-piece [eg, an Argyle intermittent infusion plug (Consolidated Medical Equipment, Utica, NY, USA; Sherwood Medical Co., St. Louis, MO, USA) or a Barron port interlock dilator ( Burron Medical, Bethlehem, PA, USA), which are already supplied with the required amount of heparinized saline].

Alternatively, a stopcock with two non-functioning heads can be used. However, a minimum of 3 ml of lavage solution is required to flush all parts of the stopcock, which increases the potential for fluid overload error in extremely low birth weight preterm infants.

5. The cork is treated with an antiseptic and 0.4-0.8 ml of heparinized saline is injected through the cork, washing out the blood from the needle or catheter.

6. Before each use, the cork is treated with an antiseptic.

7. Re-produce the heparin block with heparinized flushing solution after each intravenous infusion. (Routine flushing is done every 6-12 hours depending on frequency of use.)

Rules for the care of a central venous catheter;

To prevent purulent complications, you should follow the rules of asepsis and antisepsis, at least 1 time in 3 days, if necessary more often, change the fixing bandage with the treatment of the puncture hole and the skin around it with an antiseptic; wrap a sterile napkin around the junction of the catheter with the system for intravenous drip infusions, and after infusion - the free end of the catheter. Repeated contact with the element of the infusion system should be avoided, access to it should be minimized. Carry out a change of infusion systems for intravenous infusion of solutions, antibiotics daily, replacement of tees and conductors - once every two days (for patients with a cytopenic state - daily). The use of a sterile fixing bandage provides protection against infection from the outer surface of the catheter.

In order to prevent thrombosis of the catheter by a blood clot, it is preferable to use catheters with an anticoagulant coating. If the catheter is thrombosed, it is unacceptable to flush it to remove the thrombus.

To prevent bleeding from the catheter, the plug should be tightly closed, tightly fixed with a gauze cap, and the position of the plug should be constantly monitored.

In order to prevent air embolism, it is necessary to use catheters with a lumen diameter of less than 1 mm. Manipulations, which are accompanied by disconnection and attachment of syringes (droppers), are preferably carried out on exhalation, pre-blocking the catheter with a special plastic clamp, and if there is a tee, blocking its corresponding channel. Before connecting a new line, make sure it is completely filled with mortar. It is preferable to use small highways (the probability of an air embolism decreases).

To prevent spontaneous removal and migration, use only standard catheters with needle pavilions, fix the catheter with adhesive tape (a special fixing bandage). Before infusion, check the position of the catheter in the vein with a syringe. Do not use scissors to remove the adhesive tape, as the catheter may be accidentally cut off and migrate into the circulatory system.

Workplace equipment: 1) a bottle with a filled system for intravenous drip infusions of a single use, a tripod; 2) a bottle with heparin with a volume of 5 ml with an activity of 1 ml - 5000 IU, an ampoule (bottle) with a solution of sodium chloride 0.9% - 100 ml; 3) syringes with a capacity of 5 ml, single-use injection needles; 4) sterile catheter plugs; 5) sterile material (cotton balls, gauze triangles, napkins, diapers) in biks or packages; 6) tray for sterile material; 7) tray for used material; 8) caps in the package; 9) sterile tweezers; 10) tweezers in a disinfectant solution; 11) file, scissors; 12) a container-dispenser with an antiseptic agent for treating the skin of patients and the hands of staff; 13) a container with a disinfectant for processing ampoules and other injectable dosage forms; 14) plaster (regular or Tegoderm type) or other fixative bandage; 15) mask, medical gloves (single use), waterproof decontaminated apron, goggles (plastic screen); 16) tweezers for working with used tools; 17) containers with a disinfectant for disinfecting surfaces, washing used needles, syringes (systems), soaking used syringes (systems), soaking used needles, disinfecting cotton balls, gauze wipes, used rags; 18) clean rags; 19) tool table.

4. Put on an apron, mask, gloves.

5. Treat the surface of the manipulation table, tray, apron, bix with a disinfectant solution. Wash gloved hands with soap and running water, dry.

6. Put the necessary equipment on the tool table.

7. Cover the sterile tray, putting everything you need on it. There is another option for working with sterile material when it is in packages.

The main stage of the manipulation. Connecting the infusion system to the CVC. 8. Treat the vial with isotonic sodium chloride solution.

9. Draw 1 ml of solution into one syringe, 5 ml into the other.

11. Clamp the catheter with a plastic clamp. Clamping the catheter prevents bleeding from the vessel and air embolism.

12. Remove the "old" pear-shaped bandage from the catheter cannula.

13. Treat the catheter cannula and plug with an antiseptic, keeping the end of the catheter suspended at a certain distance from the cannula.

14. Put the treated part of the catheter on a sterile diaper, placing it on the baby's chest.

15. Treat gloved hands with an antiseptic.

16. Remove the cork from the cannula and discard. If there are no additional sterile plugs, then put it in an individual container with alcohol(used once).

17. Attach the syringe with sodium chloride solution 0.9%, open the clamp on the catheter, remove the contents of the catheter.

18. Using another syringe, flush the catheter in an amount of 5-10 ml.

To avoid air embolism and bleeding, it is necessary to pinch the catheter with a plastic clamp each time before disconnecting the syringe, system, plug from it.

19. Attach the system for intravenous drip infusion to the cannula of the jet-to-jet catheter.

20. Adjust the rate of introduction of drops.

21. Wrap a sterile cloth around the junction of the catheter with the system.

Disconnecting the infusion set from the CVC. Heparin "lock". 22. Check the stickers on the bottles with heparin and sodium chloride solution 0.9%(name of the drug, quantity, concentration).

23. Prepare vials for manipulation.

24. Draw 1 ml of heparin into the syringe. Introduce 1 ml of heparin into a vial with a solution of sodium chloride 0.9% (100 ml).

25. Draw 2 - 3 ml of the resulting solution into a syringe.

26. Close the dropper, pinch the catheter with a plastic clamp.

27. Remove the gauze covering the joint between the catheter cannula and the system cannula. Transfer the catheter to another sterile napkin (diaper) or to the inner surface of any sterile package.

28. Treat your hands with an antiseptic solution.

29. Disconnect the dropper and attach a syringe with diluted heparin to the cannula, remove the clamp and inject 1.5 ml of the solution into the catheter.

30. Clamp the catheter with a plastic clamp, disconnect the syringe.

31. Process the catheter cannula ethyl alcohol, to remove traces of blood, another protein preparation, glucose from its surface.

32. Put a sterile cork on a sterile napkin with sterile tweezers and close the catheter cannula with it.

33. Wrap the catheter cannula with sterile gauze and secure with a rubber band or adhesive tape.

Changing the bandage that fixes the CVC. 34. Remove the old fixing bandage.

35. Treat gloved hands with an antiseptic solution (put on sterile gloves).

36. Treat the skin around the catheter insertion site first 70% alcohol, then antiseptic iodobac (betadine etc.) in the direction from the center to the periphery.

37. Cover with a sterile napkin, withstand exposure for 3-5 minutes.

38. Dry with a sterile cloth.

39. Apply a sterile dressing to the catheter entry site.

40. Fix the bandage with a Tegoderm plaster (Mefix, etc.), completely covering the sterile material.

41. Indicate on the top layer of the patch the date of applying the bandage.

Note. If an inflammatory process occurs around the site of catheter insertion (redness, induration), after consultation with the attending physician, it is advisable to use ointments (betadine, seen, ointment with antibiotics). In this case, the dressing is changed daily, and on the patch, in addition to the date, it is indicated - "ointment".

The final stage of the manipulation.42. Disinfect used medical instruments, catheters, infusion systems, apron in appropriate containers with a disinfectant solution. Treat work surfaces with a disinfectant solution. Remove gloves and decontaminate them. Wash hands under running water with soap, dry, treat with cream.

43. Provide a protective regime for the child.

44. Make an entry in the medical records indicating the date, time of infusion, the solution used, its amount.

Possible complications: 1) purulent complications (suppuration of the puncture channel, thrombophlebitis, phlegmon, sepsis); 2) thrombosis of the catheter with a blood clot; 3) bleeding from the catheter; 4) air embolism, thromboembolism; 5) spontaneous removal and migration of the catheter; 6) sclerosis of the central vein in case of frequent change of the catheter; 7) infiltration; 8) an allergic reaction to drugs, etc.

PUNCTION AND CATHETERIZATION OF PERIPHERAL VEINS

General information. The use of a peripheral venous catheter (PVC) enables long-term infusion therapy, makes the catheterization procedure painless, and reduces the frequency of psychological trauma associated with numerous punctures of peripheral veins. The catheter can be inserted into the superficial veins of the head, upper and lower extremities.

The duration of operation of one catheter is 3-4 days. For patients receiving long-term treatment, it is advisable to start venous catheterization with a peripheral catheter from the veins of the hand or foot. In this case, during their obliteration, the possibility of using higher-lying veins remains. When operating a peripheral venous catheter, the rules of asepsis and antisepsis should be strictly observed. Thoroughly clean the connection points of the catheter with the system for intravenous drip infusions, connector, cork from blood residues, cover with a sterile napkin. Monitor the condition of the vein and skin in the puncture area. To prevent bleeding from the catheter, air embolism, firmly fix the plug on the catheter cannula, press the vein to the top of the catheter each time before removing the plug, turning off the system, syringe. If a connector (wire) with a tee is attached to the catheter, block the corresponding channel of the tee. To avoid thrombosis of the catheter with a blood clot, the catheter temporarily not used for infusion must be filled with a heparin solution (see paragraphs "Care of the central venous catheter"). To prevent external migration of the catheter with the formation of a subcutaneous hematoma and (and) paravasal administration of a medicinal substance, constantly monitor the reliability of fixation of the catheter, check its position in the vein with a syringe. When placing a catheter in the joint area, use a splint.

Workplace equipment: 1) vial (ampoule) with sodium chloride solution 0.9%; 2) peripheral venous catheter, plugs for the catheter; 3) syringes with a capacity of 5 ml, single-use injection needles; 4) sterile material (cotton balls, gauze wipes, diapers) in bixes or packages; 5) tray for sterile material; 6) tray for used material; 7) hoes in packages; 8) sterile tweezers; 9) tweezers in a disinfectant solution; 10) nail file, scissors; 11) tourniquet; 12) a container-dispenser with an antiseptic agent for treating the skin of patients and the hands of staff; 13) a container with a disinfectant solution for processing ampoules and other injectable dosage forms; 14) plaster (regular or Tegoderm type) or other fixative bandage; 15) mask, medical gloves (single use), waterproof apron, goggles (plastic screen); 16) tool table; 17) tweezers for working with used tools; 18) containers with a disinfectant for disinfecting surfaces, washing used syringes (systems), soaking used syringes (systems), soaking used needles, disinfecting cotton and gauze balls, used rags; 19) clean rags.

Preparatory stage of the manipulation. 1.Inform the patient (close relatives) about the need to perform and the essence of the procedure.

2. Obtain the consent of the patient (close relatives) to perform the procedure.

3. Wash hands with running water, lathering twice. Dry them with a disposable napkin (individual towel). Treat your hands with an antiseptic.

4. Put on an apron, mask, gloves.

5. Treat the surface of the manipulation table, tray, apron, bix with a disinfectant solution. Wash gloved hands with running water and soap, dry, treat with an antiseptic.

6. Put the necessary equipment on the tool table. Check the expiration dates, the integrity of the packages.

7. Cover the sterile tray, putting everything you need on it. There is another option for working with sterile material when it is in packages.

8. Treat the vial with sodium chloride solution 0.9%.

9. Draw 5 ml of the solution into the syringe.

10. Put on safety goggles (plastic shield).

The main stage of the manipulation. 11. Apply a tourniquet above the intended site of the catheter. In young children, it is better to use digital vein pressure (performed by a nurse assistant). 12. Treat the skin in the area of ​​the veins of the back of the hand or the inner surface of the child's forearm with an antiseptic agent (two balls, wide and narrow).

13. Treat hands with an antiseptic.

14. Take the catheter in your hand with three fingers and, pulling the skin in the vein area with the other hand, puncture it at an angle of 15-20.

15. When blood appears in the indicator chamber, slightly pull the needle while pushing the catheter into the vein.

17. Press the vein to the top of the catheter (through the skin), remove the needle completely.

18. Connect a syringe with isotonic sodium chloride solution to the catheter, rinse the catheter with the solution.

19. In the same way, pressing the vein with one hand, disconnect the syringe with the other hand and close the catheter with a sterile stopper.

20. Clean the outer part of the catheter and the skin under it from traces of blood.

21. Fix the catheter with a plaster.

22. Wrap the cannula of the catheter with a sterile gauze, fix it with adhesive plaster, bandage it.

23. Transfer (transport) the child to the ward, connect the dropper (syringe pump). If intravenous infusions through a peripheral venous catheter will not be carried out in the near future, fill it with a solution of heparin (see paragraph "Care of the central venous catheter").

The final stage of the manipulation. 24. Disinfect used medical instruments, catheters, infusion systems, apron in appropriate containers with a disinfectant solution. Treat work surfaces with a disinfectant solution. Remove gloves and decontaminate them. Wash hands under running water with soap, dry, treat with cream.

25. Provide a protective regime for the child.

26. Make an entry in the medical records indicating the date, time of infusion, the solution used, its amount.

Puncture of the veins of the calvarium

BUTTERFLY NEEDLE WITH CATHETER

General information. For young children, drugs can be injected into the superficial veins of the head. During the procedure, the child is fixed. His head is held by a nurse assistant, hands to the body and legs are fixed with a diaper (sheet). If there is hairline at the site of the intended puncture, the hair is shaved off.

Workplace equipment: 1) “butterfly” needle with a single-use catheter; 2) a bottle with a filled system for intravenous drip infusions of a single use, a tripod; 3) an ampoule (bottle) with a solution of sodium chloride 0.9%; 4) a single-use syringe with a volume of 5 ml, injection needles; 5) sterile material (cotton balls, gauze triangles, napkins, diapers) in packages or bixes; 6) tray for sterile material; 7) tray for used material; 8) caps in the package; 9) sterile tweezers; 10) tweezers in a disinfectant solution; 11) file, scissors; 12) a container-dispenser with an antiseptic agent for treating the skin of patients and the hands of staff; 13) a container with a disinfectant solution for processing ampoules and other injectable dosage forms; 14) plaster (regular or Tegoderm type) or other fixative bandage; 15) medical gloves (single use); mask, goggles (plastic screen), waterproof decontaminated apron; 16) tweezers for working with used tools; 17) containers with a disinfectant for treating surfaces, washing used needles, syringes (systems), soaking used syringes (systems), needles, disinfecting cotton balls and gauze wipes, used rags; 18) clean rags; 19) tool table.

Preparatory stage of the manipulation. 1. Inform the patient (close relatives) about the need to perform and the essence of the procedure.

2. Obtain the consent of the patient (close relatives) to perform the procedure.

3. Wash hands under running water, lathering twice. Dry hands with a disposable napkin (individual towel). Treat your hands with an antiseptic. Wear an apron, gloves, mask.

4. Treat the surface of the manipulation table, tray, apron, stand for the system with a disinfectant solution. Wash gloved hands under running water with soap, dry, treat with an antiseptic.

5. Put the necessary equipment on the tool table.

6. Cover the sterile tray.

7. Print the packages with the butterfly catheter, syringes, put them on the tray. There is another option for working with sterile material when it is in packages.

8. Treat the ampoule (vial) with sodium chloride solution 0.9%.

9. Draw 2 ml into the syringe connect to the catheter, fill it and put it on the tray.

10. Fix the child (performed by a nurse assistant). Put a sterile diaper next to the baby's head.

11. Put on safety goggles (plastic shield).

The main stage of the manipulation.12. Select a vessel for puncture and treat the injection site with two balls with an antiseptic (one wide, the other narrow) in the direction from the parietal to the frontal region. For better blood supply to the vein, it is convenient to use a special elastic band applied around the head below the punctured area (above the eyebrows). Local digital vein clamping is ineffective due to the abundance of venous anastomoses of the cranial vault. The crying of the child also contributes to the swelling of the veins of the head.

13. Treat gloved hands with an antiseptic.

14. Stretch the skin in the area of ​​the proposed puncture to fix the vein.

15. Puncture a vein with a butterfly needle with a catheter in three stages . To do this, direct the needle along the blood flow at an acute angle to the surface of the skin and puncture it. Then advance the needle approximately 0.5 cm, pierce the vein and direct it along its course. If the needle is not in the vein, return it without removing it from under the skin and re-puncture the vein.

Insertion of a needle into a vessel immediately after skin puncture may result in puncture of both walls of the vessel.

16. Pull the plunger of the syringe connected to the catheter. The appearance of blood indicates the correct position of the needle. If an elastic band was used to increase blood supply to the vein, remove it.

17. Inject 1 - 1.5 ml sodium chloride solution 0.9%, to avoid thrombosis of the needle with a blood clot and to exclude the possibility of extravasal administration of the drug.

18. Fix the needle with three strips of adhesive tape: 1st - across the needle to the skin. 2nd - under the "wings" of the "butterfly" needle with a cross over them and fixation to the skin, 3rd - across the wings of the "butterfly" needle to the skin.

19. Roll up the catheter and fix it with adhesive tape on the scalp to prevent its displacement.

20. If necessary, if the angle of the needle with respect to the curve of the skull is large, place a gauze (cotton) ball under the cannula of the needle.

21. Pull the plunger of the syringe connected to the catheter to recheck the position of the needle in the vein.

22. Disconnect the syringe, connect the dropper on the solution jet.

23. Use the clamp to adjust the rate of drug administration.

24. Cover the junction of the cannulae of the catheter and dropper with a sterile gauze.

The final stage of the manipulation.25. After completion of the infusion, clamp the dropper tube with a clamp. Carefully peel off the adhesive tape from the skin. Press the ball with an antiseptic into the place where the needle enters the vein. Remove the needle (catheter) along with the adhesive tape.

26. Apply a sterile napkin to the puncture site, a pressure bandage on top.

27. Disinfect used medical instruments, catheters, infusion systems, apron in appropriate containers with a disinfectant solution. Treat work surfaces with a disinfectant solution. Remove gloves and decontaminate them. Wash hands under running water with soap, dry, treat with cream.

28. Provide a protective regime for the child.

29. Make an entry in the medical records indicating the date, time of infusion, the solution used, its amount.

Possible complications: 1) purulent complications (suppuration of the puncture channel, thrombophlebitis, phlegmon, sepsis); 2) thrombosis of the catheter with a blood clot; 3) bleeding from the catheter; 4) air embolism; 5) spontaneous removal and migration of the catheter; 6) vein sclerosis in case of frequent catheter change; 7) infiltration; 8) an allergic reaction to drugs, etc.

to the Instructions for the execution technique

medical and diagnostic procedures and manipulations in the disciplines "Nursing in Pediatrics", "Pediatrics" in the specialties 1 "Nursing", 1 "General Medicine"

General information. Preventive vaccinations are an effective means of combating childhood infectious diseases. The vaccination preparations used contribute to the development of immunity, immunity to a particular infection.

Vaccinations are carried out in specially equipped vaccination rooms of medical institutions, medical offices of schools and other educational institutions. The vaccination room should be equipped to provide emergency care. In order to avoid inactivation of vaccine preparations, a "cold chain" must be observed all the way from the manufacturing institute until the moment of vaccination.

Immediately before vaccination, the child should be examined by a doctor (paramedic). Without written permission to vaccinate, a nurse is not authorized to administer it. In the first 30-60 minutes after vaccination, the child should be under medical supervision in a clinic (school, preschool institution).

Workplace equipment: 1) vaccination preparations: vaccine against viral hepatitis B ("Angerix-B", Euvax-B, Eberbiovak NV, Shenvak-B, etc.), BCG, BCG-M, DTP, DTP-M, ADS, ADS-M, AD-M, OPV, IPV, ZhKV, ZHPV, "Rudivax", "Trimovax"; 2) solvents for BCG, ZhKV, ZHPV, Trimovax, Ruvaks vaccines; 3) single use syringes with a capacity of 1-2 ml, injection needles for subcutaneous and intramuscular injections; 4) tuberculin (insulin) syringes, injection needles for intradermal injections; 5) droppers for polio vaccine; 6) file; 7) tweezers in a disinfectant solution; 8) sterile material (cotton balls and gauze pads) in a package; 9) cold element with cells; 10) light-protective cone for vaccines BCG, ZhKV, "Trimovax"; 11) 70% ethyl alcohol or other antiseptic agent for disinfecting the patient's skin and personnel's hands (dispensing container); 12) a container with a disinfectant for processing ampoules (vials); 12) a tray for placing the inoculum on the instrument table; 13) a tray for used material (without live vaccine residues or traces of blood); 14) mask; 15) medical gloves (disposable or disinfected); 16) tweezers for working with used tools; 17) containers with disinfectants: a) for surface treatment, b) for washing and soaking used syringes and needles, c) for disinfecting used ampoules (vials) and cotton balls (napkins) with live vaccine residues, d) for disinfecting used rags ; 18) clean rags; 19) tool table.

Note. When working with the BCG vaccine (BCG-M), use disinfectant solutions of high activity.

Preparatory stage of the manipulation. 1. Inform the patient (close relatives) about the need to perform and the essence of the procedure.

2. Obtain the consent of the patient (close relatives) to perform the procedure.

3. Wash and dry your hands. Treat your hands with an antiseptic.

4. Put on gloves.

5. Treat the tray, instrument table, apron with a disinfectant solution. Wash and dry hands.

6. Place the tweezers in a container with a disinfectant solution on the top shelf of the instrument table, ethyl alcohol 70%, lay out sterile material in packages, single-use syringes and needles, when performing OPV vaccinations - a package of droppers; when working with BCG, ZhIV, Trimovax vaccines- a light-protective cone, a tray for placing grafting material, a file.

7. On the bottom shelf, place containers with a disinfectant solution, tweezers for removing needles, a tray for used material.

8. Remove from the refrigerator, disinfect with a disinfectant solution and place the cold element on the tray. Cover the cold element with a two-three-layer gauze napkin.

9. Check the availability of a written permission for vaccination and compliance with its acceptable deadlines.

10. Take out the appropriate vaccine preparation (if necessary, and solvent) from the refrigerator (refrigerator bag), check the presence of the label, expiration date, integrity of the ampoule (vial), appearance of the preparation (and solvent).

11. Install the grafting preparation in the cell of the cold element.

12. Ampoules (vials) with live vaccine (ZhKV, BCG, Trimovax) cover with a light shield.

13. Wash and dry your hands, treat with an antiseptic. Wear a mask when handling live vaccines.

AGAINST VIRAL HEPATITIS B

vaccination dose . The dose is for newborns and children under 10 years old - 10 mcg (0.5 ml), for older children and adults - 20 mcg (1 ml).

Method and place of administration. The vaccine is administered intramuscularly. Newborns and young children in the anterolateral region of the thigh, older children and adults - in the deltoid muscle.

Workplace equipment and preparatory stage.P. 1 - 13 - see Vaccinations.

The main stage of the manipulation.14. Shake the vial with the vaccine until a homogeneous suspension is obtained.

15. Treat the metal cap of the bottle with a ball of alcohol, remove its central part, treat the rubber stopper with a second ball of alcohol, leave it on the bottle. Return vial to cold cell.

16. Open the syringe package, fix the needle on the cannula.

17. Draw the vaccine into the syringe: for newborns and children under 10 years old - 0.5 ml (10 mcg), for children over 10 years old - 1 ml (20 mcg).

18. Change the needle. Before changing the needle, use the plunger to draw the vaccine from the needle into the syringe.

19. Expel the air from the syringe. Throw the used ball into a container with a disinfectant solution. Treat your hands with an antiseptic.

20. Treat the skin of newborns and young children - the anterolateral surface of the thigh, for older children - the area of ​​​​the deltoid muscle with two balls with alcohol (wide and narrow).

21. Remove the cap from the needle and inject the vaccination dose of the vaccine intramuscularly.

22. Treat the skin after the injection with alcohol.

The final stage of the manipulation.23. Rinse the used syringe and needle in the first container with a disinfectant solution and, removing the needle with tweezers, immerse it disassembled in the appropriate containers with the same solution.

24. Discard the used vial into the waste tray.

25. Treat gloved hands with an antiseptic solution, remove and disinfect gloves. Wash and dry hands, treat with cream if necessary.

26. Register the vaccination, and later information about the reaction to it in the relevant documents: in the maternity hospital - in the history of the development of the newborn (recording form No. 97 / y), exchange card (recording form No. 113 / y), preventive vaccination journal (recording form No. 64/y); in the clinic - in the preventive vaccination card (recording form No. 63 / y), in the history of the child's development (recording form No. 112 / y), in the register of preventive vaccinations (recording form No. 64 / y, Fig. 59); at school - in the individual card of the child (recording form No. 26 / y) and the journal (recording form No. 64 / y). At the same time, indicate the date of vaccination, dose, control number, batch number of the drug, manufacturer.

Possible vaccination reaction: 1) pain, erythema and hardening of soft tissues at the injection site in the first 5 days after the introduction of the vaccine.

Possible unusual reactions and complications: 1) fever; 2) joint pain, myalgia, headache; 3) nausea, vomiting, diarrhea; 4) lymphadenopathy; 5) isolated cases of anaphylactic shock; 6) phlegmon, abscess; 7) tissue infiltration and necrosis, hematoma, damage to the periosteum and joint.

AGAINST TUBERCULOSIS WITH BCG VACCINE (BCG-M)

Inoculation dose. It is 0.05 mg of BCG vaccine or 0.025 mg of BCG-M vaccine. The dry vaccine is diluted in saline: 0.1 ml per vaccination dose.

Method and place of administration. The vaccine is administered strictly intradermally at the border of the upper and middle thirds of the outer surface of the left shoulder.

Equipment of the workplace and the preparatory stage, P. 1 - 13 - see Vaccinations.

The main stage of the manipulation.14. Remove two sterile balls from the kraft bag with tweezers, moisten them alcohol. Treat the neck of the ampoule with the vaccine with alcohol, file, re-treat with another ball, carefully squeezed out of alcohol (alcohol inactivates the vaccine).

15. Cover the filed end of the ampoule with a sterile gauze cap and open it. Throw the top of the ampoule with a gauze cap into a container with a disinfectant solution. Place the opened ampoule in the cell of the cold element. Cover with another gauze cap and light protection cone.

16. Treat the solvent ampoule with alcohol, file, re-process and open.

17. Open the package of the syringe with a capacity of 2 ml, fix the needle on the cannula. Draw solvent into the syringe. The amount of solvent should correspond to the number of doses of dry vaccine in the ampoule (for 20 doses - 2 ml of solvent, for 10 doses - 1 ml).

18. Remove the light-protective cone and gauze cap from the dry vaccine, slowly introduce the solvent, thoroughly washing off the particles of the sprayed vaccine from the walls of the ampoule. Mix the dissolved vaccine by reciprocating the plunger in the syringe. If the needle protrudes above the cut of the ampoule and can be hermetically connected to the tuberculin syringe, leave it in the ampoule. When using a tuberculin syringe with a cannula soldered to the needle cone, do not leave the needle in the vaccine.

19. Cover the ampoule with a sterile gauze cap and a light-protective cone.

20. Rinse the syringe and needle in containers with a disinfectant solution and immerse them disassembled in the appropriate containers with the same solution. Clean your hands with alcohol.

21. Treat with two cotton balls with alcohol skin of the outer surface of the left shoulder of the child (on the border of the upper and middle thirds).

The skin in the area of ​​the upcoming injection can be treated immediately before the administration of the drug, but in this case it is necessary to thoroughly blot the remaining alcohol on the skin with a sterile dry ball (napkin).

22. Fix the needle on the tuberculin (insulin) syringe to take the vaccine. Draw 0.2 ml of the vaccine into the syringe, after mixing the vaccine with reciprocating movements of the piston in the syringe (mycobacteria are absorbed on the walls of the ampoule). Move the piston to draw the vaccine from the needle into the syringe. Throw the used needle into a container with a disinfectant solution.

23. Close the ampoule with the vaccine with a gauze cloth and a light-protective cone.

24. Fix a thin short needle with a cap on the cannula of the syringe. Expel the air and excess vaccine from the syringe onto a cotton ball tightly pressed against the cannula of the needle.

25. Throw the used ball into a container with a disinfectant solution.

27. Treat your hands with an antiseptic.

28. Remove the cap from the needle and discard it in a container with a disinfectant solution.

29. Grasp the left shoulder of the child with your hand, pulling the skin of the previously treated area (the skin must be dry).

30. Direct the needle of the tuberculin syringe with the cut up into the surface layer of the skin and, making sure that it is in the intradermal position, press the cannula of the needle with your thumb. Inject 0.1 ml of vaccine .

With proper administration, a whitish papule with a diameter of about 8 mm is formed on the skin, usually disappearing after 15-20 minutes. Do not treat the injection site with alcohol or other antiseptic (alcohol will inactivate the vaccine).

The final stage of the manipulation.31. Rinse the tuberculin syringe and needle in the first container with a disinfectant solution, remove the needle with tweezers (if it is not soldered), immerse the disassembled syringe and the needle in the appropriate containers with the same solution.

32. Discard the used ampoule of solvent into the waste tray. The ampoule with vaccine residues that are insufficient to vaccinate another child or that have expired should be thrown into a container with a disinfectant solution.

33. Treat gloved hands with an antiseptic solution, remove and disinfect gloves. Wash and dry hands, treat with cream if necessary.

34. Register the vaccination, and later information about the reaction to it in the relevant documents (see. item 26).

Vaccination reaction: 1) After 4-6 weeks (after revaccination 1-2 weeks) - a spot, infiltrate, later a vesicle (pustule), a sore or without it, a scar from 2 to 10 mm in diameter.

Possible complications: 1) increased local reaction (ulcer more than 10 mm); 2) regional lymphadenitis; 3) cold abscess; 4) keloid scar; 5) generalized BCG infection; 6) damage to the eyes, bones, the occurrence of lupus at the site of vaccination.

AGAINST whooping cough, diphtheria, tetanus

(AKDS, AKDS-M, ADS, ADS-M, AD-M)

vaccination dose . Makes 0.5 ml of vaccine or toxoid.

Method and site of administration . DTP vaccine injected intramuscularly into the anteroexternal area of ​​the thigh, toxoids - up to 6 years of age intramuscularly, then - subcutaneously into the subscapular region.

Equipment of the workplace and the preparatory stage of the manipulation.P. 1 - 13 - see Vaccinations.

The main stage of the manipulation.14. Shake the ampoule with the vaccine until a homogeneous suspension is obtained.

15. Process alcohol, file, reprocess and open the vaccine vial. If the vaccine is in a vial, treat the metal cap, remove its central part, treat the rubber stopper with a ball of alcohol, leave it on the vial.

16. Return the ampoule (vial) to the cell of the cold element.

17. Open the syringe package, fix the needle on the cannula.

18. Draw the vaccine into the syringe.

19. If one or more doses of the vaccine remain in the ampoule (vial), cover the ampoule or vial with a needle with a sterile gauze cap and return it to the cold element cell.

20. Change the needle on the syringe with the vaccine. Before changing the needle, use the plunger to draw the vaccine from the needle into the syringe.

21. Press a dry cotton ball to the cannula of the needle and, without removing the cap, expel the air from the syringe, leaving 0.5 ml of vaccine in it.

22. Discard the cotton ball in the waste tray. Clean your hands with alcohol or other antiseptic.

23. Treat the skin in the area of ​​the anterior outer surface of the thigh or the skin of the subscapular region with two balls with alcohol - when administered subcutaneously to schoolchildren ADS, ADS-M, AD-M-anatoxins.

24. Remove the cap from the needle and inject 0.5 ml of the vaccine AKDS, AKDS-M intramuscularly, ADS, ADS-M, AD-M schoolchildren - subcutaneously.

25. Treat the skin in the injection area with a ball of alcohol.

The final stage of the manipulation.26. Rinse the used syringe and needle in the first container with a disinfectant solution and, removing the needle with tweezers, immerse it disassembled in the appropriate containers with the same solution.

27. Discard the ampoule (vial) with the remnants of the vaccine preparation, insufficient for vaccinating the next child, into the waste material tray.

28. Treat gloved hands with an antiseptic solution, remove and disinfect gloves. Wash and dry hands, treat with cream if necessary.

29. Register the vaccination, and later information about the reaction to it in the relevant documents (see. Vaccination against viral hepatitis B, item 26).

Vaccination reaction: 1) hyperemia of the skin, swelling of soft tissues up to 5 cm in diameter, no more than 2 cm infiltrate at the injection site; 2) short-term fever, weakness, headache in the first 2-3 days after the introduction of the vaccine

Possible complications: 1) edema and soft tissue infiltrate more than 8 cm in diameter, phlegmon, abscess; 2) excessively strong over 3 days of fever and intoxication; 3) encephalopathy, encephalitis; 4) anaphylactic shock; 5) asthmatic syndrome, croup; 6) neuritis of the brachial nerve; 7) damage to the periosteum and joint.

Caring for your vascular catheter

Materials and tools

Table, Tray, Sterile Forceps, Disposable Syringe (10 ml), Disposable Sterile Stoppers, Waterproof Bag or Class B Waste Container, Heparinized Solution (0.01 ml of heparin per 1 ml of normal saline – i.e. 50 U/1 ml ) in a volume equal to the internal volume of an intravenous catheter, 0.9% sodium chloride solution (5.0–10.0 ml), an alcohol-containing antiseptic for skin treatment and a catheter, as well as all its connections, including a CVC cannula (PVC) , a solution of chlorhexidine 0.5–2% in 70% ethyl or isopropyl alcohol (for treating the skin around a vascular catheter), a 10% solution of povidone-iodine in 70% ethyl or isopropyl alcohol (with contraindications to use of chlorhexidine solution), antiseptic (for), sterile gauze swabs, sterile gauze pads or self-adhesive sterile dressing, sterile diaper, sterile transparent dressing or sterile transparent dressing containing chlorhexidine, plaster, sterile gloves, medical hat, mask.

Algorithm for caring for a vascular catheter (central) - dressing change

Preparatory stage

You should identify the patient, introduce yourself, explain the course and purpose of the procedure to be performed.

Written consent is not required.

Voluntary informed consent is required for the procedure. If not, ask your doctor about what to do next.

You must wear a mask and medical cap.

Deliver the manipulation table to the ward, having prepared everything you need.

Progress

Inspect the site of entry of the catheter into the skin in order to identify signs of inflammation (swelling, soreness). If signs of inflammation are found, call a doctor.

Then remove the bandage. At the same time, in order to prevent damage to the skin around the site of entry of the catheter into the skin, do not pull it up, but slowly wrap it parallel to the skin in the direction of hair growth.

Do not treat gloves with an antiseptic, this will violate their barrier properties.

Use a sterile gauze spatula to treat all connections, including the cannula and the catheter itself.

When using a sterile transparent dressing, it is necessary to make sure that the catheter entry point into the skin is in the center of the transparent window to control the catheter entry point into the skin.

If necessary, secure the catheter lines.

Final stage

Remove gloves, put them in a waterproof bag or container.

Used material should be disposed of as Class B waste.

Hygienically clean hands, dry.

Make an entry in the medical records.

Vascular Catheter Care Algorithm (Central/Peripheral) – Catheter Flushing

Preparatory stage

You should identify the patient, introduce yourself, explain the course and purpose of the procedure to be performed. Written consent is not required.

Voluntary informed consent is required for the procedure for administering the medicinal product. If not, ask your doctor about what to do next.

Put on a medical cap and mask.

Help the patient to take a comfortable position, lying on his back, without pillows, turn his head to the opposite side.

Remove clothing from the area where the catheter is placed.

Hygienically treat hands.

Treat hands with an antiseptic, do not dry, wait for the antiseptic to dry, put on sterile gloves.

Then, 5 ml of a 0.9% sodium chloride solution should be drawn into a syringe (10 cm 3).

When setting up a “heparin lock” with CVC, prepare a syringe (10 cm 3) with a heparinized solution (0.01 ml of heparin per 1 ml of 0.9% sodium chloride solution - 50 U / 1 ml) in a volume equal to the internal volume of intravenous catheter.

The dose of heparinized solution is calculated individually.

With PVK "" is not done without a doctor's prescription.

Progress

Special clamps should be used to close the CVC lines included in the catheter kit.

If there is no clamp, it is necessary to ask the patient to hold his breath, to exhale.

When closing the catheter, a new sterile plug must be used, as CVC and PVC plugs are sterile and disposable.

With a sterile cloth moistened with an antiseptic, the catheter connector should be treated by making 15 rotational movements.

If a "heparin lock" was previously inserted into the catheter, it is necessary to pull it out by attaching a syringe (10 cm 3) with 0.9% sodium chloride solution (5 ml), pull it towards you.

You can make sure that the patency of the catheter is not broken, as follows. A new syringe (10 cm 3) should be attached with a 0.9% sodium chloride solution (5 ml).

Then you should open the clamp and easily pull the piston towards you. In this case, blood should appear. Next, you need to enter the contents of the syringe, close the clamp. If the passage of the solution is difficult, you should call a doctor.

To put a "heparin lock", it is necessary to connect a syringe (10 cm 3) with a heparinized solution to the catheter.

Then remove the clamp and inject the heparinized solution in a volume not exceeding the internal volume of the catheter lumen. The clamp should be closed. The volume of each of the gaps is indicated on the packaging of the CVC.

Then, with a sterile napkin moistened with an antiseptic, the catheter connector should be treated by making 15 rotational movements.

With a new sterile plug, without touching the inside of the plug and the catheter connector, carefully close the catheter lumen.

Final stage

At the final stage, remove used gloves and put them in a waterproof bag or container.

Deliver the used material to the treatment room for further disinfection and disposal of class B waste.

In a hygienic way, treat your hands, dry them.

Ask the patient how he is feeling.

Make a record of the results in the medical records.

Care algorithm for a vascular catheter (peripheral) - dressing change

Preparatory stage

You should identify the patient, introduce yourself to him, explain the purpose and course of the procedure to be performed. Written consent is not required.

Voluntary informed consent is required for the procedure. If not available, ask your doctor about what to do next.

First, put on a mask and a medical cap. Deliver the manipulation table to the ward, having prepared everything you need.

Assist the patient in a comfortable position to access the insertion site of the peripheral venous catheter.

Remove clothing from the area where the catheter is placed.

Hygienically treat hands.

Treat hands with an antiseptic, do not dry, waiting for the antiseptic to dry.

Then put on sterile gloves.

Progress

Inspect the site of entry of the catheter into the skin through an intact dressing for signs of possible inflammation (swelling, soreness).

If signs of inflammation are found, call a doctor.

During the procedure with a catheter in a peripheral vein, the patient can sit or lie on his back.

The arm, in the vein of which the catheter is located, should be located along the body.

If the catheter is located in the cubital or in the vein of the forearm - palm up, if in the veins of the hand - palm down. Removing the plug does not affect the breathing phase.

During the procedure with a catheter in the femoral vein, the foot end of the bed is lowered by 25 degrees.

The removal of the plug is not related to the phase of breathing.

You need to remove the bandage. To prevent the occurrence of damage to the skin around the site of entry of the catheter into the skin, do not pull it up, but slowly wrap it parallel to the skin in the direction of hair growth.

Put the bandage in a waterproof bag or container.

Take off the used gloves and put them in the same place.

Do not treat gloves with an antiseptic, which will violate their barrier properties.

Determine that the catheter is not displaced by the mark.

Treat the skin around the catheter with an antiseptic: with a sterile gauze ball from the center to the periphery using sterile tweezers.

Use a sterile gauze spatula to treat all connections, including the cannula, and the catheter itself.

Put a sterile diaper on the skin around the catheter.

Wait for the antiseptic to dry completely.

Apply a sterile dressing, fixing it with a bactericidal plaster (sterile plaster or self-adhesive sterile dressing).

When using a sterile special transparent bandage, it is necessary to make sure that the catheter entry point into the skin is in the center of the transparent window to control the catheter entry point into the skin.

If necessary, secure the catheter lines. When changing dressings in patients with sensitive skin, it is recommended to apply a sterile barrier agent to protect the skin and wait for it to dry completely.

The choice of dressing must be carried out taking into account individual characteristics.

If the child is older than two months and there are factors predisposing to the development of infection (the duration of CVC standing for more than three days; immunity is reduced (in case of oncological diseases), the risk of colonization of the catheter is increased), it is recommended to choose a transparent polyurethane dressing containing a gel pad with chlorhexidine.

For other cases, the usual transparent polyurethane bandage is optimal.

If bleeding is observed around the catheter entry site on the first day after its introduction, it is permissible to use a non-woven bandage with an absorbent pad, which should be replaced with a transparent polyurethane after 24 hours.

Replace transparent dressings with CVC every 5-7 days (if the fixation is not broken, the vision is preserved and there is no discharge).

I replace transparent polyurethane dressings with PVK every 3–4 days (if the fixation is not broken, the view is preserved and there is no discharge).

With CVC, the setting of a “heparin lock” of the catheter is carried out 1 time per day (morning/evening) and in the absence of infusion.

When infused during the day or several injections of drugs, before and after blood sampling, 5–10 ml of a 0.9% sodium chloride solution without a “heparin lock” is used.

If PVC is not used 2 times a day (morning/evening), PVC should be washed before and after drug administration.

At least once a day, it is necessary to conduct a visual inspection of the installation site of the vascular catheter.

As a result of flushing the catheter and, if necessary, setting a "heparin lock", it should be passable. After the bandage is changed, irritation and inflammation should not be observed under the bandage.

Final stage

To prevent purulent complications, you should follow the rules of asepsis and antisepsis, at least 1 time in 3 days, if necessary more often, change the fixing bandage with the treatment of the puncture hole and the skin around it with an antiseptic; wrap a sterile napkin around the junction of the catheter with the system for intravenous drip infusions, and after infusion - the free end of the catheter. Repeated contact with the element of the infusion system should be avoided, access to it should be minimized. Carry out a change of infusion systems for intravenous infusion of solutions, antibiotics daily, replacement of tees and conductors - once every two days (for patients with a cytopenic state - daily). The use of a sterile fixing bandage provides protection against infection from the outer surface of the catheter.

In order to prevent thrombosis of the catheter by a blood clot, it is preferable to use catheters with an anticoagulant coating. If the catheter is thrombosed, it is unacceptable to flush it to remove the thrombus.

To prevent bleeding from the catheter, the plug should be tightly closed, tightly fixed with a gauze cap, and the position of the plug should be constantly monitored.

In order to prevent air embolism, it is necessary to use catheters with a lumen diameter of less than 1 mm. Manipulations, which are accompanied by disconnection and attachment of syringes (droppers), are preferably carried out on exhalation, pre-blocking the catheter with a special plastic clamp, and if there is a tee, blocking its corresponding channel. Before connecting a new line, make sure it is completely filled with mortar. It is preferable to use small highways (the probability of an air embolism decreases).

To prevent spontaneous removal and migration, use only standard catheters with needle pavilions, fix the catheter with adhesive tape (a special fixing bandage). Before infusion, check the position of the catheter in the vein with a syringe. Do not use scissors to remove the adhesive tape, as the catheter may be accidentally cut off and migrate into the circulatory system.

Workplace equipment: 1) a bottle with a filled system for intravenous drip infusions of a single use, a tripod; 2) a bottle with heparin with a volume of 5 ml with an activity of 1 ml - 5000 IU, an ampoule (bottle) with a solution of sodium chloride 0.9% - 100 ml; 3) syringes with a capacity of 5 ml, single-use injection needles; 4) sterile catheter plugs; 5) sterile material (cotton balls, gauze triangles, napkins, diapers) in biks or packages; 6) tray for sterile material; 7) tray for used material; 8) caps in the package; 9) sterile tweezers; 10) tweezers in a disinfectant solution; 11) file, scissors; 12) a container-dispenser with an antiseptic agent for treating the skin of patients and the hands of staff; 13) a container with a disinfectant for processing ampoules and other injectable dosage forms; 14) plaster (regular or Tegoderm type) or other fixative bandage; 15) mask, medical gloves (single use), waterproof decontaminated apron, goggles (plastic screen); 16) tweezers for working with used tools; 17) containers with a disinfectant for disinfecting surfaces, washing used needles, syringes (systems), soaking used syringes (systems), soaking used needles, disinfecting cotton balls, gauze wipes, used rags; 18) clean rags; 19) tool table.

4. Put on an apron, mask, gloves.

5. Treat the surface of the manipulation table, tray, apron, bix with a disinfectant solution. Wash gloved hands with soap and running water, dry.

6. Put the necessary equipment on the tool table.

7. Cover the sterile tray, putting everything you need on it. There is another option for working with sterile material when it is in packages.

The main stage of the manipulation. Connecting the infusion system to the CVC. 8. Treat the vial with isotonic sodium chloride solution.

9. Draw 1 ml of solution into one syringe, 5 ml into the other.

11. Clamp the catheter with a plastic clamp. Clamping the catheter prevents bleeding from the vessel and air embolism.

12. Remove the "old" pear-shaped bandage from the catheter cannula.

13. Treat the catheter cannula and plug with an antiseptic, keeping the end of the catheter suspended at a certain distance from the cannula.

14. Put the treated part of the catheter on a sterile diaper, placing it on the baby's chest.

15. Treat gloved hands with an antiseptic.

16. Remove the cork from the cannula and discard. If there are no additional sterile plugs, then put it in an individual container with alcohol(used once).

17. Attach the syringe with sodium chloride solution 0.9%, open the clamp on the catheter, remove the contents of the catheter.

18. Using another syringe, flush the catheter in an amount of 5-10 ml.

To avoid air embolism and bleeding, it is necessary to pinch the catheter with a plastic clamp each time before disconnecting the syringe, system, plug from it.

19. Attach the system for intravenous drip infusion to the cannula of the jet-to-jet catheter.

20. Adjust the rate of introduction of drops.

21. Wrap a sterile cloth around the junction of the catheter with the system.

Disconnecting the infusion set from the CVC. Heparin "lock". 22. Check the stickers on the bottles with heparin and sodium chloride solution 0.9%(name of the drug, quantity, concentration).

23. Prepare vials for manipulation.

24. Draw 1 ml of heparin into the syringe. Introduce 1 ml of heparin into a vial with a solution of sodium chloride 0.9% (100 ml).

25. Draw 2 - 3 ml of the resulting solution into a syringe.

26. Close the dropper, pinch the catheter with a plastic clamp.

27. Remove the gauze covering the joint between the catheter cannula and the system cannula. Transfer the catheter to another sterile napkin (diaper) or to the inner surface of any sterile package.

28. Treat your hands with an antiseptic solution.

29. Disconnect the dropper and attach a syringe with diluted heparin to the cannula, remove the clamp and inject 1.5 ml of the solution into the catheter.

30. Clamp the catheter with a plastic clamp, disconnect the syringe.

31. Process the catheter cannula ethyl alcohol, to remove traces of blood, another protein preparation, glucose from its surface.

32. Put a sterile cork on a sterile napkin with sterile tweezers and close the catheter cannula with it.

33. Wrap the catheter cannula with sterile gauze and secure with a rubber band or adhesive tape.

Changing the bandage that fixes the CVC. 34. Remove the old fixing bandage.

35. Treat gloved hands with an antiseptic solution (put on sterile gloves).

36. Treat the skin around the catheter insertion site first 70% alcohol, then antiseptic iodobac (betadine etc.) in the direction from the center to the periphery.

37. Cover with a sterile napkin, withstand exposure for 3-5 minutes.

38. Dry with a sterile cloth.

39. Apply a sterile dressing to the catheter entry site.

40. Fix the bandage with a Tegoderm plaster (Mefix, etc.), completely covering the sterile material.

41. Indicate on the top layer of the patch the date of applying the bandage.

Note. If an inflammatory process occurs around the site of catheter insertion (redness, induration), after consultation with the attending physician, it is advisable to use ointments (betadine, seen, ointment with antibiotics). In this case, the dressing is changed daily, and on the patch, in addition to the date, it is indicated - "ointment".

42. Disinfect used medical instruments, catheters, infusion systems, apron in appropriate containers with a disinfectant solution. Treat work surfaces with a disinfectant solution. Remove gloves and decontaminate them. Wash hands under running water with soap, dry, treat with cream.

43. Provide a protective regime for the child.

44. Make an entry in the medical records indicating the date, time of infusion, the solution used, its amount.

Possible complications: 1) purulent complications (suppuration of the puncture canal, thrombophlebitis, phlegmon, sepsis); 2) thrombosis of the catheter with a blood clot; 3) bleeding from the catheter; 4) air embolism, thromboembolism; 5) spontaneous removal and migration of the catheter; 6) sclerosis of the central vein in case of frequent change of the catheter; 7) infiltration; 8) an allergic reaction to drugs, etc.

PUNCTION AND CATHETERIZATION OF PERIPHERAL VEINS

General information. The use of a peripheral venous catheter (PVC) enables long-term infusion therapy, makes the catheterization procedure painless, and reduces the frequency of psychological trauma associated with numerous punctures of peripheral veins. The catheter can be inserted into the superficial veins of the head, upper and lower extremities.

The duration of operation of one catheter is 3-4 days. For patients receiving long-term treatment, it is advisable to start venous catheterization with a peripheral catheter from the veins of the hand or foot. In this case, during their obliteration, the possibility of using higher-lying veins remains. When operating a peripheral venous catheter, the rules of asepsis and antisepsis should be strictly observed. Thoroughly clean the connection points of the catheter with the system for intravenous drip infusions, connector, cork from blood residues, cover with a sterile napkin. Monitor the condition of the vein and skin in the puncture area. To prevent bleeding from the catheter, air embolism, firmly fix the plug on the catheter cannula, press the vein to the top of the catheter each time before removing the plug, turning off the system, syringe. If a connector (wire) with a tee is attached to the catheter, block the corresponding channel of the tee. To avoid thrombosis of the catheter with a blood clot, the catheter temporarily not used for infusion must be filled with a heparin solution (see paragraphs 20-31 “Care of the central venous catheter”). To prevent external migration of the catheter with the formation of a subcutaneous hematoma and (and) paravasal administration of a medicinal substance, constantly monitor the reliability of fixation of the catheter, check its position in the vein with a syringe. When placing a catheter in the joint area, use a splint.

Workplace equipment: 1) a bottle (ampoule) with a solution of sodium chloride 0.9%; 2) peripheral venous catheter, plugs for the catheter; 3) syringes with a capacity of 5 ml, single-use injection needles; 4) sterile material (cotton balls, gauze wipes, diapers) in bixes or packages; 5) tray for sterile material; 6) tray for used material; 7) hoes in packages; 8) sterile tweezers; 9) tweezers in a disinfectant solution; 10) nail file, scissors; 11) tourniquet; 12) a container-dispenser with an antiseptic agent for treating the skin of patients and the hands of staff; 13) a container with a disinfectant solution for processing ampoules and other injectable dosage forms; 14) plaster (regular or Tegoderm type) or other fixative bandage; 15) mask, medical gloves (single use), waterproof apron, goggles (plastic screen); 16) tool table; 17) tweezers for working with used tools; 18) containers with a disinfectant for disinfecting surfaces, washing used syringes (systems), soaking used syringes (systems), soaking used needles, disinfecting cotton and gauze balls, used rags; 19) clean rags.

Preparatory stage of the manipulation. 1.Inform the patient (close relatives) about the need to perform and the essence of the procedure.

2. Obtain the consent of the patient (close relatives) to perform the procedure.

3. Wash hands with running water, lathering twice. Dry them with a disposable napkin (individual towel). Treat your hands with an antiseptic.

4. Put on an apron, mask, gloves.

5. Treat the surface of the manipulation table, tray, apron, bix with a disinfectant solution. Wash gloved hands with running water and soap, dry, treat with an antiseptic.

6. Put the necessary equipment on the tool table. Check the expiration dates, the integrity of the packages.

7. Cover the sterile tray, putting everything you need on it. There is another option for working with sterile material when it is in packages.

8. Treat the vial with sodium chloride solution 0.9%.

9. Draw 5 ml of the solution into the syringe.

10. Put on safety goggles (plastic shield).

The main stage of the manipulation. 11. Apply a tourniquet above the intended site of the catheter. In young children, it is better to use digital vein pressure (performed by a nurse assistant). 12. Treat the skin in the area of ​​the veins of the back of the hand or the inner surface of the child's forearm with an antiseptic agent (two balls, wide and narrow).

13. Treat hands with an antiseptic.

14. Take the catheter in your hand with three fingers and, pulling the skin in the vein area with the other hand, puncture it at an angle of 15-20.

15. When blood appears in the indicator chamber, slightly pull the needle while pushing the catheter into the vein.

16. Remove the tourniquet.

17. Press the vein to the top of the catheter (through the skin), remove the needle completely.

18. Connect a syringe with isotonic sodium chloride solution to the catheter, rinse the catheter with the solution.

19. In the same way, pressing the vein with one hand, disconnect the syringe with the other hand and close the catheter with a sterile stopper.

20. Clean the outer part of the catheter and the skin under it from traces of blood.

21. Fix the catheter with a plaster.

22. Wrap the cannula of the catheter with a sterile gauze, fix it with adhesive plaster, bandage it.

23. Transfer (transport) the child to the ward, connect the dropper (syringe pump). If intravenous infusions through a peripheral venous catheter will not be carried out in the near future, fill it with a solution of heparin (see paragraphs 22-33 "Care of the central venous catheter").

The final stage of the manipulation. 24. Disinfect used medical instruments, catheters, infusion systems, apron in appropriate containers with a disinfectant solution. Treat work surfaces with a disinfectant solution. Remove gloves and decontaminate them. Wash hands under running water with soap, dry, treat with cream.

25. Provide a protective regime for the child.

26. Make an entry in the medical records indicating the date, time of infusion, the solution used, its amount.

Possible Complications

Puncture of the veins of the calvarium

BUTTERFLY NEEDLE WITH CATHETER

General information. In young children, drugs can be injected into the superficial veins of the head. During the procedure, the child is fixed. His head is held by a nurse assistant, hands to the body and legs are fixed with a diaper (sheet). If there is hairline at the site of the intended puncture, the hair is shaved off.

Workplace equipment: 1) “butterfly” needle with a single-use catheter; 2) a bottle with a filled system for intravenous drip infusions of a single use, a tripod; 3) an ampoule (bottle) with a solution of sodium chloride 0.9%; 4) a single-use syringe with a volume of 5 ml, injection needles; 5) sterile material (cotton balls, gauze triangles, napkins, diapers) in packages or bixes; 6) tray for sterile material; 7) tray for used material; 8) caps in the package; 9) sterile tweezers; 10) tweezers in a disinfectant solution; 11) file, scissors; 12) a container-dispenser with an antiseptic agent for treating the skin of patients and the hands of staff; 13) a container with a disinfectant solution for processing ampoules and other injectable dosage forms; 14) plaster (regular or Tegoderm type) or other fixative bandage; 15) medical gloves (single use); mask, goggles (plastic screen), waterproof decontaminated apron; 16) tweezers for working with used tools; 17) containers with a disinfectant for treating surfaces, washing used needles, syringes (systems), soaking used syringes (systems), needles, disinfecting cotton balls and gauze wipes, used rags; 18) clean rags; 19) tool table.

Preparatory stage of the manipulation. 1.Inform the patient (close relatives) about the need to perform and the essence of the procedure.

2. Obtain the consent of the patient (close relatives) to perform the procedure.

3. Wash hands under running water, lathering twice. Dry hands with a disposable napkin (individual towel). Treat your hands with an antiseptic. Wear an apron, gloves, mask.

4. Treat the surface of the manipulation table, tray, apron, stand for the system with a disinfectant solution. Wash gloved hands under running water with soap, dry, treat with an antiseptic.

5. Put the necessary equipment on the tool table.

6. Cover the sterile tray.

7. Print the packages with the butterfly catheter, syringes, put them on the tray. There is another option for working with sterile material when it is in packages.

8. Treat the ampoule (vial) with sodium chloride solution 0.9%.

9. Draw 2 ml into the syringe connect to the catheter, fill it and put it on the tray.

10. Fix the child (performed by a nurse assistant). Put a sterile diaper next to the baby's head.

11. Put on safety goggles (plastic shield).

12. Select a vessel for puncture and treat the injection site with two balls with an antiseptic (one wide, the other narrow) in the direction from the parietal to the frontal region. For better blood supply to the vein, it is convenient to use a special elastic band applied around the head below the punctured area (above the eyebrows). Local digital vein clamping is ineffective due to the abundance of venous anastomoses of the cranial vault. The crying of the child also contributes to the swelling of the veins of the head.

13. Treat gloved hands with an antiseptic.

14. Stretch the skin in the area of ​​the proposed puncture to fix the vein.

15. Puncture a vein with a butterfly needle with a catheter in three stages . To do this, direct the needle along the blood flow at an acute angle to the surface of the skin and puncture it. Then advance the needle approximately 0.5 cm, pierce the vein and direct it along its course. If the needle is not in the vein, return it without removing it from under the skin and re-puncture the vein.

Insertion of a needle into a vessel immediately after skin puncture may result in puncture of both walls of the vessel.

16. Pull the plunger of the syringe connected to the catheter. The appearance of blood indicates the correct position of the needle. If an elastic band was used to increase blood supply to the vein, remove it.

17. Inject 1 - 1.5 ml sodium chloride solution 0.9%, to avoid thrombosis of the needle with a blood clot and to exclude the possibility of extravasal administration of the drug.

18. Fix the needle with three strips of adhesive tape: 1st - across the needle to the skin. 2nd - under the "wings" of the "butterfly" needle with a cross over them and fixation to the skin, 3rd - across the wings of the "butterfly" needle to the skin.

19. Roll up the catheter and fix it with adhesive tape on the scalp to prevent its displacement.

20. If necessary, if the angle of the needle with respect to the curve of the skull is large, place a gauze (cotton) ball under the cannula of the needle.

21. Pull the plunger of the syringe connected to the catheter to recheck the position of the needle in the vein.

22. Disconnect the syringe, connect the dropper on the solution jet.

23. Use the clamp to adjust the rate of drug administration.

24. Cover the junction of the cannulae of the catheter and dropper with a sterile gauze.

The final stage of the manipulation. 25. After completion of the infusion, clamp the dropper tube with a clamp. Carefully peel off the adhesive tape from the skin. Press the ball with an antiseptic into the place where the needle enters the vein. Remove the needle (catheter) along with the adhesive tape.

26. Apply a sterile napkin to the puncture site, a pressure bandage on top.

27. Disinfect used medical instruments, catheters, infusion systems, apron in appropriate containers with a disinfectant solution. Treat work surfaces with a disinfectant solution. Remove gloves and decontaminate them. Wash hands under running water with soap, dry, treat with cream.

28. Provide a protective regime for the child.

29. Make an entry in the medical records indicating the date, time of infusion, the solution used, its amount.

Possible Complications: 1) purulent complications (suppuration of the puncture channel, thrombophlebitis, phlegmon, sepsis); 2) thrombosis of the catheter with a blood clot; 3) bleeding from the catheter; 4) air embolism; 5) spontaneous removal and migration of the catheter; 6) vein sclerosis in case of frequent catheter change; 7) infiltration; 8) an allergic reaction to drugs, etc.

Appendix 5

to the Instructions for the execution technique

medical and diagnostic procedures and manipulations in the disciplines "Nursing in Pediatrics", "Pediatrics" in the specialties 2-79 01 31 "Nursing", 2-79 01 01 "General Medicine"

5. IMMUNOPROPHYLAXIS

General information. Preventive vaccinations are an effective means of combating childhood infectious diseases. The vaccination preparations used contribute to the development of immunity, immunity to a particular infection.

Vaccinations are carried out in specially equipped vaccination rooms of medical institutions, medical offices of schools and other educational institutions. The vaccination room should be equipped to provide emergency care. In order to avoid inactivation of vaccine preparations, a "cold chain" must be observed all the way from the manufacturing institute until the moment of vaccination.

Immediately before vaccination, the child should be examined by a doctor (paramedic). Without written permission to vaccinate, a nurse is not authorized to administer it. In the first 30-60 minutes after vaccination, the child should be under medical supervision in a clinic (school, preschool institution).

IMCCINATIONS

Workplace equipment: 1) vaccination preparations: vaccine against viral hepatitis B ("Angerix-B", Euvax-B, Eberbiovak NV, Shenvak-B, etc.), BCG, BCG-M, DTP, DTP-M, ADS, ADS-M, AD-M, OPV, IPV, ZhKV, ZHPV, "Rudivax", "Trimovax"; 2) solvents for BCG, ZhKV, ZHPV, Trimovax, Ruvaks vaccines; 3) single use syringes with a capacity of 1-2 ml, injection needles for subcutaneous and intramuscular injections; 4) tuberculin (insulin) syringes, injection needles for intradermal injections; 5) droppers for polio vaccine; 6) file; 7) tweezers in a disinfectant solution; 8) sterile material (cotton balls and gauze pads) in a package; 9) cold element with cells; 10) light-protective cone for vaccines BCG, ZhKV, "Trimovax"; 11) 70% ethyl alcohol or other antiseptic agent for disinfecting the patient's skin and personnel's hands (dispensing container); 12) a container with a disinfectant for processing ampoules (vials); 12) a tray for placing the inoculum on the instrument table; 13) a tray for used material (without live vaccine residues or traces of blood); 14) mask; 15) medical gloves (disposable or disinfected); 16) tweezers for working with used tools; 17) containers with disinfectants: a) for surface treatment, b) for washing and soaking used syringes and needles, c) for disinfecting used ampoules (vials) and cotton balls (napkins) with live vaccine residues, d) for disinfecting used rags ; 18) clean rags; 19) tool table.

Note. When working with the BCG vaccine (BCG-M), use disinfectant solutions of high activity.

Preparatory stage of the manipulation. 1.Inform the patient (close relatives) about the need to perform and the essence of the procedure.

2. Obtain the consent of the patient (close relatives) to perform the procedure.

3. Wash and dry your hands. Treat your hands with an antiseptic.

4. Put on gloves.

5. Treat the tray, instrument table, apron with a disinfectant solution. Wash and dry hands.

6. Place the tweezers in a container with a disinfectant solution on the top shelf of the instrument table, ethyl alcohol 70%, lay out sterile material in packages, single-use syringes and needles, when performing OPV vaccinations - a package of droppers; when working with BCG, ZhIV, Trimovax vaccines- a light-protective cone, a tray for placing grafting material, a file.

7. On the bottom shelf, place containers with a disinfectant solution, tweezers for removing needles, a tray for used material.

8. Remove from the refrigerator, disinfect with a disinfectant solution and place the cold element on the tray. Cover the cold element with a two-three-layer gauze napkin.

9. Check the availability of a written permission for vaccination and compliance with its acceptable deadlines.

10. Take out the appropriate vaccine preparation (if necessary, and solvent) from the refrigerator (refrigerator bag), check the presence of the label, expiration date, integrity of the ampoule (vial), appearance of the preparation (and solvent).

11. Install the grafting preparation in the cell of the cold element.

12. Ampoules (vials) with live vaccine (ZhKV, BCG, Trimovax) cover with a light shield.

13. Wash and dry your hands, treat with an antiseptic. Wear a mask when handling live vaccines.

IMPLEMENTING

AGAINST VIRAL HEPATITIS B

VACCINE "ANGERIX-B"

vaccination dose . The dose is for newborns and children under 10 years old - 10 mcg (0.5 ml), for older children and adults - 20 mcg (1 ml).

Method and place of administration. The vaccine is administered intramuscularly. Newborns and young children in the anterolateral region of the thigh, older children and adults - in the deltoid muscle.

Equipment of the workplace and the preparatory stage. P. 1 - 13 - see. Vaccinations.

The main stage of the manipulation. 14. Shake the vial with the vaccine until a homogeneous suspension is obtained.

15. Treat the metal cap of the bottle with a ball of alcohol, remove its central part, treat the rubber stopper with a second ball of alcohol, leave it on the bottle. Return vial to cold cell.

16. Open the syringe package, fix the needle on the cannula.

17. Draw the vaccine into the syringe: for newborns and children under 10 years old - 0.5 ml (10 mcg), for children over 10 years old - 1 ml (20 mcg).

18. Change the needle. Before changing the needle, use the plunger to draw the vaccine from the needle into the syringe.

19. Expel the air from the syringe. Throw the used ball into a container with a disinfectant solution. Treat your hands with an antiseptic.

20. Treat the skin of newborns and young children - the anterolateral surface of the thigh, for older children - the area of ​​​​the deltoid muscle with two balls with alcohol (wide and narrow).

21. Remove the cap from the needle and inject the vaccination dose of the vaccine intramuscularly.

22. Treat the skin after the injection with alcohol.

The final stage of the manipulation. 23. Rinse the used syringe and needle in the first container with a disinfectant solution and, removing the needle with tweezers, immerse it disassembled in the appropriate containers with the same solution.

24. Discard the used vial into the waste tray.

25. Treat gloved hands with an antiseptic solution, remove and disinfect gloves. Wash and dry hands, treat with cream if necessary.

26. Register the vaccination, and later information about the reaction to it in the relevant documents: in the maternity hospital - in the history of the development of the newborn (recording form No. 97 / y), exchange card (recording form No. 113 / y), preventive vaccination journal (recording form No. 64/y); in the clinic - in the preventive vaccination card (recording form No. 63 / y), in the history of the child's development (recording form No. 112 / y), in the register of preventive vaccinations (recording form No. 64 / y, Fig. 59); at school - in the individual card of the child (recording form No. 26 / y) and the journal (recording form No. 64 / y). At the same time, indicate the date of vaccination, dose, control number, batch number of the drug, manufacturer.

Possible vaccination reaction: 1) pain, erythema and hardening of soft tissues at the injection site in the first 5 days after the introduction of the vaccine.

Possible unusual reactions and complications: 1) fever; 2) joint pain, myalgia, headache; 3) nausea, vomiting, diarrhea; 4) lymphadenopathy; 5) isolated cases of anaphylactic shock; 6) phlegmon, abscess; 7) tissue infiltration and necrosis, hematoma, damage to the periosteum and joint.

IMPLEMENTING

AGAINST TUBERCULOSIS WITH BCG VACCINE (BCG-M)

vaccination dose. Makes 0.05 mg of BCG vaccine or 0.025 mg of BCG-M vaccine. The dry vaccine is diluted in saline: 0.1 ml per vaccination dose.

Method and place of administration. The vaccine is administered strictly intradermally at the border of the upper and middle thirds of the outer surface of the left shoulder.

Equipment of the workplace and preparatory stage, P. 1 - 13 - see. Vaccinations.

The main stage of the manipulation. 14. Remove two sterile balls from the kraft bag with tweezers, moisten them alcohol. Treat the neck of the ampoule with the vaccine with alcohol, file, re-treat with another ball, carefully squeezed out of alcohol (alcohol inactivates the vaccine).

15. Cover the filed end of the ampoule with a sterile gauze cap and open it. Throw the top of the ampoule with a gauze cap into a container with a disinfectant solution. Place the opened ampoule in the cell of the cold element. Cover with another gauze cap and light protection cone.

16. Treat the solvent ampoule with alcohol, file, re-process and open.

17. Open the package of the syringe with a capacity of 2 ml, fix the needle on the cannula. Draw solvent into the syringe. The amount of solvent should correspond to the number of doses of dry vaccine in the ampoule (for 20 doses - 2 ml of solvent, for 10 doses - 1 ml).

18. Remove the light-protective cone and gauze cap from the dry vaccine, slowly introduce the solvent, thoroughly washing off the particles of the sprayed vaccine from the walls of the ampoule. Mix the dissolved vaccine by reciprocating the plunger in the syringe. If the needle protrudes above the cut of the ampoule and can be hermetically connected to the tuberculin syringe, leave it in the ampoule. When using a tuberculin syringe with a cannula soldered to the needle cone, do not leave the needle in the vaccine.

19. Cover the ampoule with a sterile gauze cap and a light-protective cone.

20. Rinse the syringe and needle in containers with a disinfectant solution and immerse them disassembled in the appropriate containers with the same solution. Clean your hands with alcohol.

21. Treat with two cotton balls with alcohol skin of the outer surface of the left shoulder of the child (on the border of the upper and middle thirds).

The skin in the area of ​​the upcoming injection can be treated immediately before the administration of the drug, but in this case it is necessary to thoroughly blot the remaining alcohol on the skin with a sterile dry ball (napkin).

22. Fix the needle on the tuberculin (insulin) syringe to take the vaccine. Draw 0.2 ml of the vaccine into the syringe, after mixing the vaccine with reciprocating movements of the piston in the syringe (mycobacteria are absorbed on the walls of the ampoule). Move the piston to draw the vaccine from the needle into the syringe. Throw the used needle into a container with a disinfectant solution.

23. Close the ampoule with the vaccine with a gauze cloth and a light-protective cone.

24. Fix a thin short needle with a cap on the cannula of the syringe. Expel the air and excess vaccine from the syringe onto a cotton ball tightly pressed against the cannula of the needle.

25. Throw the used ball into a container with a disinfectant solution.

27. Treat your hands with an antiseptic.

28. Remove the cap from the needle and discard it in a container with a disinfectant solution.

29. Grasp the left shoulder of the child with your hand, pulling the skin of the previously treated area (the skin must be dry).

30. Direct the needle of the tuberculin syringe with the cut up into the surface layer of the skin and, making sure that it is in the intradermal position, press the cannula of the needle with your thumb. Inject 0.1 ml of vaccine .

With proper administration, a whitish papule with a diameter of about 8 mm is formed on the skin, usually disappearing after 15-20 minutes. Do not treat the injection site with alcohol or other antiseptic (alcohol will inactivate the vaccine).

The final stage of the manipulation. 31. Rinse the tuberculin syringe and needle in the first container with a disinfectant solution, remove the needle with tweezers (if it is not soldered), immerse the disassembled syringe and the needle in the appropriate containers with the same solution.

32. Discard the used ampoule of solvent into the waste tray. The ampoule with vaccine residues that are insufficient to vaccinate another child or that have expired should be thrown into a container with a disinfectant solution.

33. Treat gloved hands with an antiseptic solution, remove and disinfect gloves. Wash and dry hands, treat with cream if necessary.

34. Register the vaccination, and later information about the reaction to it in the relevant documents (see. item 26).

Graft reaction: 1) After 4-6 weeks (after revaccination 1-2 weeks) - spot, infiltrate, later vesicle (pustule), ulcer or without it, scar from 2 to 10 mm in diameter.

Possible complications: 1) increased local reaction (ulcer more than 10 mm); 2) regional lymphadenitis; 3) cold abscess; 4) keloid scar; 5) generalized BCG infection; 6) damage to the eyes, bones, the occurrence of lupus at the site of vaccination.

IMPLEMENTING

AGAINST whooping cough, diphtheria, tetanus

(AKDS, AKDS-M, ADS, ADS-M, AD-M)

vaccination dose . Makes 0.5 ml of vaccine or toxoid.

Method and site of administration . DTP vaccine injected intramuscularly into the anteroexternal area of ​​the thigh, toxoids - up to 6 years of age intramuscularly, then - subcutaneously into the subscapular region.

Equipment of the workplace and the preparatory stage of the manipulation. P. 1 - 13 - see. Vaccinations.

The main stage of the manipulation. 14. Shake the vial with the vaccine until a homogeneous suspension is obtained.

15. Process alcohol, file, reprocess and open the vaccine vial. If the vaccine is in a vial, treat the metal cap, remove its central part, treat the rubber stopper with a ball of alcohol, leave it on the vial.

16. Return the ampoule (vial) to the cell of the cold element.

17. Open the syringe package, fix the needle on the cannula.

18. Draw the vaccine into the syringe.

19. If one or more doses of the vaccine remain in the ampoule (vial), cover the ampoule or vial with a needle with a sterile gauze cap and return it to the cold element cell.

20. Change the needle on the syringe with the vaccine. Before changing the needle, use the plunger to draw the vaccine from the needle into the syringe.

21. Press a dry cotton ball to the cannula of the needle and, without removing the cap, expel the air from the syringe, leaving 0.5 ml of vaccine in it.

22. Discard the cotton ball in the waste tray. Clean your hands with alcohol or other antiseptic.

23. Treat the skin in the area of ​​the anterior outer surface of the thigh or the skin of the subscapular region with two balls with alcohol - when administered subcutaneously to schoolchildren ADS, ADS-M, AD-M-anatoxins.

24. Remove the cap from the needle and inject 0.5 ml of the vaccine AKDS, AKDS-M intramuscularly, ADS, ADS-M, AD-M schoolchildren - subcutaneously.

25. Treat the skin in the injection area with a ball of alcohol.

The final stage of the manipulation. 26. Rinse the used syringe and needle in the first container with a disinfectant solution and, removing the needle with tweezers, immerse it disassembled in the appropriate containers with the same solution.

27. Discard the ampoule (vial) with the remnants of the vaccine preparation, insufficient for vaccinating the next child, into the waste material tray.

28. Treat gloved hands with an antiseptic solution, remove and disinfect gloves. Wash and dry hands, treat with cream if necessary.

29. Register the vaccination, and later information about the reaction to it in the relevant documents (see. Vaccination against viral hepatitis B, item 26).

Graft reaction: 1) hyperemia of the skin, swelling of soft tissues up to 5 cm in diameter, no more than 2 cm infiltrate at the injection site; 2) short-term fever, weakness, headache in the first 2-3 days after the introduction of the vaccine

Possible complications: 1) edema and soft tissue infiltrate more than 8 cm in diameter, phlegmon, abscess; 2) excessively strong over 3 days of fever and intoxication; 3) encephalopathy, encephalitis; 4) anaphylactic shock; 5) asthmatic syndrome, croup; 6) neuritis of the brachial nerve; 7) damage to the periosteum and joint.

CARE OF YOUR CENTRAL VENOUS CATHETER (CVC)

Indications for the use of central veins: 1) the need for long-term infusion therapy; 2) the introduction of vasoactive and irritating peripheral veins of substances; 3) for rapid volumetric infusion of solutions; 4) carrying out hemosorption and plasmapheresis; 5) in the absence of venous access in the periphery; 6) monitor monitoring of pressure in the cavities of the heart; 7) rational, "without pain", blood sampling for analysis.

General information. Catheterization of the central vein is carried out by a doctor. The procedural nurse is responsible for preparing the workplace, preparing the patient for the procedure, helping the doctor put on sterile overalls, assisting him in performing catheterization. After the procedure, the child is placed on his back without a pillow with his head turned to the side (prevention of aspiration of vomit). He controls his drinking regimen: he is allowed to drink no earlier than 2 hours later, eat - 4 hours after catheterization. Conducts constant monitoring of blood pressure, heart rate, respiratory rate. Provides care for the central venous catheter.

How to care for your central venous catheter

To prevent purulent complications, you should follow the rules of asepsis and antisepsis, at least 1 time in 3 days, if necessary more often, change the fixing bandage with the treatment of the puncture hole and the skin around it with an antiseptic; wrap a sterile napkin around the junction of the catheter with the system for intravenous drip infusions, and after infusion - the free end of the catheter. Repeated contact with the element of the infusion system should be avoided, access to it should be minimized. Carry out a change of infusion systems for intravenous infusion of solutions, antibiotics daily, replacement of tees and conductors - once every two days (for patients with a cytopenic state - daily). The use of a sterile fixing bandage provides protection against infection from the outer surface of the catheter.

In order to prevent thrombosis of the catheter by a blood clot, it is preferable to use catheters with an anticoagulant coating. If the catheter is thrombosed, it is unacceptable to flush it to remove the thrombus.

To prevent bleeding from the catheter, the plug should be tightly closed, tightly fixed with a gauze cap, and the position of the plug should be constantly monitored.

In order to prevent air embolism, it is necessary to use catheters with a lumen diameter of less than 1 mm. Manipulations, which are accompanied by disconnection and attachment of syringes (droppers), are preferably carried out on exhalation, pre-blocking the catheter with a special plastic clamp, and if there is a tee, blocking its corresponding channel. Before connecting a new line, make sure it is completely filled with mortar. It is preferable to use small highways (the probability of an air embolism decreases).

To prevent spontaneous removal and migration, use only standard catheters with needle pavilions, fix the catheter with adhesive tape (a special fixing bandage). Before infusion, check the position of the catheter in the vein with a syringe. Do not use scissors to remove the adhesive tape, as the catheter may be accidentally cut off and migrate into the circulatory system.

Workplace equipment: 1) a bottle with a filled system for intravenous drip infusions of a single use, a tripod; 2) a bottle with heparin with a volume of 5 ml with an activity of 1 ml - 5000 IU, an ampoule (bottle) with a solution of sodium chloride 0.9% - 100 ml; 3) syringes with a capacity of 5 ml, single-use injection needles; 4) sterile catheter plugs; 5) sterile material (cotton balls, gauze triangles, napkins, diapers) in biks or packages; 6) tray for sterile material; 7) tray for used material; 8) caps in the package; 9) sterile tweezers; 10) tweezers in a disinfectant solution; 11) file, scissors; 12) a container-dispenser with an antiseptic agent for treating the skin of patients and the hands of staff; 13) a container with a disinfectant for processing ampoules and other injectable dosage forms; 14) plaster (regular or Tegoderm type) or other fixative bandage; 15) mask, medical gloves (single use), waterproof decontaminated apron, goggles (plastic screen); 16) tweezers for working with used tools; 17) containers with a disinfectant for disinfecting surfaces, washing used needles, syringes (systems), soaking used syringes (systems), soaking used needles, disinfecting cotton balls, gauze wipes, used rags; 18) clean rags; 19) tool table.

Preparatory stage of the manipulation. 1.

3. Wash hands with running water, lathering twice. Dry them with a disposable napkin (individual towel). Treat your hands with an antiseptic.

4. Put on an apron, mask, gloves.

5. Treat the surface of the manipulation table, tray, apron, bix with a disinfectant solution. Wash gloved hands with soap and running water, dry.

6. Put the necessary equipment on the tool table.

7. Cover the sterile tray, putting everything you need on it. There is another option for working with sterile material when it is in packages.

Connecting the infusion system to the CVC. 8. Treat the vial with isotonic sodium chloride solution.

9. Draw 1 ml of solution into one syringe, 5 ml into the other.

11. Clamp the catheter with a plastic clamp. Clamping the catheter prevents bleeding from the vessel and air embolism.

12. Remove the "old" pear-shaped bandage from the catheter cannula.

13. Treat the catheter cannula and plug with an antiseptic, keeping the end of the catheter suspended at a certain distance from the cannula.

14. Put the treated part of the catheter on a sterile diaper, placing it on the baby's chest.

15. Treat gloved hands with an antiseptic.

16. Remove the cork from the cannula and discard. If there are no additional sterile plugs, then put it in an individual container with alcohol(used once).

17. Attach the syringe with sodium chloride solution 0.9%, open the clamp on the catheter, remove the contents of the catheter.

18. Using another syringe, flush the catheter sodium chloride solution 0.9% in an amount of 5-10 ml.

To avoid air embolism and bleeding, it is necessary to pinch the catheter with a plastic clamp each time before disconnecting the syringe, system, plug from it.

19. Attach the system for intravenous drip infusion to the cannula of the jet-to-jet catheter.

20. Adjust the rate of introduction of drops.

21. Wrap a sterile cloth around the junction of the catheter with the system.

Disconnecting the infusion set from the CVC. Heparin "lock". 22. Check the stickers on the bottles with heparin and sodium chloride solution 0.9%(name of the drug, quantity, concentration).

23. Prepare vials for manipulation.

24. Draw 1 ml of heparin into the syringe. Introduce 1 ml of heparin into a vial with a solution of sodium chloride 0.9% (100 ml).

25. Draw 2 - 3 ml of the resulting solution into a syringe.

26. Close the dropper, pinch the catheter with a plastic clamp.

27. Remove the gauze covering the joint between the catheter cannula and the system cannula. Transfer the catheter to another sterile napkin (diaper) or to the inner surface of any sterile package.

28. Treat your hands with an antiseptic solution.

29. Disconnect the dropper and attach a syringe with diluted heparin to the cannula, remove the clamp and inject 1.5 ml of the solution into the catheter.

30. Clamp the catheter with a plastic clamp, disconnect the syringe.

31. Process the catheter cannula ethyl alcohol, to remove traces of blood, another protein preparation, glucose from its surface.

32. Put a sterile cork on a sterile napkin with sterile tweezers and close the catheter cannula with it.

33. Wrap the catheter cannula with sterile gauze and secure with a rubber band or adhesive tape.

Changing the bandage that fixes the CVC. 34. Remove the old fixing bandage.

35. Treat gloved hands with an antiseptic solution (put on sterile gloves).

36. Treat the skin around the catheter insertion site first 70% alcohol, then antiseptic iodobac (betadine etc.) in the direction from the center to the periphery.

37. Cover with a sterile napkin, withstand exposure for 3-5 minutes.

38. Dry with a sterile cloth.

39. Apply a sterile dressing to the catheter entry site.

40. Fix the bandage with a Tegoderm plaster (Mefix, etc.), completely covering the sterile material.

41. Indicate on the top layer of the patch the date of applying the bandage.

Note. If an inflammatory process occurs around the site of catheter insertion (redness, induration), after consultation with the attending physician, it is advisable to use ointments (betadine, seen, ointment with antibiotics). In this case, the dressing is changed daily, and on the patch, in addition to the date, it is indicated - "ointment".

42. Disinfect used medical instruments, catheters, infusion systems, apron in appropriate containers with a disinfectant solution. Treat work surfaces with a disinfectant solution. Remove gloves and decontaminate them. Wash hands under running water with soap, dry, treat with cream.

43. Provide a protective regime for the child.

44. Make an entry in the medical records indicating the date, time of infusion, the solution used, its amount.

Possible complications: 1) purulent complications (suppuration of the puncture canal, thrombophlebitis, phlegmon, sepsis); 2) thrombosis of the catheter with a blood clot; 3) bleeding from the catheter; 4) air embolism, thromboembolism; 5) spontaneous removal and migration of the catheter; 6) sclerosis of the central vein in case of frequent change of the catheter; 7) infiltration; 8) an allergic reaction to drugs, etc.

PUNCTION AND CATHETERIZATION OF PERIPHERAL VEINS

General information. The use of a peripheral venous catheter (PVC) enables long-term infusion therapy, makes the catheterization procedure painless, and reduces the frequency of psychological trauma associated with numerous punctures of peripheral veins. The catheter can be inserted into the superficial veins of the head, upper and lower extremities.

The duration of operation of one catheter is 3-4 days. For patients receiving long-term treatment, it is advisable to start venous catheterization with a peripheral catheter from the veins of the hand or foot. In this case, during their obliteration, the possibility of using higher-lying veins remains. When operating a peripheral venous catheter, the rules of asepsis and antisepsis should be strictly observed. Thoroughly clean the connection points of the catheter with the system for intravenous drip infusions, connector, cork from blood residues, cover with a sterile napkin. Monitor the condition of the vein and skin in the puncture area. To prevent bleeding from the catheter, air embolism, firmly fix the plug on the catheter cannula, press the vein to the top of the catheter each time before removing the plug, turning off the system, syringe. If a connector (wire) with a tee is attached to the catheter, block the corresponding channel of the tee. To avoid thrombosis of the catheter with a blood clot, the catheter temporarily not used for infusion must be filled with a heparin solution (see paragraphs 20-31 “Care of the central venous catheter”). To prevent external migration of the catheter with the formation of a subcutaneous hematoma and (and) paravasal administration of a medicinal substance, constantly monitor the reliability of fixation of the catheter, check its position in the vein with a syringe. When placing a catheter in the joint area, use a splint.

Workplace equipment: 1) a bottle (ampoule) with a solution of sodium chloride 0.9%; 2) peripheral venous catheter, plugs for the catheter; 3) syringes with a capacity of 5 ml, single-use injection needles; 4) sterile material (cotton balls, gauze wipes, diapers) in bixes or packages; 5) tray for sterile material; 6) tray for used material; 7) hoes in packages; 8) sterile tweezers; 9) tweezers in a disinfectant solution; 10) nail file, scissors; 11) tourniquet; 12) a container-dispenser with an antiseptic agent for treating the skin of patients and the hands of staff; 13) a container with a disinfectant solution for processing ampoules and other injectable dosage forms; 14) plaster (regular or Tegoderm type) or other fixative bandage; 15) mask, medical gloves (single use), waterproof apron, goggles (plastic screen); 16) tool table; 17) tweezers for working with used tools; 18) containers with a disinfectant for disinfecting surfaces, washing used syringes (systems), soaking used syringes (systems), soaking used needles, disinfecting cotton and gauze balls, used rags; 19) clean rags.

Preparatory stage of the manipulation. 1.Inform the patient (close relatives) about the need to perform and the essence of the procedure.

2. Obtain the consent of the patient (close relatives) to perform the procedure.

3. Wash hands with running water, lathering twice. Dry them with a disposable napkin (individual towel). Treat your hands with an antiseptic.

4. Put on an apron, mask, gloves.

5. Treat the surface of the manipulation table, tray, apron, bix with a disinfectant solution. Wash gloved hands with running water and soap, dry, treat with an antiseptic.

6. Put the necessary equipment on the tool table. Check the expiration dates, the integrity of the packages.

7. Cover the sterile tray, putting everything you need on it. There is another option for working with sterile material when it is in packages.

8. Treat the vial with sodium chloride solution 0.9%.

9. Draw 5 ml of the solution into the syringe.

10. Put on safety goggles (plastic shield).

The main stage of the manipulation. 11. Apply a tourniquet above the intended site of the catheter. In young children, it is better to use digital vein pressure (performed by a nurse assistant). 12. Treat the skin in the area of ​​the veins of the back of the hand or the inner surface of the child's forearm with an antiseptic agent (two balls, wide and narrow).

13. Treat hands with an antiseptic.

14. Take the catheter in your hand with three fingers and, pulling the skin in the vein area with the other hand, puncture it at an angle of 15-20.

15. When blood appears in the indicator chamber, slightly pull the needle while pushing the catheter into the vein.

16. Remove the tourniquet.

17. Press the vein to the top of the catheter (through the skin), remove the needle completely.

18. Connect a syringe with isotonic sodium chloride solution to the catheter, rinse the catheter with the solution.

19. In the same way, pressing the vein with one hand, disconnect the syringe with the other hand and close the catheter with a sterile stopper.

20. Clean the outer part of the catheter and the skin under it from traces of blood.

21. Fix the catheter with a plaster.

22. Wrap the cannula of the catheter with a sterile gauze, fix it with adhesive plaster, bandage it.

23. Transfer (transport) the child to the ward, connect the dropper (syringe pump). If intravenous infusions through a peripheral venous catheter will not be carried out in the near future, fill it with a solution of heparin (see paragraphs 22-33 "Care of the central venous catheter").

The final stage of the manipulation. 24. Disinfect used medical instruments, catheters, infusion systems, apron in appropriate containers with a disinfectant solution. Treat work surfaces with a disinfectant solution. Remove gloves and decontaminate them. Wash hands under running water with soap, dry, treat with cream.

25. Provide a protective regime for the child.

26. Make an entry in the medical records indicating the date, time of infusion, the solution used, its amount.

Possible Complications

Puncture of the veins of the calvarium

BUTTERFLY NEEDLE WITH CATHETER

General information. In young children, drugs can be injected into the superficial veins of the head. During the procedure, the child is fixed. His head is held by a nurse assistant, hands to the body and legs are fixed with a diaper (sheet). If there is hairline at the site of the intended puncture, the hair is shaved off.

Workplace equipment: 1) “butterfly” needle with a single-use catheter; 2) a bottle with a filled system for intravenous drip infusions of a single use, a tripod; 3) an ampoule (bottle) with a solution of sodium chloride 0.9%; 4) a single-use syringe with a volume of 5 ml, injection needles; 5) sterile material (cotton balls, gauze triangles, napkins, diapers) in packages or bixes; 6) tray for sterile material; 7) tray for used material; 8) caps in the package; 9) sterile tweezers; 10) tweezers in a disinfectant solution; 11) file, scissors; 12) a container-dispenser with an antiseptic agent for treating the skin of patients and the hands of staff; 13) a container with a disinfectant solution for processing ampoules and other injectable dosage forms; 14) plaster (regular or Tegoderm type) or other fixative bandage; 15) medical gloves (single use); mask, goggles (plastic screen), waterproof decontaminated apron; 16) tweezers for working with used tools; 17) containers with a disinfectant for treating surfaces, washing used needles, syringes (systems), soaking used syringes (systems), needles, disinfecting cotton balls and gauze wipes, used rags; 18) clean rags; 19) tool table.

Preparatory stage of the manipulation. 1.Inform the patient (close relatives) about the need to perform and the essence of the procedure.

2. Obtain the consent of the patient (close relatives) to perform the procedure.

3. Wash hands under running water, lathering twice. Dry hands with a disposable napkin (individual towel). Treat your hands with an antiseptic. Wear an apron, gloves, mask.

4. Treat the surface of the manipulation table, tray, apron, stand for the system with a disinfectant solution. Wash gloved hands under running water with soap, dry, treat with an antiseptic.

5. Put the necessary equipment on the tool table.

6. Cover the sterile tray.

7. Print the packages with the butterfly catheter, syringes, put them on the tray. There is another option for working with sterile material when it is in packages.

8. Treat the ampoule (vial) with sodium chloride solution 0.9%.

9. Draw 2 ml into the syringe connect to the catheter, fill it and put it on the tray.

10. Fix the child (performed by a nurse assistant). Put a sterile diaper next to the baby's head.

11. Put on safety goggles (plastic shield).

The main stage of the manipulation. 12. Select a vessel for puncture and treat the injection site with two balls with an antiseptic (one wide, the other narrow) in the direction from the parietal to the frontal region. For better blood supply to the vein, it is convenient to use a special elastic band applied around the head below the punctured area (above the eyebrows). Local digital vein clamping is ineffective due to the abundance of venous anastomoses of the cranial vault. The crying of the child also contributes to the swelling of the veins of the head.

13. Treat gloved hands with an antiseptic.

14. Stretch the skin in the area of ​​the proposed puncture to fix the vein.

15. Puncture a vein with a butterfly needle with a catheter in three stages . To do this, direct the needle along the blood flow at an acute angle to the surface of the skin and puncture it. Then advance the needle approximately 0.5 cm, pierce the vein and direct it along its course. If the needle is not in the vein, return it without removing it from under the skin and re-puncture the vein.

Insertion of a needle into a vessel immediately after skin puncture may result in puncture of both walls of the vessel.

16. Pull the plunger of the syringe connected to the catheter. The appearance of blood indicates the correct position of the needle. If an elastic band was used to increase blood supply to the vein, remove it.

17. Inject 1 - 1.5 ml sodium chloride solution 0.9%, to avoid thrombosis of the needle with a blood clot and to exclude the possibility of extravasal administration of the drug.

18. Fix the needle with three strips of adhesive tape: 1st - across the needle to the skin. 2nd - under the "wings" of the "butterfly" needle with a cross over them and fixation to the skin, 3rd - across the wings of the "butterfly" needle to the skin.

19. Roll up the catheter and fix it with adhesive tape on the scalp to prevent its displacement.

20. If necessary, if the angle of the needle with respect to the curve of the skull is large, place a gauze (cotton) ball under the cannula of the needle.

21. Pull the plunger of the syringe connected to the catheter to recheck the position of the needle in the vein.

22. Disconnect the syringe, connect the dropper on the solution jet.

23. Use the clamp to adjust the rate of drug administration.

24. Cover the junction of the cannulae of the catheter and dropper with a sterile gauze.

The final stage of the manipulation. 25. After completion of the infusion, clamp the dropper tube with a clamp. Carefully peel off the adhesive tape from the skin. Press the ball with an antiseptic into the place where the needle enters the vein. Remove the needle (catheter) along with the adhesive tape.

26. Apply a sterile napkin to the puncture site, a pressure bandage on top.

27. Disinfect used medical instruments, catheters, infusion systems, apron in appropriate containers with a disinfectant solution. Treat work surfaces with a disinfectant solution. Remove gloves and decontaminate them. Wash hands under running water with soap, dry, treat with cream.

28. Provide a protective regime for the child.

29. Make an entry in the medical records indicating the date, time of infusion, the solution used, its amount.

Possible Complications: 1) purulent complications (suppuration of the puncture channel, thrombophlebitis, phlegmon, sepsis); 2) thrombosis of the catheter with a blood clot; 3) bleeding from the catheter; 4) air embolism; 5) spontaneous removal and migration of the catheter; 6) vein sclerosis in case of frequent catheter change; 7) infiltration; 8) an allergic reaction to drugs, etc.

Appendix 5

to the Instructions for the execution technique

medical and diagnostic procedures and manipulations in the disciplines "Nursing in Pediatrics", "Pediatrics" in the specialties 2-79 01 31 "Nursing", 2-79 01 01 "General Medicine"