Heparin lock technique. We do not have an easy job - we need to make an injection internally! We will be glad to your food and advice

Preparation of the surgical field (for all types of catheters)

Treat the catheter with tampons with alcohol (3 times), and then with povidone-iodine (3 times), following the following rules:

Touch the circular ruffles from the center to the periphery, but do not turn the swab into the already shaved area.

Vikoristani tampons wikidayut. Use special tampons to unify your hands.

Do not whitewash the excess PVPYoda, but let it dry. Vologiy povidone-iodine is not bactericidal.

Apply PVPyoda ointment on the site of the catheter.

Apply a gauze bandage or a sterile adhesive sticker. The gauze bandage changes every other day (if it gets wet, then more often). Prozor sticker changes 1-3 times a day. With neutropenia, dressings should be worn more often.

Keeping an eye on the catheter pavilion

Timchasovі TsVK
Irrigate the catheter pavilion with povidone-iodine 30 seconds before opening.

post_yni CVC
Treat the pavilion with alcohol (3 times), then povidone-iodine (3 times). Please enter the port. The pavilion of the catheter is often the gate of the catheter infection.

Keeping an eye on the pavilion of the Central Exhibition Complex

The processing of the pavilion is guilty of being carried out before the skin examination. In the first place, there will be nobility of the cowboy from the Central Exhibition Complex, replacing the coworker and the infusion systems, or the last.

Keeping an eye on the pavilion of the post catheter(Tunnel catheter, through the central catheter and the pediatric infusion port).

Prepare:

Swabs with alcohol (3).

Tamponi with povidone-iodine (3).

Servetki with alcohol (2).

Zatiskachі for the CVC, as the stench comes out on the catheter itself.

Leukoplastyr 5 cm wide.

As much as possible contact with blood or other visions, put on clean non-sterile gloves and know the plasters from the moment of giving the pavilion of the CVC with a small bag or the internal infusion system.

To clean up the area near the start of the day with circular motions from the center to the periphery. Spoon the tampon with some sprinkle with alcohol, and then with povidone-iodine. The radius of the blasted surface should be 5 cm. Press the CVC.

Obernіt offense to children with servetki with alcohol, then let’s find a pack or infusion system. Proceed with priming the catheter with servetka with alcohol, replace the catheter with an infusion system, fill up a shelter for further treatment and flush the catheter with heparin.

Give a small pack for the infusion system and clean it quickly with a plaster.

Keeping an eye on the pavilion of the tim-clock catheter(One-, two- and three-lumen catheters, Cordis, Swan Ganz, arterial catheters). Treat the complete coupling with povidone-iodine for 30 seconds.

Keeping an eye on the port

Before the vicars, clean the port for 30 seconds with povidone-iodine.

Keeping an eye on the Central Exhibition Complex

The processing of the port of the Central Exhibition Complex is guilty before the skin entrance to the ін'єкційный port at the Central Exhibition Complex, or at the time of installation from the Central Exhibition Complex of the infusion system. To the ін'єкцій ports the following shall be carried out:

Kovpachki for ін'єкцій.

Buretrolnye ін'єкційні portti (call in at PP, do not be vicious).

Ін'єкційні ports on the іnfusion systems, from the Central Exhibition Complex.

Keeping an eye on the port of the permanent CVK(Tunnel catheter, through central catheter, pediatric infusion port).
Wipe your hands carefully. If possible contact with blood or other visions, wear clean, non-sterile gloves. Infiltrate the onslaught port for 30 seconds with povidone-iodine.

Replacement of the infusion system

All systems for internal infusions are responsible for skin changes for 72 years. Vignette є recycle system parenteral feeding(Amino acid sums, solutions of glucose and fatty emulsions), as well as a day.

Portable device for introducing leads and adjustments for patient-controlled analgesia (infusion tubes change at once with cassettes).

Zatiskachі, U-shaped adapters and subjugular tubes went together with the infusion systems.

Principles to look at the CVK

All procedures for looking after the CVC are directed to the protection of infectious and mechanical expeditions. The principles of asepsis are guilty of taking care of all manual manipulations with the catheter and attached to the new lines.

Whenever there are any manipulations from the Central Exhibition Complex, you can see the outside world.

In non-term situations, the rosetting of the catheter top is monitored radiographically until the ear is infused.

Kovpacs for bagatorazovyh are guilty of a change in pressure, if the catheter does not fit.

With transfusion, there is a great amount of blood regurgitation and thrombosis of the infusion system. For the prevention of tsikh accelerated vikoristovuyut pristіy, scho zapobіgaє zorotny strum.

Applied armbands on the CVC

Misce vikhodu TsVK maє buti covered with a bandage. Tse mozhe buti:

Sterile gauze with leukoplastir (zm_nuyut every other day).

The sticker is sterile (change 1-3 times per week).

Whatever kind of bandage is best suited for a sick person, you are a nurse. In a number of vipadk_v it is rotten to carry the stickers. Tse buvaє at p_vischen_pіdlivost_, sensitive shkіrі or leakage of line in the pathway of the catheter, as well as with neutropenia. Slid also vrahovuvati the thought of the ailing one.

In case of obrobtsі shkіri dezіnfіkuyuyuyu drugs in ailments can be discouraged in the area of ​​the CVC. If necessary, for the passage of the ailing drug, change.

After 2-3 hours after installing the catheters of Hikman, Brovik or Groshong, we are allowed to take a shower or a bath. When the soul is wet, the bandage is pulled out, the skin is covered according to the protocol, and a new sterile bandage is applied. If you need to take a shower earlier than the term, the catheter should be closed with a waterproof bandage.

Replacing the dressing at the CVK

When working on the surface, disinfect it with alcohol and thoroughly wipe your hands.

Prepare:

swabs with alcohol (3),

tampon with povidone-iodine (3),

ointment form PVPyoda,

dressing material - sterile gauze swabs with a size of 5 × 5 cm, leukoplastir and a sticker for the hole.

Turn the head of the sick person to the opposite side of the doctor and mark the old bandage. Reverse, why there is no reason for the child, when the catheter is not changed at the start of the trip.

To polish the point of the catheter outlet from the center to the periphery with circular rods. Spoon the tampon with some sprinkle with alcohol, and then with povidone-iodine. The diameter of the blasted surface should be close to 5 cm.

Apply a small amount of PVPyoda ointment (a speck of size about a pea) on the skin of the catheter.

Put on a bandage and fix the CVC, you will not change.

Recommendations for a glance behind through the insertion of central catheters

When the bandage is visible, pull the catheter towards the shoulder, and do not displace the catheter. In most cases for the fixation of the catheter, the patient should be given leukoplastyr. An alternative option is to fit the catheter to the shkiri. As soon as the leukoplastira is not shy, the skin is crumbled above / near them. Smuzhki plaster zmіnyuyut 1 time per week.

For the prevention of bleeding, or the establishment of a hematoma in the first 24 years, you can press on for the installation of a percutaneous central catheter. When the term ends, apply a gauze bandage or a sticker to the hole. It is difficult to cope with catheterization of vena or trauma for the prevention of phlebitis, apply an anti-aging compress (20 skin blemishes for 6 years in advance).

If the catheter is close to ailments, the catheter can be closed with a Kerlix® bandage at the point of entry of the catheter.

Procedure for rinsing catheters with heparin

Per hour post-infusion of catheter with heparin is not necessary.
Standard dose of heparin: 300 OD (3 ml, 100 OD / ml in the lumen of the catheter).
Children (grown up with a low wagon): Not more than 50 OD / kg wagi for dobu (but not for a one-time promotion).

To carry out the promotion of the CVC with heparin after the offensive indicators:

When the catheter is closed - skin is 24 years old (for a vignette of a childish catheter Arrow, it is 4-6 years to wash the skin).

In case of intravenous infusion (in case of intermittent administration of medications, abo ridin).

For taking blood from the CVC (which is necessary in the region).

Introduced through the periphery of the central catheter - a standard dose of 150 OD to heparin (1.5 ml to heparin at 100 OD / ml).

Pidshkirni infusion port. The standard dose for promising: 500 OD to heparin (5 ml to heparin at 100 OD / ml) + 5 ml of 0.9% sodium chloride.

CVC Groshong - 5 ml of 0.9% NaCl solution for washing.

Blood collection from CVC

You should take shelter from the CVC for the analysis of the throat system, you need to take 6 ml of blood before taking samples for the next day. At the laboratory directly, it was said: "The blood was taken from the ___________ catheter."

It is possible to take shelter at the CVC for bacteriological seeding. For the whole, you can vikoristovuvat first 6 ml of blood.

Taking blood from the CVC with a syringe

Please select the amount of blood required for transferring children. Prepare tubes and racks. Pick up clean, non-sterile gloves. Using a simple scheme, clean up the catheter sleeve and override all channels of the CVC. These canals, which do not go out of their way to collect blood, become covered with closed stretches of all the procedures.
UVAGA! The catheter is NOT thrombosed;

Bring a sterile syringe to the CVC. Know the zasiskach from the Central Exhibition Complex and collect 6 ml of blood for visualization (it’s not guilty but it’s turned). Press the CVC and get a new sterile syringe.

Know the crowd and get shelter for the preschool. Repeat the last two days, until all the necessary portions of blood are not removed. Use a new sterile syringe once again. In order to eliminate the necessary amount of blood, outlast the CVC. Until a single hour, you can turn the sick person into 6 ml of blood.

If necessary, rinse the CVC 3-5 ml of physiological solution (0.9% NaCl), and sometimes with heparin. Cover the CVC with a small bag or bring an infusion system for further infusion. Transfer the shelter from the sample tube.

Rejection of blood with a syringe through the іn'єktsіyny port:

Place sleeve # 20 up to the blood drawer.

Before the ear of the procedure, process the in-port port according to the protocol.

Technique for blood sampling with a vacutainer (vacuum attachment for blood sampling)

Check the amount of blood required for the day. Prepare a variety of tubes, racks, and a 7-ml tube with a worm on top. You can see the blood in the test tube, or the clot is sent to the blood bank.

Find the vacutainer with the Luer interceptor (don't know the gum kovpac on the headset inserted into the vacutainer). Remove clean, non-sterile gloves.

Revise the catheter pavilion according to the protocol.

Pin the infusion and block all channels of the CVC. Switch on the infusion system and know the small bag with the CVC lining for blood sampling.

Bring a vacutainer to the pavilion of the Central Exhibition Complex. Know the flow only from the channel for blood sampling and collect 7 ml into a test tube with a worm on top for visualization. Then bring the test tubes to the vacuayer for collecting blood for a pre-test (the analysis of the test is carried out from the rest of the blood). To remove the necessary amount of blood, survive the Central Exhibition Complex and find a vacutainer.

If necessary, wash the CVC with 3-5 ml of 0.9% NaCl solution, and then with heparin. Cover the CVC with a small bag or bring an infusion system for further infusion. Put the vacuum cleaner trim in the plastic box and fill it with alcohol. (Guilt is guilty, but it will be increased by alcohol coating).

Otrimannya blood with a vacutainer through a puncture of a kovpak for ін'єкцій:

Get head # 20 with a size of 2.5 cm or less to the luer adapter of the vasnik of the vacutainer.

To polish a small box for ін'єкцій under the protocol.

Revealing of pediatric infusion ports (Port-a-caths®)

For infusion through the infusion of infusions through the infusion of vikoristovuyu to go to Huber for the use of any continuous internal infusion or medication.

Spray the work surface with alcohol and wipe your hands thoroughly.

Prepare 3 tampons with alcohol, 3 tampons with povidone-iodine, 1 pair of sterile gloves, a 5 ml syringe with 0.9% NaCl solution (physiological solution), 1 Huber's head ("Gripper" is standard).
The grapper head is supplied complete with a subjugular tube. With Huber's standard gooseneck, push until the end of the jaw tube.

Palpate the membrane to the port.

Treat the skir above the port three times with alcohol, and then three times with povidone-iodine. Cut the skirting from the center of the port to the periphery with circular ruches once and for all. The blasted surface is guilty of folding approximately 10 cm in diameter. Crimson yourself with sterile gloves.

Bring a 5 ml syringe with a physiological opening from the Huber pod and flush the system. It is even more important to preserve the sterility of the head.

Place your fingers on the membrane of the port and insert the Huber head perpendicular to it. Slide the head through the port and the membrane until the head is pressed into the bottom of the port.



Introduce close to 3 ml of physiological solution into the port. Pull the syringe plunger on yourself to control the vortex blood flow. When a swelling appears near the head, it’s an hour to talk about those who have gone to port. See the goal and try again.

Introduce any differences and clamp the subjugular tube. View the syringe and connect to the infusion system. Now it is possible to fix the introduced solutions or medicines.

Huber’s head is guilty of changing the situation, as it is won’t be left in the port for a post-infusion. The bandage over the port can also be changed once a day.

You can put on a bagatorazovy іn'єktsіyny kovpachok on the podzhuvalnuyu tube, and the port can be victorious for the introduction of a number of medications. The port is cleaned up every day, and when there are dermal infusions. If you see Huber's goals, you need to follow these rules:

Rub the work surface with alcohol and wipe your hands thoroughly.

Prepare 1 pair of clean, non-sterile gloves. From a 10 ml syringe, draw up 500 OD heparin (5 ml heparin, 100 OD / ml) і 5 ml 0.9% NaCl.

Press the podzhuvalnuyu tube on the Huber's head, test the instant and see the infusion system.

Bring the syringe with heparin and physiological gap to the subjugular tube, note the jam, and if necessary, inject close to 8 ml of pressure into the port.



See Huber's head, giving a positive grip in the syringe. Squeeze the port with 2 fingers in one hour. Come in and allow reflux of blood into the port.

Keeping an eye on the Central Exhibition Complex in the home minds

If necessary, trivial preservation of the central venous access, ailments can be taken to the home from the CVC. It is not recommended to use vipisuvati ailments with time-clock catheters (for example, percutaneous Arrow ® and Cook ® catheters).

The ailing one needs to look closely behind the Central Exhibition Complex. Bazhano pochati navchannya minimum three days before the transfer of whiskey. In the IDEAL, the next step is to fix a message about the installation of the catheter. If illnesses cannot independently look after the catheter, it is necessary to find out a member of the family or other close people. Ailments і / anyway, if you look after him, you will find instructions from the onset of food:

Replace the dressing over the catheter.

Rinsing the catheter with heparin through the in-box.

Replacement of the in-house kovpachka.

Solution of by-beat problems and dispensary of caution.

3. Prepare a tray with dressing material and tweezers.

4. Prepare lіkarski zasobi for cleaning the shkіri near the catheter: alcohol 70 °, 1% of diamante greens.

5. Roz'yasniti to the patient of the sense of manipulation.

6. Roztashuvati of the patient to incriminate himself, in a hand for a new position.

7. Take the old bandage

8. It is important to take a look at the point of the catheter puncture and at the time of the embankment, hyperexia, and severe visions of the spik of 70 ° and 1% diamond green

9. Placement of sterile gauze "shtants" near the catheter.

10.Fix the catheter to shkiri with adhesive tape

11.Reset the dressing material in the department with a disinfectant solution.

12.Reset the gloves and gloves into the department with a disinfectant.

1. To prevent clogging of the catheter with a thrombus, when the infusion ends, or in the intervals between infusions (4 times per dose), it is necessary to insert the catheter with a 0.9% physiological break and set the "heparin lock".

Preparing the "heparin lock":

100 ml physiological+ 5000 OD to heparin (5000 OD - 1 ml.) - inject 2 - 3 ml.

2. When depressurizing the catheter plug, it is necessary to replace it.

Before tim, as vіdkriti, or close the catheter cap, you need to ask the ailing one to re-register.

3. If the catheter is damaged, it will be damaged!

Have a look behind the catheter at the central vein

1. Apron, eyepieces, mask, gum mittens.
2. Prepare on the oversupply table: leukoplast, knives, 5000 OD. heparin / 5% sodium citrate /, 100 ml 0.9% sodium chloride, 1% iodonate, 0.25% novokain, 70% alcohol. Store the system with an indifferent difference.
3. Prepare on a sterile table: a n / a catheter with a mandrel and a cork, iglusm with a plug, diameter 2 mm, sterile pouches, servetki, two syringes, two heads for intravenous injection, tweezers.

Cleaning of the catheter in the area of ​​catheter placement: cleaning of the catheter with the toilet of the catheter is about to be rocked every day, or in the world of obstruction. At her enter: the nobility of the old dressing / leukoplastira /, looking around and palpation in the area of ​​the catheter, filing the opening and the shkiri near the catheter with a swab, soaked alcohol, applying gauze "pins", dry with alcohol wipes, from the pads ...

Zmіna heparin "lock": the price of the introduction of heparin into the catheter in dilution 1:10, і 1: 100 with physiological solution ml. The heparin "lock" is protected from skin insertion into the catheter of lykarskoy speech, as well as the insertion of the catheter by means of heparin 3 times, as the catheter is functional (carried out dribbled through the new one). In case of absence of heparin, it is possible to vikoristovuvati 5% of sodium citrate.

Injection of drugs into the catheter:

1. Introduction lykarsky zasobiv, Іnfusії zdіysnyuyutsya only through the gum plug.

2. Before the introduction of the drug, the passage of the catheter is recalculated by pulling the syringe plunger on itself.

3. Connection of systems and carried out on vidihu.

4. After the end of the introduction of the leaks - the catheter was inserted with a physiological breakdown.

5. To carry out thrombosis prophylaxis in a catheter (heparin lock) and navkolnogo (graph є at the post of a medical nurse):

The gum plug is coated with 70% alcohol. From the syringe, draw 5-10 ml of heparinized solution (5000 OD. - 1 ml of heparin per 100 ml of isotonic sodium chloride) and injecting it through the puncture of the gum plug. With an important introduction, a lykarya viklikayut, a kind of blood clot, because K. Proshtovkhuvati is categorically hardened.

6. All drugs should be administered more frequently.

7. If the catheter is loose, there is a reason in the area of ​​the catheter insertion, if pain is evident, it is necessary to take care of the patient's health.

8. The catheter can be seen for the signs of the drug.

9. Apply aseptic dressings to the wound.

Heparin lock technique

Methods of vikonannya heparin lock in children:

1. Wash your hands and put on your mittens.

2. Prepare the system for the internal introduction of the catheter and the antiseptic solution.

3. Connect the internal introduction and exit the system from the pavilion of the head or the catheter, which has been removed in the opening.

4. Close the pavilion of the catheter with a sterile stopper or a T-shaped adapter [for example, a stopper for Argyll infusion (Consolidated Medical Equipment, Utica, NY, USA; Sherwood Medical Co., St. Louis, MO, USA) or an interlocking port Burron Medical, Bethlehem, PA, USA), as well as not providing the necessary amount of heparinized physiological diagnosis].

Alternatively, a locking tap with two non-flammable heads can be used as an alternative. However, for the production of all parts of the shut-off faucet, it is necessary, as a minimum, 3 ml size for the production, so that it is possible to change the amount of time in prematurity with a low weight of body.

5. The crusts are coated with an antiseptic and inject 0.4-0.8 ml of heparinized physiological growth through the plug, which is vimivable from the head of the catheter.

6. Before dermal vikoristannyam the cork is sprinkled with an antiseptic.

7. Repeat the heparin block after the additional heparinized line for the treatment of skin infusion. (Routine production of skin for 6-12 years in the presence of the frequency of registration.)

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Keeping an eye on the pidclavicular (venous) catheter

meta: Prevention of accelerated: malignant embolism, infarction of veni and shkiri in the place of catheter insertion.

show: an accessory catheter is inserted with the help of a trivial infusion therapy.

Equipment: sterile dressing material, sterile antiseptic, sterile syringe, heparin, izotonic rozchin.

in and- medical sister of the highest possible visibility. Having entered the patient with arterial bleeding from the middle third of the right gomilka. You will need to put on a blood-back jgut.

Applied jgut for arterial bleeding.

meta: timchasova zupinka bleeding.

show: arterial bleeding.

equipment: blood-spine jgut, servetka, papir, olivets, IPP, Cramer's splint.

The medical sister is a visitor to the new surgery. When the patient turns up, on the 3rd day I eat a boil on the liver. You need to bandage the wound.

meta: vividness from the wound, prevention of secondary

іnfіkuvannya, setting the minds for the wounds.

show: the manifestation of a grievous wound.

equipment: ocular eyepieces, mask, glue apron, mittens,

antiseptic, sterile pincets - 3, bulbous probe, gum drainage.

sterile dressing material, antiseptic solutions, ointments,

hypertonic razchin, mnist with a disinfectant.

A nurse of a traumatological point is seen. A patient was delivered to you with a close fracture of the middle third of the right side of the file. It is necessary to carry out a political immobilization.

authorization panel

Even though you are not registered in the system, you can go through an easy restoration right at a time. If you enter a password, go through the procedure for updating the password to your account.

Peripheral venous catheter

Peripheral venous catheter Good venous access is the only moment of successful internal therapy.

CROC 1. Vibir punctuation

When choosing a catheterization, it is necessary to ensure that the patient is overhauled, ease of access to the point of contact and accessibility of the court for catheterization.

Peripheral venous cannulas are used for insertion only in peripheral veins. Vibor priorities for punctuation:

1. Dobre vizualizuyutsya veni with good rozvinenny kolaterals.
2. The day is not dominated by the side (for right-handers - lіva, for lіvshіv - right).
3. A collection of vicoristovuvati distal veins
4. Vikoristovuvati veni m'yakі і elastichnі on dotyk
5. Visiting the side of the protolezhnoy operative involvement.
6. View with the largest diameter.
7. The presence of a direct veni connection according to an additional generation of an additional genital cannula.

Most suitable for the installation of PVC veins and zones (the til side of the brush, the inner surface of the front).

Vvazhayutsya non-standard for cannulation of the onset of veni:

1. Vidnya lower kintzivok(Low fluidity of blood flow in the veins of the lower blood flow to produce thrombosis to the degree of failure).
2. Mіsja viginіv kіntsіvok (navkoloslobovyh areas).
3. Catheterize the veins earlier (you can use the inner wall of the judge).
4. Today, the retailers are close to the arteries (the possibility of carrying out the arteries).
5. Mid Likty Vienna (Vena mediana cubiti). The punctuation of this vein according to the protocols is permissible in 2 types - blood sampling for analysis, with the provision of extra help and rotations of the veins.
6. The day of the hollow of the upper hands
7. Days on kintsevki, on yaky were held surgical engagement or chemotherapy.
8. Weekend of the School of Cinema.
9. It is rotten to see the surface of the veins.
10. Tendin and sclerosis of veins.
11. Areas of lymphadenopathy.
12. Іnfіkovanі dіlyanka і dіlyanka shkіri shkіri.
13. Gliboko scho to lie veni.

PVC building throughput

Shvidke transfusion of great volumes of birth or blood preparations.

Transfusion of great relations of birth and blood preparations.

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

Patients on trivial internal therapy (2-3 years for doba).

Patients on trivial internal therapy, pediatrics, oncology.

Oncology, pediatrics, fine sclerosing veins.

CROC 2. Vibir type and size of the catheter

When vibrating the catheter, it is necessary to monitor the following criteria:

1. veni diameter;
2. the need for the speed of the introduced gap;
3. potential hour of catheter injection in vein;
4. the power of the difference, which is introduced;
5. the cannula is not at all responsible for occluding the vein.

The main principle of a catheter vibrator is to choose the one who chooses the most suitable size, so that it will not be necessary to introduce it into the most accessible peripheral veins.

All PVCs are distributed on a transfer (from the presence of an additional in-service port) and non-portability (without a port). Transferred PVC may have an additional in-line port for the introduction of drugs without additional puncture. In addition, it is possible to administer a bolus-free (re-administered) drug without re-infusion.

In every day, there are such basic elements, such as a catheter, a guide-guide, a plug and a storage box. For the help of the head, venesection is carried out, a catheter is inserted one hour. The plug is used to close the opening of the catheter, if the infusion therapy is not carried out (with the exception of contamination), the cap is used to secure the catheter and the catheter, and must be known before the manipulation. For easy insertion of the catheter (cannula) into the vein, the tip of the catheter can be drawn through the cone.

In addition, the catheter can be supervised with a supplementary element of the design - "kriltsi". With the help of the PVC, it is not only necessary to fix on the skirts, or to avoid a decrease in the risk of bacterial obstruction, since the stench does not allow direct contact between the back of the catheter plug and the shkiri.

CROC 3. Placement of a peripheral venous catheter

1. wipe your hands;
2. take a standard set for vena catheterization, including a set of catheters of different diameters;
3. invert the package and the term of the possession;
4. perekonayte, scho in front of you that ailment, which is designated venia catheterization;
5. make sure you have a good illumination, help your patients know how to do it;
6. to explain to the patient the essence of the procedure, create the atmosphere of doviri, give the opportunity to set food, and make sure that the patient passes through the place of insertion of the catheter;
7. Prepare a container in the easy-to-reach area for disposing of hospitality items;
8. clean your hands and dry them;
9. impose a jgut on the nose of the transfer zone and catheterization;
10. ask the patient to squeeze and print the fingers of the brush for filling the veins with blood;
11. vibrate the vein with a palpation path;
12. know jgut;
13. Take the most suitable catheter, with a look at: the size of the vein, the need for the speed of the introduction, the schedule of the internal therapy, the viscosity of the infusion;
14. re-clean your hands, use an antiseptic, and put on gloves;
15. impose jgut on the other side;
16. to treat the place of catheterization with an antiseptic in the course of a few seconds at all, let them hang on their own; Nepalputsya Vіden SUDDENLY;
17. fix the vein by squeezing your finger lower than the inserted catheter;
18. Take a catheter of an inverted diameter vicoristovuchi for all one of the options for storage (late or transverse) and the sign of the storage chokhol. If there is a dodatkov plug on the chokholi, do not wipe the chokhol, but trim it with the fingers of your hand;
19. perekonayte, scho the head of the PVK is located at the top position;
20. insert a catheter on the head from the bottom up to the temperature of 15 degrees, preventing the appearance of blood in the indicator chambers;
21. when there is blood in the indicator chambers, it is necessary to zupiniti farther away from the head;
22. Fix the stylet head, and blow the cannula up to the end from the head into the vein (you cannot see the stylet head from the catheter);
23. know jgut. DO NOT insert the head INTO THE CATHETER PISLYA SHIFT YOGO HOLDS AT VIDEN
24. to clamp the vein with a broach to reduce bleeding and to visually see the head from the catheter;
25. wikidate about the rules of safety;
26. in times, if the head is thrown, appeared, but the vein is ruined, it is necessary to replace the catheter from the surface of the shkiri, because of the control of the gap to remove the PVC (pull the catheter on the head), the procedure of installation and the whole time
27. know the plug from the chuck і close the catheter by inserting the heparin plug through the port or fit the infusion system;
28. fix the catheter to the start;
29. register the procedure for catheterization of the vein for the sake of the sacrifice;
30. look at the basis of the rules of safety technology and sanitary and epidemiological regime.

Standard kit for peripheral venous catheterization:

1. sterile tray
2. tray for smittya
3. heparinized syringe 10 ml (1: 100)
4. sterile cotton bags and servet
5. leukoplastir i / abo adhesive bandage
6. shkirny antiseptic
7. peripheral internal catheters of decalcous sizes
8. adapter i / for a tube supplied or an obturator
9. sterile gloves
10. knives
11. langeta
12. middle bandage
13. 3% solution to water peroxide

CROC 4. Visualization of a venous catheter

1. wipe your hands
2. pinch the infusion or know the bandage bandage (yaksho є)
3. clean your hands with an antiseptic and put on gloves
4. from the periphery to the center I see a bandage without a knife
5. Mostly and safely see the catheter from the vein
6. gently squeeze the catheterization site with a sterile gauze swab with 2-3 quilins
7. Apply a sterile bandage to the catheterization site, apply a sterile bandage to the catheterization site, press and fix it with a bandage. Don’t know the bandage and don’t wet the place of catheterization.
8. Invert the integrity of the catheter cannula. If there is a blood clot, or if a catheter is diagnosed, the tip of the cannula is drawn with sterile knives, put into a sterile test tube and sent to the bacteriological laboratory for further information (for the sign of the doctor)
9. Record in the documentation the hour, date and the reason for the catheter being seen
10. check in according to the rules of safety technology and sanitary and epidemiological regime

Kit for viewing a venous catheter

1. sterile gloves
2. sterile gauze pouches
3. leukoplastir
4. knives
5. shkirny antiseptic
6. tray for smittya
7. sterile test tube, knife and tray

CROC 5. Onset of venipuncture

If you want to know, you need to make a number of PVK performances, change them in conjunction with the end of the recommended term for transferring the PVK in Vienna, or for those who decide to speed up, read the recommendations for the vibrator of the function

1. A minimum of catheterization is recommended every hour.
2. Cutaneous onset venipuncture is carried out on the opposite hand or proximal (in the direction of the vein) in front of the anterior venipuncture.

CROC 6. A quick glance behind the catheter

1. Skin connection of the catheter is the gateway for the penetration of infections. Unique bagatoraz dots with your hands until you possess it. Do not forget about asepsis, use only sterile gloves.
2. Frequently remove the sterile plugs, do not use plugs, the inner surface of which may have been identified.
3. Immediately after the introduction of antibiotics, concentrated solutions of glucose, blood preparations, flush the catheter with a small amount of physiological size.
4. Follow the bandage and change it if necessary, about once every three days.
5. Check the spot regularly for early warning. If there is a swelling, ear, temperature changes, catheter leaks, weakness, and also in case of ailing symptoms when the drug is injected, inform the doctor and see the catheter.
6. When changing the Leukoplastyrna dressings, use knives to bore them. There is no safety problem for the catheter, but it is ready to use, which is used to draw the catheter into the circulatory system.
7. To prevent thrombophlebitis, apply thrombolytic ointments (for example, "Traumeel", "Heparinova", "Troxevasin") to the vein with a thin ball.
8. The catheter flushing is guilty before and after a skin session with heparinized infusion (5 ml of isotonic sodium chloride +2500 OD heparin) through the port.

Unimportant to those who catheterization of peripheral veins is not a safe procedure in the context of catheterization of central veins, it doesn’t have the potential to slow down, as if it were a procedure that would destroy the whole life of the school. Greater speed can be unique, the staff of the nursing manipulation technique, the suvorogo attention to the rules of asepsis and antiseptics and correct guess behind the catheter.

It is necessary to see more of these plugs, additional elements and "drops" before entering the PVVK, installation, in such a rank to get ahead of the good fortune in the infusion system. An important role is played by the overhaul of the sealing of the entire system. The risk of discernible embolism during peripheral cannulation is interconnected with a positive peripheral venous vise (3-5 mm water column). A negative grip in the peripheral veins can be established during the vibration of the installation of the PVK vische rivnya sertsya.

Hematoma, tied to the visible catheter

Press on the venipuncture point for the catheter

3-4 min. for the good news.

Hematoma, tied with the installation of PVC

It is necessary to ensure that the venipuncture procedure is adequately performed and the venipuncture procedure should not be punctured weakly contouring the vertebral cavity.

A slid of a unique venipuncture of the lower features, as well as the setting of the minimum possible diameter of the PVVC, so that it can be kept in the vessel of the catheter without interruption.

Slid vikoristovuvati aseptic technique of installation of PVVK, select the smallest possible size for reaching the communications necessary for internal therapy; it is necessary to fix a catheter for enlarging your vein; to prevent adequate recognition of licars and their introduction with a wide variety of services; carry out the replacement of the PVVK skin 48-72 years or earlier (in the number of minds) and along the side of the body for the installation of the catheter.

CROC 7. Keeping an eye on the central catheter

Punctuation of catheterization of the central vascular system - for the purpose of manipulation. It is possible to punctuate the clavicular vein, the jugular and the stegnova veins, like evil, and on the right. The central venous catheter can function and be uninfluenced by the baguch pressure. Tse reach by way of the suvorogo dotrimannya rules to look behind the catheter, including the attention to the rules of asepsis before the hour of the installation, come in when you see it.

In case of a trivial catheter in the PV, the following can be observed:

Thrombocytopenia and discomfort of embolism;

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

The very same catheterization of the central veins of the vimaginal spotting ruled to look after the catheter:

1. Before the use of manipulation, wipe your hands with a nice touch, hang and wash them with 70% alcohol, put on sterile gum mittens.

2. Shkіra near the catheter to look around and get covered with 70% alcohol and 2% iodine or 1% diamond green.

3. The dressing changes from day to time in the world of communication.

4. Before the ear of the infusion therapy, ask the sick person to breathe in and start the therapy. Remove the gum stopper, bring the syringe with 0.5 ml of physiological rose to the catheter, pull the plunger on yourself and move the syringe into the syringe with good blood. Bring the system for infusion to the catheter, allow the sick person to dyhati, adjust the frequency of the dribbles. Blood from the syringe into the tray.

5. For the end of the infusion therapy, it is necessary to put the heparin lock with the next rank:

Ask the sick person to breathe in and overturn the dichannya;

Muffle the catheter with a gum plug and allow the sick person to dyhati;

Introduce 5 ml of solution through the stopper, in front of the front with alcohol, inject 5 ml of solution: 2500 OD (0.5 ml) heparin + 4.5 ml of physiological solution;

Close the plug on the catheter with leukoplastir.

6. Regularly swivel the catheter with the same control, when setting the heparin lock in the onset of the fall:

Pislya injection of a drug through a catheter;

When blood appears in the catheter.

7. Zaboronyayutsya the straps of the catheter, applied to the catheter with non-transferring design of the plugs, drinking the power into the catheter.

8. In case of development of problems associated with the catheter: bіl, swelling of the hands, soaking the dressing with blood, exudate or infusional middle, increased temperature, evils of the catheter - it is innocently caused by the doctor.

9. The catheter is seen as a physician or physician of anesthesia service with the onset of a disease in the history of ailments.

10. Get out of the box with a catheter! In the case of a single direction to the establishment of ailments, he is guilty of being a supervised medical practitioner; In the vip report, be sure to ask for a message about the presence of a clavicle catheter in the patient.

V.L. GOLOVCHENKO, L. M. ROMANOVA

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Basic rules for looking after and keeping an eye on the catheter

The development of such a delay, such as a catheter failure, a paravenous insertion of a catheter, a catheter thrombosis, an embolism, a catheter escaping from a catheter and into a vein and in.

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Rules to look behind the central venous catheter

For the prevention of ginny slowing down the rules of asepsis and antiseptics, not earlier than 1 time in 3 days, if necessary, carry out a change of a fixed dressing from a complete puncture antiseptic opening on a small area; wrap the catheter with a system for internal drip infusion with a sterile servette, and if infusion is used, the catheter is closed. Slid a unique bagatoraz dots to the element of the infusion system, bring to the minimum access in the middle of the world. Carry out a change of infusion systems for internal infusion of rosters, antibiotics, and change of networks and providers - once every two days (for those who are sick with a cytopenic mill - a day). Making a sterile fixed dressing will protect you from penetration of infection on the surface of the catheter.

Using a blood clot to reduce the thrombosis of the catheter is more effective than the vicoristovuvati catheter with anticoagulant pokritty. If the catheter is clogged, it is unacceptable to remove it for a visible thrombus.

For the prevention of bleeding from the catheter, close the creek tightly, tightly with a gauze pad, and continuously control the stub.

In order to increase the degree of obstruction, it is necessary to insert a catheter with a diameter of less than 1 mm. Manipulations, which are supervised to see the given and attached syringes (drip-trays), draw more on the vidiha, in front of the catheter, twist the catheter with a special plastic seal, and if there is a junction of the twisting of the channels. Before the connection of the new magistralia, it was changed, but it was re-established. More importantly, small magistrals are victorious (change in the name of the community).

For the prevention of self-vision and migration, only standard catheters with pavilions for the heads, a catheter for an additional leukoplastyr (special fixed dressings) are used. Before the infusion, convert the catheter in the vein with a syringe. If you don’t use knives for visualization of leukoplastira, as a catheter can be inserted into the circulatory system.

The equipment of the working machine: 1) a bottle with a filled-in system for internal droplet infusion of a disposable storage device, a tripod; 2) a vial with heparin volume of 5 ml with activity in 1 ml - 5000 OD, ampoule (vial) with sodium chloride 0.9% solution - 100 ml; 3) a syringe of a 5 ml mixture, a single-use disposable cartridge; 4) sterile catheter plugs; 5) sterile material (cotton pouches, gauze knickers, servetki, pelushki) in boxes or packages; 6) tray for sterile material; 7) tray for vicious material; 8) pins in packing; 9) sterile tweezers; 10) tweezers in a disinfectant rosette; 11) file, knives; 12) A dispenser unit with an antiseptic system for cleaning of patients' and hands of personnel; 13) A collection of disinfectants for the processing of ampoules and those of the second likarsky inktsiy forms; 14) plaster (very special to the "Tegoderm" type) or іnsha yaka fіksuє bandage; 15) mask, medical gloves (disposable closure), waterproof apron, eyepiece closure (plastic screen); 16) tweezers for robots with tools; 17) Possibilities for disinfecting surfaces, cleaning vicious heads, syringes (systems), soaking vicious syringes (systems), soaking vicious heads, disinfecting waddy sacks, gauze; 18) pure ganchir'ya; 19) instrument table.

4. Put on an apron, mask, gloves.

5. Process the surface of the manipulative table, tray, apron, bix with a disinfectant rosette. Vimiti hands in mittens with running water and cute, dry.

6. Put the necessary equipment on the instrument table.

7. Put on a sterile tray; It is a mobile and one-of-a-kind version of the robot with sterile material, if it is in packages.

The main stage of the vikonannya manipulation. Connecting the infusion system to the Central Exhibition Complex. 8. Refill bottle z physiological solution to sodium chloride.

9. Draw 1 ml into one syringe, and 5 ml into one syringe.

11. Re-tighten the catheter with a plastic seal. Clamping the catheter before bleeding from the vessel and causing embolism.

12. Take the "old" pear-shaped dressing from the cannula of the catheter.

13. Rub the cannula of the catheter and the stopper with an antiseptic;

14. I put a piece of the catheter on a sterile pellet, spreading it out on the baby's breasts.

15. Treat your hands in mittens with an antiseptic method.

16. Take the cork from the cannula and vikinuti. If there are no additional sterile plugs, then we should pay attention to the individual with alcohol(Vikoristovua one-time).

17. Take the syringe z the range of sodium chloride 0.9%, vidkriti zatiskach on the catheter, fit in place of the catheter.

18.Vikoristovuchi іnshy syringe, promit the catheter in a bottle of 5-10 ml.

The catheter is skinned once before the time, like the syringe, the system, the plugs.

19. Take the system for internal drip infusion up to the cannula of the "strum in strum" catheter.

20. Adjust the speed of the introduced dribble.

21. Wrap the catheter with the system with a sterile servet.

Introduction of the infusion systems from the Central Exhibition Complex. Heparinovy ​​"lock". 22. Revision stickers on bottles heparinі sodium chloride solution 0.9%(Name of the drug, amount, concentration).

23. Pidgotuvati vials until the release of the manipulation.

24. Draw 1 ml of heparin into a syringe. Inject 1 ml of heparin into a bottle with sodium chloride 0.9% (100 ml).

25. Put 2 - 3 ml of the trimmed rosch in the syringe.

26. Cross the drip tray, overwrite the catheter with a plastic pad.

27. Take a gauze servette, yak around the stick of the cannula of the catheter with the cannula of the system. Reposition the catheter onto a sterile servette (pelushka), or on the inner surface of a sterile package.

28. Rub your hands with an antiseptic rose.

29. Finish the preparation with the droplet and bring the syringe with heparin diluted to the cannula, take the plug and insert the 1.5 ml rosette into the catheter.

30. tighten the catheter with a plastic seal, pull out the syringe.

31. Trim the cannula of the catheter alcohol etilovim, vidalyti from the surface of the blood, from the blood preparation, glucose.

32. On a sterile servet with a sterile forceps, a sterile plug and close the cannula of the catheter with it.

33. Wrap the catheter cannula with sterile gauze servet and seal with a gum ring or leukoplast.

A bandage wrap 34. Take a bandage.

35. Wrap your hands in mittens with antiseptic razchin (put on sterile mittens).

36. Tumble the catheter around the time of the inserted catheter with a tip of 70% alcohol, warm with an antiseptic iodobac (betadine ta in.) straight from the center to the periphery.

37. Cover with sterile servetka, vitrimati exhibition 3-5 min.

38. Dry with sterile servetka.

39. Place a sterile bandage on the catheter inlet.

40. Fasten the bandage with Tegoderm plaster (Mephix), I will increase the sterile material.

41. Put the date of the bandage application on the upper ball of the plaster.

Note. In the event of a firing process near the point of insertion of a catheter (pochvoninnya, impaired) for a consultation with a doctor, a thoroughly sucking ointments (Betadin, like bully witnesses, ointment z antibiotics). At the same time, the change of dressing is carried out every day, and on the plaster, in the case of a date, it is applied - "ointment".

Conclusions of the stage of the publication of manipulation. 42. Conduct disinfection of vicious medical instruments, catheters, infusion systems, apron in all containers with a disinfectant solution. Treat the working surfaces with a disinfecting rod. Take mittens і znezaraziti їх. Vimiti hands under running water with sweet, dry, sprinkle with cream.

43. Provide the protection regime of the child.

44. Conduct a record of the medical documentation from the date, the hour of infusion, the definition of the differences, the number of times.

Possible accelerated: 1) hypersensitive (suppuration of the puncture canal, thrombophlebitis, phlegmon, sepsis); 2) thrombosis of the catheter with a blood clot; 3) bleeding from the catheter; 4) disrupted embolism, thromboembolism; 5) smoother visualization and migration of the catheter; 6) sclerotherapy of the central vein in times of frequent changes in the catheter; 7) information; 8) allergic reaction to drug and drug.

PUNCTION I CATHETERIZATION OF PERIPHERAL VEINS

Country houses. Stagnation of a peripheral venous catheter (PVC) gives the possibility of trivial infusion therapy, to prevent the procedure of catheterization painless, reducing the frequency of psychological trauma associated with numerical punctures of peripheral veins. The catheter can be inserted into the surface veins of the head, upper and lower edges.

The triviality of the operation of one catheter is 3-4 days. We are sick, if we can get a trivial treatment, catheterization of the peripheral veins with a catheter, to repair the veins of the hand or the foot. At the same time, at the same time, there is a possibility of viciousness of larger veins. When using a peripheral venous catheter, follow strictly the rules of asepsis and antiseptics. Miscellaneous catheter installation with a system for internal drip infusion, a connector, a plug to reliably clean out of excess blood, fasten it with a sterile servet. Controlling the country of veni and shkiri in the area of ​​punctuation. To reduce bleeding from the catheter, tighten the plug on the cannula of the catheter, press the vein to the top of the catheter skin once before the cork, connected to the system, and the syringe. Just before the supply catheter, the connector (guide) with the drawer, recline the outlet canal of the drawer. If the catheter is thrombosed by a blood clot, it’s not necessary to use the catheter for the infusion catheter for an hour, you need to store the heparin (div. PP. "Look after the central venous catheter"). For the improvement of the catheter migration from the establishment of the pediatric hematoma or (i) paravasal introduction of the likar speech, the need for permanent control of the catheter fixation, reversal of the spine in the spine. When staging a catheter in the area of ​​\ u200b \ u200bthe slope, you should wear a splint.

Work equipment: 1) bottle (ampoule) with sodium chloride 0.9% solution; 2) peripheral venous catheter, catheter plugs; 3) a syringe of a 5 ml mixture, a single-use disposable cartridge; 4) sterile material (cotton bags, gauze servetki, pelushki) in boxes or packages; 5) tray for sterile material; 6) a tray for vicious material; 7) pins in bags; 8) sterile tweezers; 9) tweezers in a disinfecting rosette; 10) file, knives; 11) jgut; 12) A dispenser unit with an antiseptic system for cleaning of patients' and hands of personnel; 13) A collection of disinfecting rods for processing ampoules and the second likarskiy inktsiynyh forms; 14) plaster (very special to the "Tegoderm" type) or іnsha yaka fіksuє bandage; 15) mask, medical gloves (disposable closure), waterproof apron, eyepieces (plastic screen); 16) instrument table; 17) tweezers for robots with tools; 18) Possibilities for disinfecting surfaces, washing of vicious syringes (systems), soaking vicious syringes (systems), soaking vicious heads, damaging cotton and gauze pots; 19) pure ganchir'ya.

Preparatory stage for the management. 1.Inform the sick person (close relatives) about the need for a visit to the day of the procedure.

2. Otrimati the year of the sick (close relatives) for the visit of the procedure.

3. Vimiti hands with flowing water, dvіchі namilyuchi. Dry it with a single servetka (individual towel). Rub your hands with antiseptic.

4. Put on an apron, mask, gloves.

5. Process the surface of the manipulative table, tray, apron, bix with a disinfectant rosette. Vimiti hands in mittens with running water with sweet, dry, sprinkle with an antiseptic spray.

6. Put the necessary equipment on the instrument table. Revise the terms of conformity, the integrity of the packages.

7. Put on a sterile tray; It is a mobile and one-of-a-kind version of the robot with sterile material, if it is in packages.

8. Refill bottle z a solution to sodium chloride 0.9%.

9. Draw 5 ml into the syringe.

10. Odyagati zhisnі eyepieces (plastic screen).

The main stage of the vikonannya manipulation. 11. Naklasti jgut in the middle of the catheter insertion. Children of the early age are more beautiful than vicoristovuvati finger pressed veins (vikonutsya as a nurse-maid). 12. Apply an antiseptic spray to the skin in the area of ​​the veins of the brush or the inner surface of the front of the child (two pouches, widely and vuzko).

13. Rub the hands with an antiseptic wand.

14. Take the catheter in the hand with three fingers, pulling the shkira in the vein area with your hand, puncturing the catheter at 15-20.

15. When blood appears in the indicator chambers, gently pull on the head, immediately stitch the catheter at the vein.

17. Squeeze the vein up to the top of the catheter (through the shkira), tighten the head up.

18. Attach a syringe with an isotonic solution to sodium chloride to the catheter, thread the catheter through the bottle.

19. In the same rank, press the vein with one hand, with your hand open the syringe and close the catheter with a sterile stopper.

20. Clean the outer part of the catheter and the bottom of the catheter from the bottom of the blood.

21. Fix the catheter with plaster.

22. Wrap the cannula of the catheter with sterile gauze servetka, close it with leukoplast, and bandage it.

23. Transfer (transport) the child to the ward, switch on the drip tray (syringe pump). As soon as the nearest hour, the internal infusion through the peripheral venous catheter will not be carried out;

Conclusions of the stage of vikonannya manipulation. 24. Carry out the disinfection of the vicious medical instruments of the catheters, the infusion systems, the apron in the containers with a disinfectant solution. Treat the working surfaces with a disinfecting rod. Take mittens і znezaraziti їх. Vimiti hands under running water with sweet, dry, sprinkle with cream.

25. Ensure the guardian regime of the child.

26. Conduct a record at the medical documentation from the date, the hour of infusion, the definition of the differences, the number of times.

PUNKTSІYA VEN the crypt of the skull

IGLOY- "Metelik" with a catheter

General information for children of early age lykarski speech can be inserted into the veins of the head. Wait an hour for a child to fix. I will put my head down to the medical sister-in-law, hands up to the tulub and legs with a pelushka (stretched out). With the presence of a hairline in the mice of the transfer of punctuation, the hair is trimmed.

Equipment of the working machine: 1) іgla- "blizzard" with a disposable catheter; 2) a vial і from a filled-in system for internal drip infusion of a disposable filling, a tripod; 3) ampoule (bottle) with sodium chloride 0.9% solution; 4) a disposable syringe with a volume of 5 ml; 5) sterile material (cotton pouches, gauze knickers, servetki, pelushki) in packs or boxes; 6) tray for sterile material; 7) tray for vicious material; 8) pins in packing; 9) sterile tweezers; 10) tweezers in a disinfectant rosette; 11) file, knives; 12) A dispenser unit with an antiseptic system for cleaning of patients' and hands of personnel; 13) A collection of disinfecting rods for processing ampoules and the second likarskiy inktsiynyh forms; 14) plaster (very special to the "Tegoderm" type) or іnsha yaka fіksuє bandage; 15) medical gloves (disposable storage); mask, protective eyepieces (plastic screen), waterproof aprons; 16) tweezers for robots with tools; 17) Containers with a disinfecting agent for cleaning surfaces, washing vicious heads, syringes (systems), soaking vicious syringes (systems), heads, disinfecting cotton balls and gauze servet, vicorian shreds; 18) pure ganchir'ya; 19) instrument table.

Preparatory stage of the procedure

2. Otrimati the year of the sick (close relatives) for the visit of the procedure.

3. Vimiti hands under running water, two namilyuchi. Dry your hands with a single servetka (individual towel). Rub your hands with an antiseptic dab. Put on an apron, mittens, mask.

4. Spread a disinfectant rosette over the surface of the manipulation table, tray, apron, tripod for the system. Vimiti hands in mittens under running water with sweet, dry, sprinkle with an antiseptic zasob.

5. Put the necessary equipment on the instrument table.

6. Cover the sterile tray.

7. Rozdrukuvati packs with a catheter-"blizzard", syringes, viklasts on the tray. A mobile version of the robot with sterile material, if it is in packages.

8. Refill the ampoule (bottle) h the range of sodium chloride 0.9%.

9. Draw 2 ml into the syringe go to the catheter, place it on the tray.

10. Fiksuvati ditini (viconu nurse-assistant). Leave the sterile peluche with a hand over the baby's head.

11. Odyagaty zhisnі eyepieces (plastic screen).

The main stage of the presentation of the management. 12. Vibrate the dish for punctuation and pound the place in two bags with antiseptic (one - broadly, one - vuzko) directly from the moment to the frontal area. For a shorter blood circulation, a special elastic line can be applied manually near the head to the lower punctured area (above the eyebrows). Locally, finger re-threading of veins is ineffective through a large number of venous anastomoses to the cranial opening. The crying of a child is also a swelling of the veins of the head.

13. Treat your hands in mittens with an antiseptic method.

14. Tighten the shkiru in the area of ​​the transfer point for the fixation of the veni.

15. to puncture the vein with an igloi-"sweep" with a catheter in three steps . In order to direct the head over the blood flow, we go with the head to the surface of the shkiri and make a puncture. Push the head in about 0.5 cm, pierce the vein and direct it along the course. As long as the golka is not interrupted by the vein, turn it back, do not vivodyach s-pіd shkіri, and re-puncture the vein.

The introduction of a head into the vessel immediately causes a puncture of the shkiri to puncture both walls of the vessel.

16. Pull the plunger of the syringe from the catheter. When blood appears, it is clear about the correct position of the head. As for the blood improvement of venya vikoristov, an elastic line was taken, znyati її.

17. Inject 1 - 1.5 ml the range of sodium chloride 0.9%, schob uniqueness of thrombosis of the head with a blood clot і vyklyuchiti imovіrnіst of extravasal administration of a drug.

18. Zafіksuvati the head with three braids with leukoplastira: 1st - across the head to the shkіri. 2nd-pid "krill" golki-"blizzards" with a cross above them and fixing to shkiri, 3rd - across krill golki-"blizzards" to shkiri.

19. Close the catheter with a ring and fix it with leukoplastyr on the head to remove it.

20. If necessary, if the head of the head is great for the head up to the vein of the skull, under the cannula of the head of the gauze (cotton) bag.

21. Pull the plunger of the syringe attached to the catheter to re-adjust the position of the head at the vein.

22. Finish the syringe with a drip tray on the stem.

23. Take care of the additional lull the speed of the introduction of lykarskoy speech.

24. Cover the stick cannulas of the catheter and drip tray with a sterile gauze servet.

Conclusions of the stage of the publication of manipulation. 25. After the completion of the infusion, the dribble tube was squeezed for an additional jam. Leukoplastir from shkiri is safe to see. Squeeze a bag of antiseptic at the entrance of the head into the vein. Fit the golku (catheter) with adhesive tape at the same time.

26. Apply a sterile servet on the puncture point, press on top.

27. Conduct disinfection of vicious medical instruments, catheters, infusion systems, apron in various capacities with a disinfectant solution. Treat the working surfaces with a disinfecting rod. Take mittens і znezaraziti їх. Vimiti hands under running water with sweet, dry, sprinkle with cream.

28. Provide the protection regime of the child.

29. Conduct a record of the medical documentation from the date, the hour of infusion, the definition of the differences, the number of times.

Possibility of accelerated: 1) gn_yni accelerated (suppuration of the puncture canal, thrombophlebitis, phlegmon, sepsis); 2) thrombosis of the catheter with a blood clot; 3) bleeding from the catheter; 4) disastrous embolism; 5) smoother visualization and migration of the catheter; 6) sclerosing veins in times of frequent changes in the catheter; 7) information; 8) an allergic reaction to drugs and i n.

prior to the instruction of the technology

of clinical and diagnostic procedures and manipulation of disciplines "Nurse on the right in pediatrics", "Pediatrics" for specialties 1 "Sister on the right", 1 "Lykuvalna on the right"

Country houses. Preventive chips є efficiently fight the kids Infectious diseases... Vikoristovuvani prickle preparations are used to dissipate immunity, non-removability until the present infection.

Scraping is carried out in specially equipped rooms for educational and prophylactic installations, medical rooms for schools and for those who are in charge. The CLIPPING cabinet is guilty of the mother inconvenient help... For the detection of the inactivation of the attached preparations on the whole problem from the institute-virobnik until the moment of the scrapping, the “cold lancer” is to blame.

Bezposeredno before the chips, the child is guilty of being glanced at by the doctor (paramedic). Without a letter of permission for scraps, a medical sister has no right to vikonuvati її. In the first 30-60 minutes of age, the child's scraps are known to be guilty of medical care in polyclinics (schools, preschool mortgages).

Equipment of the working machine: 1) clipped preparations: vaccine against viral hepatitis B ("Engerix-B", Euvax-B, Eberbiovak NV, Shenvak-V, etc.), BCG, BCG-M, DPT, DPT-M, ADS, ADS-M, AD-M, OPV, IPV, ZhKV, ZhPV, "Rudivax", "Trimovax"; 2) distributors of vaccines BCG, ZhKV, ZhPV, Trimovaks, Rudivax; 3) a disposable syringe filling with 1-2 ml mixtures, for children and for internal use; 4) syringes of tuberculosis (insulin), injections for internal education; 5) droplets for poliomyelitis vaccine; 6) file; 7) tweezers in a disinfectant rosette; 8) sterile material (cotton bags and gauze servet) in packaging; 9) cold weather element with midsections; 10) svitlozakhisnі cone for vaccines BCG, ZhKV, "Trimovaks"; 11) ethyl alcohol 70% or less antiseptic for the infection of the patient and the hands of the personnel (mnist-dispenser); 12) A collection of disinfectants for processing ampoules (vials); 12) a tray for the placement of clothes material on the instrument table; 13) tray for vicious material (without surplus of live vaccine or blood slides); 14) mask; 15) medical gloves (disposable or disinfected); 16) tweezers for robots with tools; 17) Pockets with disinfecting substances: a) for cleaning surfaces, b) for washing and soaking vicious syringes and holoks, c) for disinfecting vicious ampoules (vials) and cotton pouches (servieta) for vaccination with surplus ; 18) pure ganchir'ya; 19) instrument table.

Note. When robotic with the BCG vaccine (BCG-M), vicoristovuvati the disinfestation of high activity.

Preparatory stage of the procedure

2. Otrimati the year of the sick (close relatives) for the visit of the procedure.

3. Vimiti and dry your hands. Treat your hands with an antiseptic solution.

4. Put on mittens.

5. Process the tray, instrument table, apron with a disinfectant rose. Vimiti and dry your hands.

6. On the upper policeman of the instrument table, put the tweezers in the compartment with a ethyl alcohol 70%, Viklasty sterile material in packages, syringes and holders of a disposable filling, in case of vikonanny splitting OPV - packing drips; with robotic vaccines BCG, ZhKV, "Trimovax"- svitlozakhisnі cone, tray for spacer material, file.

7. On the lower police station, there is a set with a disinfectant solution, a tweezers for the nobility, a tray for vicious material.

8. Forgetting from the refrigerator, disinfecting it with a disinfecting solution and putting a cold element on the tray. Cover the cold element with two-trisharovoy gauze servetka.

9. Reconsider the explicitness of the written permission for chips and the reason for the admissible terms.

10. By the way from the refrigerator (cooler bag), a suitable attachment preparation (if necessary, and a retailer), reconsider the label's appearance, the term of availability, the consistency of the ampoule (vial), the name of the vial preparation (.

11. Place the prickly preparation in the middle of the cold element.

12. Ampoules (vials) with live vaccine (ZhKV, BCZh, "Trimovax") nakrit with a light cone.

13. Vimiti and dry your hands, sprinkle with an antiseptic spray. Wear a mask for robots with live vaccines.

AGAINST viral hepatitis B

PRISCHEN dose . The dose should be set for newborns and children up to 10 years - 10 mcg (0.5 ml), for older children and adults - 20 mcg (1 ml).

Method and quick introduction. Vaccines are introduced internally. For new-born children and young children in the anterolateral region it is quilted, for older children and grown-ups - in the deltoid m'yaz.

Equipment for a working machine and a preparatory stage. 1 - 13 - see. vikonannya chippings.

The main stage of the presentation of the management. 14. Chill the vial with the vaccine until the homogeneous suspension is removed.

15. Sprinkle a bag of alcohol with a metal bag of a bottle, cover the central part, sprinkle a gum cork with another bag of alcohol, add it to a bottle. Turn the bottle into a cold element.

16. Open the package of the syringe, fix the cartridge on the cannula.

17. Fill a syringe with the vaccine: for newborns and children up to 10 years - 0.5 ml (10 μg), for children over 10 years - 1 ml (20 μg).

18. Change the goal. Before the change of the head, by the collapse of the piston, draw the vaccine from the head into the syringe.

19. Vitality from the syringe. Throw Vikoristaniy the bag into the compartment with a disinfecting solution. Rub your hands with antiseptic.

20. Cover the anterolateral surface of the quilted area for new-born children and children of the young age;

21. Take from the head a small box and introduce a pinched dose of the vaccine internally.

22. Process the shkiru with alcohol.

Conclusions of the step-by-step review of manipulation. 23. Promiti vikoristani a syringe and a head in the first range with a disinfectant gap and, having used a pincer to a head, zanurit in the selected view to the same range with the same range.

24. Throw the vikoristany bottle into the tray for the used material.

25. Apply antiseptic rosin to hands in mittens, to wear and disinfect mittens. Vimiti and dry your hands, cover with cream if necessary.

26. Regarding the chips, and for a little more information about the reaction to it in the previous documents: in the shelter - in the history of the development of the newly born (regional form No. 97 / o), exchange cards (regional form), journal form No. 113 / professional form No. 64 / y); in the polyclinic - in the card of preventive chips (regional form No. 63 / o), in the history of development of the child (regional form No. 112 / o), in the magazine a field of preventive chips (regional form No. 64 / y, Fig. 59); in schools - in the child's individual card (regional form No. 26 / o) and journal (regional form No. 64 / o). When you specify the date of entry of the scraps, dose, control number, serії number of the preparation, institute-virobnik.

There can be a splitting reaction: 1) ill-feeling, Erythema and reduction of soft tissues in the first 5 days after the introduction of the vaccine.

Possible independent reactions and acceleration: 1) fever; 2) b_l in the slopes, b_l at the m'yaz, head bill; 3) nudity, bloating, diarrhea; 4) lymphadenopathy; 5) one by one anaphylactic shock; 6) phlegmon, abscess; 7) infiltration and necrosis of tissue, hematoma, enlargement of the skin and corner.

AGAINST TUBERCULOSIS VACCINE BCG (BCG-M)

PRINCIPLE dose is 0.05 mg BCG vaccines or 0.025 mg of BCG-M vaccine. The vaccine is to be diluted with a physiological solution: 0.1 ml per one pinched dose.

Ways and times of introduction. Vaccines are introduced strictly from the school on the border of the upper and middle third of the last surface of the left shoulder.

Work equipment and preparatory stage, p. 1 - 13 - see. vikonannya chippings.

The main stage of the presentation of the management. 14. Vityagti with pincers from a craft bag, two sterile bags, snag alcohol. Add alcohol to an ampoule with a vaccine, sprinkles, re-sprinkle it with a sack, and then add alcohol (alcohol to an active vaccine).

15. Cover the top of the ampoule with a sterile gauze pad. Throw off the top of the ampoule with a gauze pad into the compartment with a disinfectant bottle. Place the ampoule in the middle of the cold element. Cover with a small gauze pad and a glass cone.

16. Spray the ampoule with the razchinnik, overheads, re-sprinkle and crack with alcohol.

17. Open the package of the 2 ml syringe, fix the cartridge on the cannula. Draw a razchinnik into the syringe. The number of doses of dry vaccine in ampoules is responsible for the number of doses of dry vaccine in ampoules (for 20 doses - 2 ml of the bottle, for 10 doses - 1 ml).

18. Take a dry vaccine svitlozakhisnі cone and gauze kovpachok, by and large introduce a rozchinnik, reliably snorting particles of rosored vaccine from stinok ampoules. Mix the vaccine with a rotary-progressive stroke of the piston in the syringe. If the head is inserted over the ampoule, it can be hermetically sealed from the tuberculous syringe, and the ampoule is inserted into the ampoule. When the tuberculous syringe is viciously soldered to the under-head cone with the cannulas, do not put the head in the vaccine.

19. Cover the ampoule with a sterile gauze pad and glass cone.

20. A syringe and a bottle of promity in a set with a disinfectant solution and a zanuriti in a selected view to the same size. Rub rubbing alcohol on your hands.

21. Wrap two houses with cotton pouches si alcohol shkіra zovnіshnya surface of the child's left shoulder (at the border of the upper and middle third).

Shkіru in the area of ​​maybutnoy іn'єktsії can be poured without medication before the introduction of the drug, otherwise it is necessary to wipe off the surplus alcohol on the screen with a sterile dry sack (servetka).

22. Take a tubercular (insulin) syringe to collect the vaccine. Fill a syringe with 0.2 ml of the vaccine, having previously changed the vaccine with the vortex-moving rams of the piston in the syringe (the bacteria are absorbed on the vials of the ampoule). Use the plunger to suck the vaccine into the syringe. To throw off Vikoristanu's goal into the box with a disinfecting solution.

23. Close the ampoule with the vaccine with a gauze servet and a svitlozakhisny cone.

24. Fit a thin short head with a small cup on the syringe cannula. Vitality from the syringe and the excess of the vaccine on a cotton bag, crushed to the cannula of the head.

25. Throw the Vikoristaniy sack into the compartment with a disinfectant solution.

27. Treat your hands with an antiseptic damp.

28. Take a small bag from the head and throw it off into the box with a disinfecting solution.

29. Hunt with your hand on the shoulder of the child, pulling the shkіra in front of the crumbled dilyanka (the shkіra is guilty of being dry).

30. Direct the head of the tuberculin syringe with a head up into the surface of the ball of the head great finger hands. Inject 0.1 ml of vaccine .

With the correct introduction on the shkiri, a papule of a bluish color with a diameter of about 8 mm will appear, usually after 15-20 minutes. Mісce ін'єкції with alcohol or an antiseptic, do not spill over (alcohol is an active vaccine).

Conclusions of the step-by-step statement of the manipulation. 31. Prompt a tuberculous syringe and a head in the first compartment with a disinfectant break, pick up the head with a pincer (if it is not soldered), put the syringe in the selected eye and head in the same way for the same reason.

32. Throw the vikoristanu ampoule of the razchinnik into the tray for vikoristanu material. The ampoule with surplus vaccine, which is not sufficient for carrying out the chipping of the Chergov child, or with the stitched term zberigannya, should be thrown off into the box with a disinfectant solution.

33. Apply antiseptic rosin to hands in mittens, to wear and disinfect mittens. Vimiti and dry your hands, cover with cream if necessary.

34. Regarding the scraps, but for a little more information about the reaction to it in the relevant documents (Div. p. 26).

PRINCIPLE reaction: 1) After 4-6 times (after revaccination 1-2 times) - plyama, infiltration, piznishe Vesicle (pustule), vyrazka or without it, a scar from 2 to 10 mm in diameter.

Possibility of accelerating: 1) strengthening the muscle reaction (bend more than 10 mm); 2) regional lymphoma; 3) cold abscess; 4) keloid scar; 5) generalized by BCG-infection; 6) urazhennya eyes, kistok, vyniknennya vovchak at the meeting.

Anti cough, diphtheria, pravtsya

(DTP, DTP-M, ADS, ADS-M, AD-M)

PRISCHEN dose . Make 0.5 ml of vaccine or toxoid.

Way and easy introduction . DPT vaccine to be introduced internally into the antero-outer area of ​​the stitus, anatoxin - up to the 6-point viku internally, then - podshkirno into the subscapularis.

Equipment for the work machine and preparatory stage. 1 - 13 - see. vikonannya chippings.

The main stage of the presentation of the management. 14. Scrub the ampoule with the vaccine until the homogeneous suspension is removed.

15. Obrobiti alcohol, slots, re-fill and open the ampoule with the vaccine. If a splinter preparation is in the bottle, sprinkle the metal cup, see the central part, sprinkle the gum stopper with a sack of alcohol, put it on the bottle.

16. Turn the ampoule (bottle) into the middle of the cold element.

17. Open the package of the syringe, fix the cartridge on the cannula.

18. Put the vaccine into the syringe.

19. If there is one or more doses of vaccine in the ampoule (bottle), close the ampoule or the bottle with a bare sterile gauze pad and turn it into a cold element.

20. Change on a syringe with a vaccine golk. Before the change of the head, by the collapse of the piston, draw the vaccine from the head into the syringe.

21. Press a dry cotton bag down to the cannula, if you don’t know the small bag, tighten the syringe, having left 0.5 ml of the vaccine in the new one.

22. Throw the cotton bag into the tray for the vicious material. Rub your hands with alcohol or an antiseptic.

23. Wrap two bags with alcohol in the area of ​​the anterior-lateral surface of the stigma, or in the subscapular area - in case of pediatric schoolchildren ADS, ADS-M, AD-M-anatoxin.

24. Take a small pack from the head and inject 0.5 ml of the vaccine DTP, DTP-M internal'yazovo, ADS, ADS-M, AD-M for schoolchildren - pedagogical.

25. Process the shkir in the region with a sack of alcohol.

Conclusions of the step-by-step review of manipulation. 26. Promiti vikoristani a syringe and a head in the first range with a disinfectant gap and, having used a pincer to a head, zanurit in the selected view to the same range with the same range.

27. Throw off the ampoule (bottle) with the surplus of the clip-on preparation, which is not enough for the chipping of the Chergovy child, into the tray for the dispensed material.

28. Apply antiseptic rosin to hands in mittens, to wear and disinfect mittens. Vimiti and dry your hands, cover with cream if necessary.

29. Regarding the scraps, but for a little more information about the reaction to it in the relevant documents (Div. Dealing with splinters against viral hepatitis B, p. 26).

PRINCIPLE reaction: 1) hyperemia of small curvatures, swelling of soft fabrics up to 5 cm in diameter, not more than 2 cm of infiltrate in the mixture; 2) short-term temperature adjustment, weakness, headache in the first 2-3 days after the introduction of the vaccine

Possible accelerated: 1) swelling and infiltration of soft tissues more than 8 cm in diameter, phlegmon, abscess; 2) overwhelmingly strong for 3 days fever and intoxication; 3) encephalopathy, encephalitis; 4) anaphylactic shock; 5) asthmatic syndrome, croup; 6) brachial nerve neuritis; 7) the area around and around the corner.

Date added: 6 | Review: 4637 | Violation of copyright

showing... For the sake of passing through and preventing the establishment of blood clots in the catheter, if it is not permanent. For the additional cost of the technique, it is possible to save the passage only in large lumen catheters (2.5 Fr or more). In a catheter with a size of 2 Fr, clots are less easily established when post-infusion is interrupted.

ustatkuvannya

1. A syringe with a volume of 10 ml, to put 3 ml of hepa-rinized physiological rose (10 OD / ml); how to size the syringe follow the recommendations of the virobnik.
2. Servetki with alcohol.
3. Padding for the catheter (guilty but without teeth or the pad on the jaws) or padding, which is supplied together with the catheter.
4. Mittens.
5. Kovpachok for internal ін'єкцій (recommend headless).

Central venous catheter look-ahead technique

1. Formation of heparin lock.
a. Wash your hands up.
b. Put on sterile gloves.
v. I am preparing a sterile robot for a dilyanka.
To achieve sterility, open the package with a sterile in-box and in advance store it heparinized with a physiological break.

e. Spread an antiseptic, for example, alcoholic servet, on the side of the catheter and system for infusion to the pavilion. Repeat from the side. Give the antiseptic to dry.
e. Put a blood-back seal on the catheter, put pads on the branches of the catheter, or close the catheter seal.
f. With an alcoholic servette, see the catheter pavilion from the system for internal infusion.
h. Take a long time to fill the box up to the catheter pavilion, every hour you need to wash it, so you can put it into the catheter.

i. Know the flush and flush the catheter with 1-3 ml of heparinized physiological gap (in the presence of the size of the catheter).
j. I know to put a lock, immediately push on the plunger of the syringe with heparin, so that the blood flows into the catheter (positive vice).
l. Fix the catheter with plastic to abdomen.
m. Flush the catheter heparinized with a physiological cut of the skin for 6-12 years (depending on the recommendation of a specific drug deposit).

2. rinsing the catheter... The setting is the same as for the "heparin lock".
a. Wash your hands up.
b. Put on gloves and prepare a sterile field.
v. Oroblyayut ін'єкційный kovpachok with an antiseptic solution, give it to you dry.

m Yaksho ін'єкційный kovpachok - a part of the headless system, fit a new infusion syringe. Insert the head into the catheter plug into the vipad. Make sure to puncture the catheter with a diameter of 2.5 cm.
e. Know the amount of heparin from the catheter and inject 1-2 ml of heparin (depending on the size of the catheter). I know to put a seal on the catheter, to inject the rosette at once to prevent the revolting flow of blood into the new one. Vipuskayut ін'єкційні kovpachki with a positive grip for zobіgannya vortex flow.
e. Zmіnyut іn'єktsіyny kovpachok. Most of the virobniks recommend miniature skin packs for 3-7 days, if the drug is injected into the blood, or if there is a sign of the drug (div.

meta: Prevention of accelerated: malignant embolism, infarction of veni and shkiri in the place of catheter insertion.

show: An accessory catheter is inserted with the help of trivial infusion therapy.

Equipment: sterile dressing material, sterile antiseptic, sterile syringe, heparin, izotonic rozchin.

Simulation number 34.

Visited sister of the priyymalnogo viddilennya. Having entered the patient with arterial bleeding from the middle third of the right gomilka. You will need to put on a blood-back jgut.

Etalon of vidpovidі.

Applied jgut for arterial bleeding.

meta: timchasova zupinka bleeding.

show: arterial bleeding.

equipment: blood-spine jgut, servetka, papir, olivets, IPP, Cramer's splint.

simulation # 35

The medical sister is a visitor to the new surgery. When the patient turns up, on the 3rd day I eat a boil on the liver. You need to bandage the wound.

Etalon of vidpovidі.

Bandaging a gn_ynoy wound.

meta: vividness from the wound, prevention of secondary

іnfіkuvannya, setting the minds for the wounds.

show: the manifestation of a grievous wound.

equipment: ocular eyepieces, mask, glue apron, mittens,

antiseptic, sterile pincets - 3, bulbous probe, gum drainage.

sterile dressing material, antiseptic solutions, ointments,

hypertonic razchin, mnist with a disinfectant.

simulation # 36

Keeping an eye on your catheter

Materials and tools

Table, tray, sterile tweezers, disposable syringe (10 ml), disposable sterile plugs, non-wetting bag or container for entering class B, heparinized rosin (0.01 ml of heparin per 1 ml of physiological solution - i.e. 50 OD / 1 ml ) in the community, which is suitable for the internal volume of the internal catheter, 0.9% sodium chloride solution (5.0-10.0 ml), an alcohol-containing antiseptic for cleaning the catheter, and also all of the canals, including (PVK), chlorhexidine solution 0.5-2% in 70% ethyl alcohol (for cleaning the skin near the catheter), 10% solution with povidone-iodine in 70% ethyl alcohol ( if indicated before the consumption of chlorhexidine), antiseptic (for), sterile gauze swabs, sterile gauze servetts, or self-adhesive sterile dressing, sterile pellet, sterile dressing, sterile dressing, sterile dressing, dressing , medical I'm a hat, a mask.

Algorithm to look behind the lateral catheter (central) - dressing change

Preparatory stage

Slide the identification of the patient, introduce yourself, explain the direction and meta procedures, how to carry out the request.

Written confirmation is not required.

It is necessary to be informed voluntarily during the year for the procedure. When every day, look at the doctor about other activities.

It is necessary to put on a mask and a medical cap.

Deliver a manipulative table to the ward, having prepared all the necessary.

hid vikonannya

Look around at the entrance of the catheter into the shkira with a sign of heat (swelling, soreness). When vyavlennі sign zapalennya viclikati lіkarya.

Take off the bandage. At the same time, with the help of prevention, it is necessary to check that the catheter enters the skin near the point of entering the catheter into the skin, it should not be allowed to go up, but rather curl up parallel to the skin in the right direction of hair growth.

It is not possible to sprinkle the mittens with an antiseptic, to destroy the bar'erni power.

Use a sterile gauze spatula to grind all parts, including the cannula and the catheter itself.

In case of a sterile open dressing, it is necessary to fix it so that the catheter entry into the chamber is located in the center of the center, it is projected to control the entry of the catheter into the chamber.

If necessary, close the line of the catheter.

final stage

Take mittens, put them in a waterproof bag or container.

Vikoristaniy material went to waste in class B.

Gіgієnіchnym way to dab your hands, dry.

Zrobiti is recorded at the medical documentation.

Algorithm to look behind the catheter (central / peripheral) - catheter insertion

Preparatory stage

Slide the identification of the patient, introduce yourself, explain the direction and the meta procedure, how to carry it out. Written confirmation is not required.

It is necessary to be voluntarily informed about the year of the procedure for the introduction of the drug. When every day, look at the doctor about other activities.

Put on a medical cap and a mask.

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

Zvіlniti odyagu mіsce, de insertion of the catheter.

Gіgієnіchnym way to cut your hands.

Rub your hands with an antiseptic, do not dry them, having finished hanging an antiseptic, put on sterile gloves.

Then pour into a syringe (10 cm 3) 5 ml of 0.9% solution of sodium chloride.

When staging a "heparin lock" with CVC, prepare a syringe (10 cm 3) with a heparinized rose (0.01 ml of heparin per 1 ml of 0.9% solution to sodium chloride - 50 OD / 1 ml) I have an internal catheter.

The dose of heparinized drugs is insured individually.

In case of PVC "", do not be afraid without the sign of a lykar.

hid vikonannya

Special clamps should be used to close the CVC line, which should be included in the catheter kit.

Iakscho there is no lull, it is necessary to ask the patient to take over the dikhannya, zrobiti vidikh.

When the catheter is closed, a new sterile plug is required, as the plugs for CVC and PVC are sterile and disposable.

Sterile servetka, soaked in an antiseptic, then pound the catheter roses, having broken 15 overturned sleeves.

If a "heparin lock" was previously inserted into the catheter, it is necessary to tighten it, having brought a syringe (10 cm 3) with 0.9% sodium chloride solution (5 ml), pull it on yourself.

Perekonatisya, scho the passage of the catheter is not damaged, it is possible by the offensive rank. Slide a new syringe (10 cm 3) with a 0.9% solution to sodium chloride (5 ml).

Then you can easily pull the piston on yourself. She is guilty of a shelter. Dal it is necessary to insert the syringe into the place of the syringe, close the zatiskach. When twisting the passage, the size of the wicker is slid.

Put the "heparin lock", you need to put a syringe (10 cm 3) with a heparinized rosette with the catheter.

Then take the cuff and introduce the heparinized solution into the community, no more than the internal cleaning of the catheter. Slid zatiskach. Obsyag of skin enlightenment is indicated on the packaging of the CVC.

Drink a sterile servetka, soaked in an antiseptic, and then cut a catheter with a rose, having cut through 15 overturned ruks.

With a new sterile plug, do not stick to the inner part of the plug and the catheter connector, carefully close the catheter lumen.

final stage

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

Deliver the vicarious material to the procedural room for further disinfection and disposal in class B.

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

Check with the patient about his self-respect.

Zrobiti record about the results in the medical documentation.

Algorithm to look behind the vascular catheter (peripheral) - dressing change

Preparatory stage

Slide the identification of the patient, introduce yourself to you, explain the meta and go of the procedure, how to carry out the request. Written confirmation is not required.

It is necessary to be voluntarily informed during the year for the procedure. When you go out, ask the doctor about the other kids.

Put on a mask and a medical cap. Deliver a manipulative table to the ward, having prepared all the necessary.

Help the patient to take a hand position in order to access before the installation of a peripheral venous catheter.

Zvіlniti odyagu mіsce, de insertion of the catheter.

Gіgієnіchnym way to cut your hands.

Rub your hands with an antiseptic, do not dry them, having finished hanging an antiseptic.

Then put on sterile gloves.

hid vikonannya

Look around at the entrance of the catheter into the skin of a non-patient with a bandage to reveal a sign of swelling, soreness.

When vyavlennі sign zapalennya viclikati lіkarya.

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

The hand, in the vein where there is a catheter, is to blame for the removal of the udovzh tuluba.

Likewise, the catheter of retouching is in the cubital or in the veins before the burn - when you burn down, but in the veins of the hand - I go down. Removing the plugs does not flow into the mixing phase.

During procedures with a catheter, it is possible to be in the stegovy vein, the lower end of the descent is 25 degrees.

Removing the plugs is not tied to the dikhannya phase.

You need to wear a bandage. For prophylaxis, the diagnosis of scrubs near the entrance of the catheter to the scabbard should not be allowed to go up, but rather curl up in parallel with the scruff right in the direction of hair growth.

Put the bandage in a waterproof bag or container.

Take vikoristani mittens for the rest of the day.

It is not possible to sprinkle the mittens with an antiseptic to destroy the barriers of power.

For mіttsі viznachiti, scho the catheter is not usunuyu.

Use an antiseptic to sprinkle the skin around the catheter: use a sterile gauze bag from the center to the periphery behind the addition of a sterile pincer.

Use a sterile gauze spatula to sprinkle all parts, including the cannula, and the catheter itself.

Place a sterile pellet on the screen near the catheter.

Possibly a general anti-septic agent.

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

In case of a sterile special opening of the dressing, it is necessary to make the dressing so that the catheter entrance into the chamber is located in the center of a transparent window to control the entry of the catheter into the chamber.

If necessary, close the line of the catheter. When changing the bandage at the patients with a sensitive dress, it is recommended for the child to apply a sterile bar for the child with a second contact.

Vibrating bandage is necessary for individual specialties.

If a child is older than two months, and to develop an infection factor until the development of an infection factor (the triviality of the CVC's stay is three; decrease in immunity (in case of cancer patients), it is recommended to reduce the risk of infection in the colonies.

For those who are sick, the optimal size is a polyurethane bandage.

As soon as near the entrance of the catheter into the first place, if the insertion is made, bleeding is prevented, it is permissible to wear a non-woven bandage with a small pad, which should be replaced by polyurethane opening after 24 years.

Replace the bandages on the CVC for 5-7 days (if the fixation is not damaged, you should look around and see it).

I will replace the penetrating polyurethane dressings with PVC for the skin for 3-4 days (if the fixation is not damaged, it is safe to look around and see no signs of it).

With CVC, the "heparin lock" of the catheter should be inserted 1 time for additional (wound / evening) and when there is an infusion.

In case of infusion during the day, or decilkoh injection of lycars, before and after taking blood - 5-10 ml of 0.9% solution of sodium chloride without a "heparin lock".

Yakshho PVK will not be victorious 2 times for additional (ranok / evening) next to the PVK until after the introduction of licars.

Not earlier than 1 time before it is necessary to conduct a visual inspection of the installation of the catheter.

As a result of the insertion of the catheter and if it is necessary to install a "heparin lock", the fault is passable. For that, the bandage was replaced, because the bandage was not guilty of teasing and burning.

final stage