静脉输液并发症的预防与处理知识分享

1、静脉输液并发症的预防与处理静脉输液操作并发症的预防与处理一、发热反应1、原因：因输入致热物质引起。多由于输液瓶清洁灭菌不彻底，输入的溶 液或药物制品不纯、消毒保存不良，输液器消毒不严格或被污染，输液过程中 未能严格执行无菌操作等所致。2、症状：病人表现为发冷、寒战和高热。轻者体温在 38C左右，停止输液 后数小时可自行恢复正常；严重者起初起寒战，继之高热，体温可达 41C，并 伴有头疼、恶心、呕吐、脉速等全身症状。3、预防及处理：(1) 输液前认真检查药液质量，输液器包装及灭菌日期、有效期，严格无 菌技术操作。(2) 反应轻者，可减慢点滴速度或停止输液，通知医生，同时注意体温变 化。(3) 对

2、高热病人给予物理降温，观察生命体征，必要时遵医嘱给予抗过敏 药物或激素治疗。(4) 反应严重者，应立即停止输液，并保留剩余溶液和输液器进行检测， 查找反应原因。二、急性肺水肿1、原因：(l )由于输液速度过快，短时间内输入过多液体，使循环血容量急剧增 加，心脏负荷过重引起。(2) 病人原有心肺功能不良，尤多见于急性左心功能不全者。2、症状：病人突然出现呼吸困难、胸闷、咳嗽、咯粉红色泡沫样痰，严重 时痰液可从口、鼻涌出，听诊肺部布满湿啰音，心率快且节律不齐。3、预防及处理：(1) 在输液过程中，要密切观察病人情况，对老年人、儿童、心肺功能不 良的病人尤需注意控制滴注速度不宜过快和输液量不宜过多。

3、(2) 出现上述症状，立即减慢或停止输液并通知医生，进行紧急处理。如 病情允许可使病人端坐，双腿下垂，以减少下肢静脉回流，减轻心脏负担。必 要时进行四肢轮扎。用橡胶止血带或血压计袖带适当加压四肢，以阻断静脉血 流，但动脉血仍可通过。每 510min轮流放松一个肢体上的止血带，可有效地 减少静脉回心血量。症状缓解后，逐渐解除止血带。(3) 给予高流量氧气吸入，一般氧气流量为 68L/ min,以提高肺泡内氧 分压，增加氧的弥散，改善低氧血症。最好用 50%-70油精湿化后吸入，酒精能 降低泡沫表面张力，从而改善肺部气体交换，缓解缺氧症状。(4) 遵医嘱给予镇静剂、平喘、强心、利尿和扩血管药物。(

4、5) 安慰病人，解除病人的紧张情绪。三、静脉炎1、原因：由于长期输注高浓度、刺激性较强的药液，静脉内放置刺激性大 的塑料管或静脉留置针放置时间过长，引起局部静脉壁发生化学性反应；也可 因输液过程中未严格执行无菌操作，导致局部静脉感染。2、症状：沿静脉走向出现条索状红线，局部组织发红、肿胀、灼热、疼痛，有时伴有畏寒、发热等全身症状。3、预防及处理：(1) 严格执行无菌操作。对血管壁有刺激性的药物应充分稀释后再应用。 点滴速度宜慢，防止药物漏出血管外。同时，要有计划地更换输液部位，以保 护静脉。(2) 停止在此部位输液，并将患肢抬高、制动。局部用 50%硫酸镁溶液湿 敷(早期冷敷，晚期热敷)，每日

5、2次，每次20min。(3) 超短波理疗，每日I次，每次1520min。(4) 中药治疗，将如意金黄散加醋调成糊状，局部外敷，每日2次，具有 清热、止痛、消肿的作用。(5) 如合并感染，遵医嘱给予抗生素治疗。四、空气栓塞I、原因：(1) 输液导管内空气未排尽，导管连接不紧，有漏气。(2) 加压输液、输血时无人守护，液体输完未及时更换药液或拔针。发生空气栓塞是由于进人静脉的空气形成的气栓，随血流首先被带到右心房，然后进入右心室。如空气量少，则被右心室随血液压入肺动脉并分散到肺 小动脉内。最后经毛细血管吸收，损害较小；如空气量大，空气在右心室内阻 塞肺动脉入口，使血液不能进入肺内，气体交换发生障碍

6、，引起机体严重缺氧 而立即死亡。2、症状：病人感到不适或胸骨后疼痛，随之出现呼吸困难和严重发绀，有 濒死感。听诊前区可闻及响亮的、持续的“水泡声”，心电图呈现心肌缺血和急性 肺源性心脏病的改变。3、预防及处理：(1) 输液前认真检查输液器的质量，排尽输液导管内的空气。(2) 输液过程中加强巡视，输液中及时更换输液瓶或添加药物；输液完毕 及时拔针；加压输液时应有专人在旁守护。(3) 立即让病人取左侧卧位并头低脚高，以便气体能浮向右心室尖部。避 开肺动脉入口，随着心脏舒缩，将空气混成泡沫，分次小量进入肺动脉内，逐 渐被吸收。(4) 立即绐予高流量氧气吸入，提高病人的血氧浓度，纠正缺氧状态；有 条件

7、者可通过中心静脉导管抽出空气；严密观察病人病情变化：如有异常及时 对症处理。五、液体外渗1 原因：穿剌时刺破血管或输液过程中针头或留置导管滑出血管外，使液 体进入穿刺部位的血管外组织而引起。2症状：局部组织肿胀、苍白、疼痛，输液不畅，如药物有刺激性或毒 性，可引起严重的组织坏死。3 预防及处理：(1) 牢固固定针头，避免移动；减少输液肢体的活动。(2) 经常检查输液管是否通畅，特别是在加药之前。(3) 发生液体外渗时，应立即停止输液，更换肢体和针头重新穿刺。(4) 抬高患肢以减轻水肿，可局部热敷 20分钟，促使静脉回流和渗出液 的吸收，减轻疼痛和水肿。六、过敏性休克的急救一旦发生过敏性休克必须

8、争分夺秒、迅速及时、就地急救。1 立即停药，患者就地平卧，进行抢救。2. 立即皮下注射0.1 %盐酸肾上腺素0.5-1ml，病儿酌减，此药是抢救过 敏性休克的首选药物，具有收缩血管、增加外周阻力，提升血压，兴奋心肌、增加心输出量及松弛支气管平滑肌的作用。如症状不缓解，可每隔30min皮下或静脉注射给药0.5ml，直至脱离危险。如发生心脏骤停立即行胸外心脏按压 术。3维持呼吸：给予氧气吸入。呼吸受抑制时肌内注射尼可刹米（可拉明） 或络贝林等呼吸兴奋剂。喉头水肿影响呼吸时，可行气管插管或气管切开术。4. 抗过敏：根据医嘱，立即给予地塞米松 5-10mg静脉注射或氢化可的松 200-400mg加人5

9、% 10%的葡萄糖液500ml，静脉滴注。应用抗组胺类药，如 肌内注射异丙嗪（非那根）25 40mg或苯海拉明20mg5. 补充血容量：静脉滴注10%葡萄糖溶液或平衡液扩充血容量。如血压下 降不回升，可用低分子右旋糖酐，必要时可用多巴胺、阿拉明等升压药物。6. 纠正酸中毒。7. 密切观察患者体温、脉搏、呼吸、血压、尿量及其他病情变化，并做好 病情动态记录。Preve nti on and man ageme nt of complicati ons of in trave nous in fusi on Febrile reacti ons1, reas on: as a result of

10、in put heati ng material. Because the in fusi on bottle is not clea n and sterilized, the solution or the medicine product is impure, the disinfection and the preservation are bad, the infusion device is not sterilized or polluted, and the aseptic operati on can not be strictly impleme nted in the i

11、n fusi on process.2 symptoms: the patient presented with chills, chills, and high fever. The light temperature at 38 degrees Celsius, a few hours after the cessation of the infusion could return to normal; serious at first followed by high fever, chills, body temperature is 41 degrees cen tigrade, a

12、nd accompa nied by headache, n ausea, vomit ing and other symptoms, pulse rate.3, preve nti on and treatme nt:(1) carefully check the quality of the liquid medicine before infusion, the packing and the date of sterilization and the valid period of the infusion, and strictly operate the aseptic tech

13、niq ue.(2) the light pers on can slow dow n the in trave nous drip or stop the in fusi on, no tify the doctor and pay atte nti on to the cha nge of the body temperature.(3) give physical cooli ng to patie nts with high fever, observe vital sig ns, and give anti allergic drugs or horm one treatme nt

14、accordi ng to doctor's orders whe n n ecessary.(4) in case of serious reacti on, the in fusi on should be stopped immediately, and the remai ning soluti on and in fusi on apparatus are retai ned for exam in ati on and the cause of the react ion is found.Two、acute pulmonary edemaL, reas ons:(L) a

15、s the in fusi on speed is too fast, too much liquid is in put in a short time, which makes the circulati ng blood volume in crease rapidly and the heart overload causes.(2) the patie nt has poor cardiopulm onary function, especially in patie nts with acute left ven tricular dysf unction.2 symptoms:

16、the patient suddenly appear dyspnea, chest tightness, cough, cough, pink foam, sputum, sputum from the mouth and nose when serious, auscultation, lungs filled with wet rale, heart rate is fast and irregular rhythm.3, preve nti on and treatme nt:(1) in the in fusi on process, we should closely observ

17、e the patie nt's con diti on, especially for the elderly, children, cardiopulmonary dysfunction patients, especially n eed to pay atte nti on to con trol the speed of in fusi on, should not be too fast and the amount of tran sfusi on should not be too much.(2) if the symptoms occur, slow down or

18、 stop the infusion and notify the doctor for emergency treatment. If the condition permits, may cause the patient to sit upright, the legs hang dow n, reduces the vein of the lower limb to retur n, reduces the heart burde n. If n ecessary, the limbs are tied. The appropriate pressure rubber tourniq

19、uet or limbs blood pressure cuffs, to preve nt venous blood flow, but still through the arterial blood. Each 5 to 10min relaxation of a tourniquet on the limb can effectively reduce the amount of venous blood. Gradually relieved the tourniq uet after symptomatic relief.(3) to give high flow oxyge n

20、in halati on, the gen eral oxyge n flow rate is 6 8L / min, in order to improve the oxyge n partial pressure in the alveoli, in crease oxyge n dispersi on, i mprove hypoxemia. It is best to use 50%-70% alcohol to in hale after wett ing. Alcohol can reduce foam surface tension, thereby impro ving lun

21、g gas excha nge and alleviati ng the symptoms of hypoxia.(4) the doctor prescribed sedative, an tiasthmatic, cardiac, diuretic and vasodilator drugs.(5) comfort the patie nt and relieve the patie nt's n ervous ness.Three phlebitis1 reasons: due to Iong-term infusion of high concentration, strong

22、 irritant liquid, placed in the venous irritation of the plastic pipe or venous indwelling needle placed too long, cause local vein wall chemical reaction; as a result of aseptic operation is not strictly en forced in the process of tran sfusi on, result ing in local venous in fecti on.2 symptoms: a

23、long the vein to streak the red line, local tissue swelling, redness, burning, pain, sometimes accompa nied by chills, fever and other symptoms.3, preve nti on and treatme nt:(1) strictly implement aseptic operation. Drugs that are irritating to the walls of the blood vessel should be fully diluted

24、and the n used. Drip speed should be slow, to prevent leakage of drugs outside the vessel. At the same time, replace the infusion site with a plan to protect the vein.(2) stop the in fusi on at this site, and raise and brake the affected limb. Local use of 50% Magn esium Sulfate soluti on wet compre

25、ss (early cold compress, late hot compress), 2 times a day, every time 20min.(3) ultrashort wave physiotherapy, l times a day, 15 to 20min every time.(4) traditi onal Chin ese medici ne treatme nt, the powder of Ruyiji nhua ng Jiacu tune into a paste, local application, 2 times a day, with heat, pai

26、n, swelling effect.(5) if in fectio n is comb in ed, an tibiotic treatme nt should be give n accord ing to doctor's advice.Four. Air embolismL, reas ons:(1) the air in the in fusi on catheter is not exhausted, the conn ect ing of the catheter is not tight, and the air leak is out.(2) there is no

27、 guardia n duri ng the pressure in fusi on or tran sfusi on, and the liquid medic ine or n eedle is not replaced in time.An air embolism is caused by air embolism into the air of the vein, which is first taken to the right atrium with the blood stream, and the n in to the right ven tricle. If the ai

28、r is small, the right ven tricle is pumped into the pul monary artery with blood and dispersed into the pulmonary arteriole. At the end of the capillary absorption, less damage; such as air volume, air block ing pul monary artery at the entrance to the right ven tricle, so that blood cannot en ter t

29、he lun gs, gas excha nge disorder, cause severe hypoxia and immediate death.2 symptoms: the patie nt discomfort or chest pain, dysp nea and cyano sis appeared serious, a feeling of impending death. The audible, persistent, "bubbling" sound in the pre - auscultati on area was associated wit

30、h myocardial ischemia and an acute pul monary heart disease.3, preve nti on and treatme nt:(1) carefully check the quality of the infusion apparatus before transfusion, and drain the air in the infusion catheter.(2) stre ngthe n the in spect ion duri ng the in fusi on process, cha nge the in fusi on

31、 bottle or add the medicine in time, and finish the needle in time after the transfusion; when the in fusi on is pressed, some one should be in charge of it.(3) immediately let the patie nt take a leftlie head low foot high, so that the gas will float to the right ventricular apex. Avoid the entranc

32、e of the pulmonary artery. As the heart con tracts, the air is mixed and the foam is divided in to small amounts into the pul monary artery and gradually absorbed.(4) immediately in trave no uslydripped with high flow oxyge n in halati on, i mprove blood oxyge n concen trati on in patie nts with the

33、 correct hypoxia con diti ons; through cen tral venous catheter from the air con diti on; close observati on of patie nts with abno rmal cha nges such as: timely symptomatic treatme nt.Five. Liquid extravasati on1. reas ons: puncture pun cture blood vessel or in fusi on process, n eedle or in dwelli

34、 ng catheter slide out of the blood vessel, so that the liquid into the pun cture site of the vascular tissue caused by.2. symptoms: local tissue swelling, pale, pain, poor infusion, such as drugs irritating or toxic, can cause severe tissue n ecrosis.3. preve nti on and treatme nt:(1) firmly fixing

35、 the needle head, avoiding movement; reducing the activities of the tran sfusi on limbs.(2) always check the pate ncy of the in fusi on tube, especially before dos ing.(3) whe n the liquid extravasati on occurs, the in fusi on should be stopped immediately, the replaceme nt of limbs and n eedles, an

36、d re pun cture.(4) lift affected limbs to reduce edema, local hot compress for 20 min utes, to promote venous reflux and exudate absorpti on, reduce pain and edema.Six、emerge ncy treatme nt of an aphylactic shockOnce allergic shock occurs, we must race against time, prompt and in situ rescue.1. imme

37、diately stop the drug, the patient on the horizon, for rescue.2. immediately subcuta neous injectio n of adre nali ne hydrochloride in 0.1% 0.5-1ml, reduce it, this drug is the drug of choice for rescuing anaphylactic shock, with vasoc on stricti on, in creased peripheral resista nee, improve blood pressure, the role of myocardial exciteme nt and in creased cardiac output and bron chial smooth muscle relaxatio n. If symptoms are not relieved, 0.