新生儿桡动脉采血止血方案的制订及应用
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摘要
目的通过制订新生儿桡动脉采血止血方案(以下简称"方案"),规范护士桡动脉采血止血方法 ,提高按压止血效率,减少采血后不良反应的发生率。方法运用文献检索、问卷调查和临床实践相结合的方法,就按压材料、姿势、力度和时间制订方案,采用纯棉非织造布片进行"三明治式点赞法"按压,基于收缩压的力度持续按压5 min。对护士进行培训后实施方案,采用一次止血成功率、掌部SpO2下降率、皮肤穿刺点失血率、皮下出血率进行效果评价。结果应用方案后,新生儿桡动脉采血一次止血成功率由69.89%上升至97.80%、掌部SpO2下降率由18.28%下降至5.49%、皮肤穿刺点失血率由35.48%下降至6.59%、皮下出血率由33.33%下降至9.89%。结论新生儿桡动脉穿刺后应用本研究方案可有效止血。
Objective To develop a guidance for applying pressure on puncture site after neonatal radial artery sampling(hereinafter referred to as the "guidance"),in order to standardize the procedure,improve the efficiency of compression,and reduce the incidence of complications after radial artery blood sampling. Methods Using literature review,questionnaire investigation and clinical practice,a standardized guidance was established with regard to dressing material,operator's finger position,pressure intensity and duration. All nurses were trained to apply a"sandwich" point pressure with non-woven pure cotton fabric over puncture site for 5 minutes,based on neonatal systolic blood pressure. To evaluate the effectiveness of the guidance,success rate of hemostasis,degree of palm pulse oxygen desaturation during compression,and bleeding rate of puncture site or subcutaneous tissue were documented. Results After applying the guidance,success rate of hemostasis rose from 69.89% to 97.80%,palm desaturation rate fell from 18.28% to 5.49%,puncture site bleeding rate fell from 35.48% to 6.59%,and subcutaneous hemorrhage rate fell from 33.33% to 9.89%. Conclusion The application of our guidance after neonatal radial artery sampling can effectively achieve hemostasis.
Objective To develop a guidance for applying pressure on puncture site after neonatal radial artery sampling(hereinafter referred to as the "guidance"),in order to standardize the procedure,improve the efficiency of compression,and reduce the incidence of complications after radial artery blood sampling. Methods Using literature review,questionnaire investigation and clinical practice,a standardized guidance was established with regard to dressing material,operator's finger position,pressure intensity and duration. All nurses were trained to apply a"sandwich" point pressure with non-woven pure cotton fabric over puncture site for 5 minutes,based on neonatal systolic blood pressure. To evaluate the effectiveness of the guidance,success rate of hemostasis,degree of palm pulse oxygen desaturation during compression,and bleeding rate of puncture site or subcutaneous tissue were documented. Results After applying the guidance,success rate of hemostasis rose from 69.89% to 97.80%,palm desaturation rate fell from 18.28% to 5.49%,puncture site bleeding rate fell from 35.48% to 6.59%,and subcutaneous hemorrhage rate fell from 33.33% to 9.89%. Conclusion The application of our guidance after neonatal radial artery sampling can effectively achieve hemostasis.
引文
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[13]郭舒文,余惠芬,李艺针,等.新生儿采用足背动脉定位采血法的可行性研究[J].护理与康复,2016,15(3):206-208.
[14]林玉清,张云峰,汪克林.桡动脉与股动脉血气分析标本采集方式和结果的临床比较[J].现代医院,2010,10(2):99-100.
[2]Brotschi B,Hug MI,Latal B,et al.Incidence and predictors of indwelling arterial catheter-related thrombosis in children[J].JThromb Haemost,2011,9(6):1157-1162.
[3]马晓艳.3M弹力绷带在危重新生儿桡动脉止血应用中的效果观察[J].护理与康复,2016,15(12):1163-1164.
[4]金利萍,戈道永,许茂莲.足背动脉穿刺法在新生儿采血中的应用[J].中华护理杂志,2010,45(2):172-173.
[5]Steffenino G,Fabrizi MB,Baralis G,et al.Implementation of radial arterial access for cardiac interventions:a strong case for quality assurance protocols by the nursing staff[J].J Cardiovasc Med,2011,12(2):116-121.
[6]黄维,周琴,谈晓轶,等.早产儿不同部位动脉采血的比较[J].中华护理杂志,2011,46(12):1176-1178.
[7]邵肖梅,叶鸿瑁,丘小汕.实用新生儿学[M].4版.北京:人民卫生出版社,2011:919.
[8]邢鑫欣,刘秋云,王艳玲.经桡动脉采血不同按压面积对止血效果的影响[J].中华护理杂志,2011,46(4):392-393.
[9]郑微艳,许莉,孙怡.《心脏术后桡动脉置管拔管止血方案》的制订和临床应用[J].中华护理杂志,2012,47(8):692-694.
[10]杨凤玲,杜中然.静脉采血拔针后按压血管止血时间及技巧[J].中国实用神经疾病杂志,2006,9(5):131-132.
[11]邵肖梅,叶鸿瑁,丘小汕.实用新生儿学[M].4版.北京:人民卫生出版社,2011:952-953.
[12]赖金环.静脉穿刺拔针不良反应分析及护理对策[J].微创医学,2008,3(3):291-292.
[13]郭舒文,余惠芬,李艺针,等.新生儿采用足背动脉定位采血法的可行性研究[J].护理与康复,2016,15(3):206-208.
[14]林玉清,张云峰,汪克林.桡动脉与股动脉血气分析标本采集方式和结果的临床比较[J].现代医院,2010,10(2):99-100.