How about Vigo Jerry's indwelling needle?

Intravenous indwelling needle, also known as trocar, is used for elderly patients, which has the advantages of reducing the number of blood vessel puncture, relieving patients' pain, unrestricted activities, reducing liquid extravasation, facilitating clinical medication and emergency rescue, and reducing nurses' workload. However, the length of its indwelling time is related to a series of problems such as local adverse reactions, phlebitis, economic burden of patients and so on.

The author collected 83 elderly patients in our hospital from 200/kloc-0 to 2004. The indwelling time of indwelling needle was longer than 1 day and less than1day. Based on the analysis of the use of indwelling needles in 83 elderly patients and 265 elderly patients, this paper discusses the safety and feasibility of prolonging the use time of indwelling needles in elderly patients.

Clinical data and methods of 1:

1. 1 materials and objects

Use 22GA intravenous trocar produced by BD Company of the United States. The subjects were 83 patients with intravenous infusion for 265 times, including 665,438 males and 22 females, aged 665,438 0-96 years (average 73.5 years).

1.2 parts and methods

The forearm vein and dorsal vein were selected, and a tourniquet was tied 6cm above the puncture point, with an area of 8cm×8cm, and disinfected with 2% iodine and 75% alcohol. Take out the indwelling needle, take off the outer sheath of the needle, gently rotate the outer sheath of the needle, instruct the patient to make a fist, tighten the skin at the puncture site with his left hand, hold the handle of the indwelling needle with his right hand, and pierce the blood vessel at an angle of15-30, and the needle insertion speed should be slow. After the blood returns, lower the height to push the puncture needle into 0.2-0.5cm, fix the needle plug with the right hand, send it into the indwelling hose with the left hand, and loosen it to stop bleeding. (Pay attention to exhausting air). Fix it on the skin with a special 3M applicator centered on the eye of the needle, indicate the puncture time and sign it.

2. Results

2. 1 day indwelling needle: among 265 cases of indwelling needle application, the longest indwelling time was 10 day, 5 cases, accounting for 5.7%, and the shortest was 1 day, 27 cases, accounting for 10.2%, with an average indwelling time of 5 days.

2.2 Phlebitis: Of the 265 patients observed, 2 cases developed phlebitis. The reason is that most of the undergraduate patients are elderly, and the elderly patients have loose skin, poor resistance, long indwelling time, and the needle mouth failed to recover in time after needle extraction.

2.3 Body fluid extravasation: 3 1 case, 265 cases, accounting for 1 1.7%, and extravasation caused by excessive joint activity, accounting for 1.9%. 5 cases were caused by vascular fragility, accounting for 65.438 0.9%; 16 cases, accounting for 6%, were caused by severe heart failure and increased vascular permeability, accounting for 1.9%.

2.4 8 cases were sealed with indwelling needle, accounting for 3%: 4 cases were not sealed with positive pressure, 3 cases were not sealed with heparin (5u/ml) due to illness, and 1 case was infused with fat emulsion.

3 discussion

Venous indwelling needle can be retained for a long time because the material used for indwelling needle has the characteristics of good flexibility and little stimulation to blood vessels. However, its retention time has been controversial. Health administrative departments, hospitals and indwelling needle manufacturers all advocate that the indwelling time should not exceed 3 to 5 days, but some literature reports are much longer than 5 days. Huang Liyun [1] and others think that it can be preserved in blood vessels for 5 ~ 7 days. Li Xiaoyan [2] and others reported that the longest time of indwelling catheter in vein was 27 days; Zhai et al. [3] think that the best time is about 15 days. If it is an adult, and the indwelling site is properly selected, the local maintenance is good, and there is no inflammatory reaction, the indwelling time can be appropriately extended. Chang Yujie [4] and others think that phlebitis is the main reason that affects the indwelling time of indwelling needle. In addition, unskilled puncture technique, incorrect tube sealing method, patients' own diseases such as hemodynamic changes and increased vascular permeability may lead to fluid leakage, catheter blockage or prolapse, which may lead to catheter failure.

Among the 265 indwelling catheters in peripheral veins analyzed in this paper, 39 cases stopped indwelling due to liquid extravasation or catheter blockage, accounting for 65,438 04.7% of the total, and 2 cases developed phlebitis, accounting for 65,438 0.3% of the total. These abnormal stops seem to have no obvious relationship with prolonging indwelling time. In the process of applying venous indwelling catheter, the author realized that the most important factors affecting the service time of indwelling catheter are: 1, improper selection or fixation of indwelling catheter; 2. Inputting polymer liquids and drugs that stimulate blood vessels; 3. The patient's own vascular problems; 4. Improper sealing method. The author found that in the application of indwelling needle, the most important thing is to observe the local redness and swelling of the needle eye and deal with it in time, which can generally avoid phlebitis.

Due to the influence of vascular sclerosis, the hardness and brittleness of blood vessels have changed obviously in the elderly, which requires high puncture technology. However, for a successful puncture, the influence of indwelling time seems to have nothing to do with age, and the average indwelling time can exceed 5 days.