When I arrived at the hospital the next day, Jin Wenhui arrived before me, and the time was only 7:40, and most of the employees had not yet arrived.

"Sister Wen Hui, so early?" I held my teacup and prepared to receive a glass of water.

"Morning, Wind Chime, when did you come back last night?" I don't even know!" Jin Wenhui said in a low voice.

"Oh, ten o'clock, I'm late to come back, I'm afraid I'll wake you up. ”

"No wonder, I don't know, if I did, I'd wake you up in the morning. ”

"It's okay, why don't you feel like there's no one at work today?" I said slowly after taking a sip of green tea.

"Today's weekend, most of the office area has to rest, and a distinguished guest will come later, otherwise I will sleep at home. ”

"Looking at my memory, no wonder the manager didn't see anyone, Lin Jing probably fell asleep. ”

"Not necessarily, from what I know of her, she's a very disciplined person, so your inference doesn't exist. Jin Wenhui smiled, and poured a cup of tea and drank it by herself.

"It seems that the most undisciplined one belongs to me, and occasionally I am late." ”

"I think it's very good, people who live too regularly also have a lot of troubles, such as me, the life of three points and one line, I haven't had time to do a spa recently, and if I continue like this, I have become a yellow-faced woman. ”

"Gaga, Sister Wen Hui, if you can turn your skin into a yellow-faced woman, then there will be no beauty in the world. ”

"Haha, it's better for you to speak nicely, let's go, follow me to inspect the inpatient department. ”

I followed behind Jin Wenhui and walked to the inpatient department, no wonder Jin Wenhui always said that he had been very busy recently, the aisles were full of people, many parents held their children on drips, and I seemed staggering when I walked.

I saw a child's bag in his hand, and the adults were asleep, so I didn't pay attention at all, so I quickly called Jin Wenhui to stop.

Jin Wenhui turned her head and said, "What's wrong?"

I pointed to the child's hand and said, "Look, it's all swollen like this, I'll take care of it." ”

The infusion tube entered the air, I discharged the gas first, the little boy was very obedient, and he didn't cry, I took the indwelling needle, and the nurse hurriedly ran over: "Jin Dong, I'm sorry, I fell asleep." ”

Jin Wenhui frowned and said, "Deal with the patient's hand first, and then talk about it later." ”

I said to Jin Wenhui: "Considering phlebitis is not necessarily a nurse's problem. ”

Jin Wenhui was a little incomprehensible: "It's not the nurse's problem?"

"Yes, generally speaking, indwelling needles can stay for three days, but many patients only stay for one day before having to withdraw the needle. ”

"Is it because of the patient's discomfort?"

"Probably, there are many reasons for only one day to pull out the needle, the infusion drip rate is slowed down, there is swelling at the puncture site, just like this little boy's hand, it is likely that it was slightly swollen before the puncture, some experienced nurses are likely to pay attention, many interns will ignore this situation, and there is also a situation where drug extravasation is considered (the infusion fluid contains 10% Of course, this situation is too common, and there is also a kind of resistance of patients to drugs, but this situation is generally rare, and the drugs used for children are relatively small doses, and the body's resistance is not large, which can be ruled out. ”

The nurse has dealt with the swollen part of the little boy's left hand, and changed to the other hand to continue to inject intravenous drips, from the perspective of this nurse's infusion technology, at least in the clinical work for more than five years, very skilled, just like this nurse said, he fell asleep, the night shift itself is very fortunate, for an adult's physical tolerance is a great test, looking at the nurse's sallow face, and then look at myself, I really don't know how to be in the blessing.

Jin Wenhui came to the nurses' station, and it happened that the shift was being handed over on this floor, and Jin Wenhui and I were standing next to me to listen.

The head nurse Qian Wei was very dissatisfied, the boss never inspected, and today I don't know that the wind blew the boss, and there happened to be a problem, which made his old face where to put it.

Jin Wenhui answered a phone call, pulled me out and said: "There are guests in the office, I'll go to receive it, please tell them about the use of indwelling needles and some precautions, I negotiated the problem just now with the head nurse, and asked them to rectify it immediately, fortunately for you, see you later." ”

"No problem, you go get busy, I'll come back to you later. ”

After Kim left, I went back to the doctor's office to participate in their shift.

"Li Qin, how did you go to work? The patient's hands are swollen like steamed buns, you are still sleeping, what should you do if you die? Who can afford this responsibility?" Qian Wei, the head nurse, roared slightly.

Li Qin lowered his head, not making a sound, since Jin Wenhui explained to me, I must still set an example, I said to everyone: " The head nurse, dissipate the gas, Jin Dong said, don't take it as an example, this is very common in clinical practice, everyone is a comrade-in-arms in the trenches, learn a lesson, Nurse Li, don't blame yourself, Jin Dong told me to rest for two days, I hope to see you the day after tomorrow is a state full of energy to work, I will not delay everyone's time, ten minutes, I will explain to you some related matters of indwelling needles. ”

still gave me face, and I didn't make a sound.

I cleared my throat and said, "Let's just say that the little patient just now, it is likely that his first indwelling needle can stay for more than three days, and the second time can only stay for one day, aside from the slowing down of the drip rate, drug extravasation, and puncture site, these reasons, because it is the same patient, the infusion of fluids and drugs is basically the same, and the indwelling needle puncture site is also the same." To talk about the differences, I personally summarized two points, the first point, the manufacturer of the indwelling needle is different, the first indwelling needle is a well-known brand of safety indwelling needle, the second puncture is another brand of indwelling needle. That is, the material and production process of the indwelling needle are not the same, the second point, the nurse who performed the indwelling needle puncture is not the same person, there may be differences in the level of operation, of course, I am not questioning your puncture level, can enter our hospital are first-class puncture masters, clinically, the indwelling needle is often extubated due to complications, such as cannula blockage, subcutaneous hematoma, The occurrence of these complications is positively correlated with the indwelling time of the indwelling needle, so is the standard for the indwelling time of the indwelling needle 3 days? Why is it used for 7 days at a time for the same patient? It is only used for 1 day at a time? What standard should be referred to for the standard of indwelling needle extraction? Does the head nurse know?

I deliberately made things difficult for this head nurse, and I was very unfriendly to the nurse named Li Qin just now, and I knew how to throw the pot when something went wrong, so why didn't I talk about my own problems? Since I am the head nurse, I have to set an example, and when something happens, where was the head nurse there? What was she doing? The salary was higher than anyone else's, and she did less than anyone else? And she liked to shake the pot.

"This ...... Or bother the little handsome guy to explain it. Qian Wei obviously couldn't answer.

I frowned and said: "Give all of you a week's time, next Monday to operate the exam, the salary of those who have passed the test will be increased by three hundred yuan this month, and those who can't pass the test will be eliminated, this is the most basic operation, I hope I can still see you next Tuesday, everyone take out a notebook and write it down, according to the "Intravenous Therapy Nursing Technical Operation Specifications" issued by the Health and Family Planning Commission of our country, it is clearly stipulated that the peripheral venous indwelling needle should be replaced once every 72-96 hours, remember this time, and the test must be taken on Monday. The article also explains as follows: under the premise of fully evaluating the puncture site and blood vessels without complications, in principle, the peripheral intravenous indwelling needle should be replaced after 72 to 96 hours of use, and the infusion of drugs that are irritating to the blood vessels, such as after the injection of contrast agent and after the use of anesthetic drugs during surgery, should be extubated immediately when phlebitis and other complications occur, and the catheter should be reinserted at a new site, in accordance with the INS "Practice Standards for Infusion Therapy" Removal of vascular access devices cannot be based solely on the duration of indwelling, as the optimal duration of indwelling has not been determined, and the standard also mentions that a short peripheral venous catheter should be removed if it is no longer part of the care plan or has not been used for 24 hours or more. The criteria for selecting a short peripheral catheter should be combined with the expected infusion treatment time, such as less than 6 days, considering the infusion characteristics (such as stimulation, packing, osmotic pressure), of course, the INS standard has more specific implementation rules, we will not list them one by one, after coming down, what is the view of the nursing department on the indwelling time and removal criteria of the indwelling needle?

There are many factors that affect the indwelling time of indwelling needles clinically, including but not limited to the following.

1. Puncture site: The vein selected during puncture should have the following conditions. That is, it is thick and straight, has abundant blood flow, has good elasticity, does not have a venous valve, and avoids the links and venous valves. Large veins such as the median elbow vein of the forearm and the important vein are ideal for the use of indwelling needles, and the lower extremity veins should not be used in patients who can get out of bed.

2. Selection of indwelling needle: choose relatively thin and short indwelling needle, the cannula material has good flexibility, low irritation, and good elasticity of bending at will, which can reduce the incidence of phlebitis and relatively prolong the indwelling time.

3. Operation factors: 2.5-3 cm for the hose to enter the vein during operation, when it is too shallow, it can cause the liquid to overflow slowly from the puncture point and shorten the indwelling time. The most important point is that emotional work is strictly prohibited, once it is found that it is dealt with seriously, what is lost or wronged, and the emotions are vented on the patient, what is this called? Two words of crime, I hope you remember, avoid rough action to reduce the damage to the inner wall of the blood vessels, to avoid causing blockage; disinfectant should not be too much, and need to be dried before puncture, to avoid phlebitis caused by chemical stimulation of disinfectant, the disinfectant referred to here is 75% alcohol.

4. Aseptic operation: infection is one of the reasons affecting the indwelling time, it is necessary to establish the concept of aseptic, the operator should pay attention to hand hygiene, prevent cross-infection, check the packaging and expiration date of the indwelling needle, strictly aseptic operation, and strive for a successful puncture.

5. Patient factors: When the patient is in a state of high tension or a state of high cohesion, I will explain in detail, when the patient stares at you and your needle, it is easy to cause local thrombosis; when the patient's compliance is poor, it is difficult to put nursing measures in place, often due to human factors caused by blood vessel blockage, and even infection, thus shortening the indwelling time.

6. Drug factors: mannitol, fat emulsion, amino acids, energy mixtures and vasoconstrictors, which are commonly used in general, stimulate blood vessels and easily cause local phlebitis.

7. Sealing method: the proper sealing method can prolong the indwelling time, and the study proves that the use of pre-flushed catheter irrigator can reduce the occurrence of cannula blockage and phlebitis.

8. Piston clamping site: The distal end of the extension tube can increase the blood return rate and increase the corresponding occlusion rate, thereby shortening the use time of the indwelling needle, so it should be avoided to clamp the distal end of the extension tube clinically.

Finally, in the process of infusion with indwelling needles, continuous moist and hot compresses can be used to puncture the side limb, improve blood circulation, and reduce the occurrence of complications such as phlebitis. Doing a good job in health education can improve patients' compliance, thereby improving patients' self-care ability.