3L袋输液排气技巧

随着静脉营养（脂肪乳、氨基酸混合液）在临床的开展,3L袋（一次性使用静脉营养输液袋）已成为护理人员输液的常用工具之一。然而,在临床输液过程中我们发现,3L袋在排气过程中特别容易产生气泡,原因是茂菲氏滴管转正呈垂立状态时,袋内液体呈直线流人液面,由于袋内负压加重力的作用,液体在快速下坠时可形成冲击力,而茂菲氏滴管内的液体容量不能有效地缓冲其冲击力,导致液体带着气泡快速而直接地流向下段滴管,故容易产生气泡。     

巧用一次性静脉营养输液袋

高热是儿科的常见症状,利用冰袋降温也是最常用的处置措施。自2002年起,笔者应用一次性静脉营养输液袋自制冰袋用于患儿高热护理,取得了良好的效果。     

透明敷料在处理输液袋漏液中的应用

临床上使用的软包装输液袋,因在配液及连接输液器等操作时,针头反复插入而容易造成输液袋加药口致密性降低。在日常输液过程中,出现过液体自加药口漏出,造成药液流失,影响治疗药物准确剂量的事件。以往采取的措施是：重新消毒加药口后,更换输液器进针位置。但是此方法效果不佳,原进针点仍可能漏液。笔者所在科室存临床工作中,尝试使用透明敷料解决了输液袋漏液问题,收到良好的效果,现报道如下。     

静脉输液中漏液的观察与护理

本文分析了静脉输液中漏液的危害、原因、临床表现和形成机理，提出了防止与处理漏液的措施及护理方法。     

巧用废弃一次性静脉营养输液袋贮水洗头

目的 推广一次性静脉营养输液袋制作贮水袋为卧床患者洗头.方法 对部分科室的卧床患者使用一次性静脉营养输液袋用于贮水洗头的情况进行分析.结果 经济实惠,环保,减轻了护士的工作量.结论 一次性静脉营养输液袋用于贮水洗头效果良好,值得临床推广.     

一次性静脉营养输液袋在关节镜手术中的应用

目的探讨一次性静脉营养输液袋在关节镜手术中的应用效果,以提高手术护理质量。方法2004年1月—2007年6月行关节镜手术的60例患者按年龄、手术方式分层随机分为试验组和对照组各30例。试验组使用容量为3 000 ml的一次性静脉营养输液袋作为术中关节腔的灌注装置;对照组使用传统的容量为500 ml开放式玻璃吊瓶作为术中关节腔的灌注装置。比较两组灌注装置在手术过程中加液时间、冲洗速度及手术时间。结果试验组手术过程中护理人员用于加冲洗液的时间平均需3.00 min,冲洗速度200.00 ml/min,平均手术时间125.00 min。而对照组手术过程中用于加冲洗液时间平均需20.00 min,冲洗速度110.00 ml/min,平均手术时间158.00 min。两组加液时间、冲洗速度、手术时间比较,差异均有统计学意义（P〈0.05）。结论一次性静脉营养输液袋作为关节镜手术中冲洗关节腔的冲洗液吊袋,缩短了术中加液时间,加快了冲洗速度,缩短了手术时间,减轻了巡回护士的工作强度,同时也减少污染机会,值得推广应用。     

3L袋截流夹用于三腔二囊管压迫止血

一次性使用静脉营养输液袋（临床也称3L袋）的截流夹,在输液完毕后一同被废弃。有报道,将截流夹回收后用于关夹吸痰管、鼻饲管效果好。我科自2007年3月至今,将3L袋截流夹回收消毒处理后,用于三腔二囊管两气囊阻断气流压迫止血,经多次临床验证后,无一漏气,效果好。     

自制一次性甲醛熏蒸袋的应用

输液操作中要求“一人一巾一带”，对于静脉输液较多的科室，每天会有大量的止血带、垫巾需要放到甲醛熏箱中熏蒸消毒。临床科室熏箱的使用率很高，熏箱中有湿化瓶、袖带、导管等大量物品进行消毒。止血带、垫巾数量相对零散，使熏箱内更加拥挤，杂乱。常常是因取、放物品时间稍长，导致护理人员流涕流泪。利用每整包输液器的包装袋将其剪成正反面均有大小不等小洞的熏蒸袋，将止血带、垫巾装入袋中。     

配制于3L聚氯乙烯袋中胰岛素活性的观察

目的为观察3L聚氯乙烯袋中胰岛素配制时、24h输注中其活性的变化,作者将相同单位的胰岛素配入3L聚氯乙烯袋内的不同混合液中。结果配制后即刻（0h）,全肠外营养混合液中的胰岛素活性明显高于葡萄糖盐水混合液中的胰岛素活性（P＜0．01）;不同温度保存48h内,各液体中胰岛素活性无明显降低（P＞0．05）。结论（1）尽量降低胰岛素在配制时的丢失;（2）配制后24h内输注是安全可靠的。     

Fluid leakage past tracheal tube cuffs: evaluation of the new Microcuff endotracheal tube

Objective This study compared the recently introduced Microcuff endotracheal tube HVLP ICU featuring an ultrathin (7-µm) polyurethane cuff membrane with endotracheal tubes from different manufacturers regarding fluid leakage past the tube cuff.Design In vitro setup.Measurements and results The following endotracheal tubes (ID 7.5 mm) were compared: Mallinckrodt HiLo, Microcuff HVLP ICU, Portex Profile Soft Seal, Rüsch Super Safety Clear, and Sheridan CF. A vertical PVC trachea model (ID 20 mm) was intubated, and cuffs were inflated to 10, 15, 20, 25, 30, and 60 cmH₂O. Colored water (5 ml) was added to the top of the cuff. The amount of leaked fluid past the tube cuff within 5, 10, and 60 min was recorded. Experiments were performed four times using two examples of each tube brand. Fluid leakage past tube cuffs occurred in all conventional endotracheal tubes at cuff pressures from 10 to 60 cmH₂O. In the Microcuff tube cuff pressure fluid leakage was observed within 10 min only at 10 cmH₂O. Results with the Microcuff tube were significantly better than all other tube brands at cuff pressures of 10–30 cmH₂O.Conclusions Within the acceptable upper limit for tracheal cuff pressure (25–30 cmH₂O) the Microcuff endotracheal tube was the only one of the tested tubes to prevent fluid leakage in our in vitro setup. In vivo studies are required to confirm these findings.This study was supported by Microcuff GmbH, Weinheim, Germany, by providing the Microcuff tubes without charge. No financial support was obtained from the manufacturer for the study. Dr. Weiss and Dr. Gerber serve on the Medical Board of Microcuff GmbH for the development of a newly designed pediatric cuffed tracheal tube.     

肾源性脓毒性休克合并严重肺毛细血管渗漏的液体复苏策略

目的 分析肾源性脓毒性休克合并严重肺毛细血管渗漏的疾病特点,探讨液体复苏对休克治疗的影响以及脉搏指示连续心排血量(PiCCO)监测的意义.方法 采用回顾性分析方法,选择8例在重症监护病房(ICU)进行PiCCO监测并成功复苏的肾、输尿管碎石手术后并发肾源性脓毒性休克伴严重肺毛细血管渗漏患者,均以入院为起点,休克纠正或转出为终点,记录全心舒张期末容积指数(GEDVI)、血管外肺水指数(EVLWI)、液体出入量、液体净平衡、氧合指数(PaO2/FiO2)、动脉血乳酸水平和X线胸片等指标,分析其内在联系,探讨肾源性脓毒性休克疾病的特点和PiCCO监测在休克液体复苏治疗中的意义.结果 8例患者手术后4.5 d(中位数)出现脓毒性休克,均伴有不同程度的肺毛细血管渗漏和低氧血症.入ICU时EVLWI均值为(22±7)ml/kg,PaO2/FiO2为(164±82) mm Hg(1 mm Hg=0.133 kPa);液体复苏均采用保守性策略,平均液体入量为(2412±1121) ml/d,液体净平衡-553 ml/d;中心静脉压(CVP)和GEDVI分别维持在(9±3)mm Hg和(749±236) ml/m2.其中6例使用呋塞米利尿,平均剂量(264± 133) mg;7例需要血管活性药物维持血压,去甲肾上腺素/多巴胺平均使用天数为(4±1)d;7例需要机械通气,通气时间(8±6)d.8例患者治疗后脓毒性休克均纠正,EVLWI下降至(11±3) ml/kg,肺部渗出吸收好转,平均住ICU天数(17±11)d.相关分析显示:EVLWI与PaO2/FiO2和动脉血乳酸水平显著相关,相关系数(r)值分别为-0.91和0.70(均P＜0.05).结论 准确评估血容量状态尤其是血管外肺水程度,参照血流动力学指标采取保守性液体复苏策略以及强调控制血管外肺水是成功救治肾源性脓毒性休克的关键,PiCCO是判断患者容量状态、指导液体复苏和评价治疗效果的有用工具.     

使用一次性塑料尿袋效果观察

对３８例使用一次性塑料尿袋的患者，进行尿液细菌学监测，结果有１０例发生尿路感染，感染菌为肠杆菌科细菌。通过对１０例尿路感染病例的观察，说明留置尿袋时间越长，感染率越高，且尿路感染与导尿病人的手术部位密切相关。与有关资料对比，导尿病人应用一次性尿袋对控制尿路感染的效果显著，明确了导尿病人更换尿袋的时间。     

Effect of 1,25-Dihydroxyvitamin D3 on the Renal Handling of Pi in Thyroparathyroidectomized Rats

The kidney adapts its tubular capacity to transport inorganic phosphate (P_i) according to the dietary supply of P_i in both intact and thyropara-thyroidectomized (TPTX) rats. However, in TPTX rats the capability of the renal tubule to adapt to a high P_i diet is diminished. In TPTX rats the production of the active vitamin D₃ metabolite, 1,25-dihydroxyvitamin D₃ [1,25-(OH)₂D₃], is also reduced. 1,25-(OH)₂D₃ has been shown to have a marked effect on P_i metabolism. Therefore the question arises whether the deficient production of 1,25-(OH)₂D₃ contributes to the alteration of the tubular transport of P_i observed in chronically TPTX rats. In the present investigation, vitamin D-replete rats were sham operated (SHAM) or thyroparathyroidectomized and then pair fed diets containing either 0.2 or 1.2 g/100 g P for 7 days. During this period, groups of SHAM and TPTX rats received i.p. 2 × 13 pmol/day of 1,25-(OH)₂D₃, a dose which was shown to just normalize the decreased intestinal absorption of Ca and P_i in TPTX rats. The capacity of tubular P_i transport was then assessed by measuring the fractional excretion of P_i (FEP_i) at increasing plasma P_i concentration ([P_i]_Pl) obtained by acute infusion of P_i. The results show that in SHAM rats fed either P diet, 1,25-(OH)₂D₃ has no effect on the renal handling of P_i. In TPTX rats fed 1.2 g/100 g P diet, 1,25-(OH)₂D₃ increases FEP_i over a wide range of [P_i]_Pl. In TPTX rats fed a 0.2 g/100 g P diet, 1,25-(OH)₂D₃ does not alter FEP_i up to a [P_i]_Pl of 3.0-3.5 mM, but does increase it at higher [P_i]_Pl. In fact, on both diets TPTX rats supplemented with 1,25-(OH)₂D₃ appear to have the same renal handling of P_i as SHAM counterparts. The effect of 1,25-(OH)₂D₃ was not associated with a change in urine pH or in urinary excretion of cyclic AMP and was maintained under marked extracellular volume expansion. It was associated with a rise in plasma calcium in the TPTX rats fed the high, but not the low, P diet. In TPTX rats fed 1.2 g/100 g P diet, 25-hydroxyvitamin D₃ in doses of 2 × 130 or 2 × 1,300 pmol/day i.p. did not increase FEP_i.