3种头皮静脉穿刺手法在烧伤患儿中的应用及效果分析

静脉输液是患儿治疗和抢救给药的重要途径，特别是烧伤总面积超过10％的患儿，需迅速建立静脉通道补液治疗以防止休克发生，静脉输液通道就是烧伤患儿的生命线。小儿头皮静脉丰富，浅表易见，不易滑动，进行头皮静脉输液既不影响患儿保暖，又不影响肢体括动，是小儿首选的静脉输液方法。临床护士进行小儿头皮静脉输液穿刺有3种常用手法，而《护理学基础》上并未对静脉穿刺具体手法作规定或比较。为此，2003年1月-2005年12月，对311例3岁以下烧伤患儿，采用3种手法行头皮静脉穿刺，探讨烧伤患儿头皮静脉穿刺最佳手法。     

烧伤小儿静脉穿刺失败原因分析及护理

目的探讨烧伤小儿静脉穿刺失败的原因及护理。方法通过加强护士心理素质培养,选用合适的针头及静脉,根据烧伤病情不同分期和血管特点,采用不同穿刺方法,而且重视穿刺后护理。结果有效提高烧伤小儿静脉穿刺成功率。结论针对引起烧伤小儿静脉穿刺失败原因,实施有效的穿刺方法,能提高烧伤小儿静脉穿刺成功率,减轻烧伤患儿及家长的痛苦,对及时抢救烧伤小儿提供了重要保证。     

烧伤患儿静脉穿刺的体会

烧伤患儿静脉补液及用药是其抢救和治疗的主要途径，特别是在患儿大面积烧伤休克期占有重要的地位。若静脉穿刺一次成功，可迅速建立静脉通道，不仅为烧伤的抢救和治疗提供了有效的保证，还为建立良好的护患关系打下基础。因此，熟练掌握小儿烧伤静脉穿刺技术非常必要。现将我科近年来提高小儿静脉穿刺成功率的经验和体会报告如下。     

烧伤患儿头皮静脉穿刺与固定技巧

2002年7月-2007年7月，我们对180例烧伤患儿进行静脉输液，经临床实践，采用头皮静脉穿刺，既不影响患儿保暖，又不影响肢体活动，是首选的静脉输液方法。现报告如下。     

危重烧伤病人阴茎静脉穿刺的技巧和方法

大面积烧伤病人由于伤后高代谢、负氮平衡、体液丢失过多,尤其是体液渗出期,胃肠功能紊乱,休克感染治疗中需要立即静脉补液。因病人体表静脉大多被破坏,穿刺条件差,所以利用阴茎静脉穿刺输液在危重烧伤病人中起了很大的作用。现将我们的做法介绍如下。     

大面积烧伤患儿头皮静脉留置针的护理

快速补液是抢救烧伤休克患儿的关键措施，但是小儿由于年龄特点，一般头皮静脉穿刺，由于烧伤后疼痛易动、导致针头滑出血管外，不得不重新穿刺，既增加患儿痛苦，又易引起护患纠纷，甚至导致药物及液体不能准确、及时输入延误治疗。近年来，小儿头皮静脉留置针在我科烧伤患儿中被广泛应用，现将具体操作及置管期间的护理叙述如下。     

特大面积烧伤患者分期静脉穿刺体会

物大面积烧伤患的静脉穿刺是烧伤护理工作中的难点之一，笔就烧伤患各期的静脉穿刺部位选择、穿刺方法、固定等进行了探索，体会到在烧伤患休克期选用大静脉穿刺，在感染期和恢复期选用周围小静脉穿刺，可以达到为急救赢得时间，避免静脉切开之苦，减少因静脉切开而导致的败血症、化脓性静脉炎等并发症发生的效果。     

烧伤患儿头皮静脉的穿刺技巧

头皮静脉穿刺适用于新生儿及3岁左右的儿童.更适用于烧伤患儿,因烧伤后患儿一方面因疼痛等原因哭闹不安,挣扎、烦躁,不配合操作,另一方面,烧伤后患儿因血容量不足致血管弹性低、呈扁平、导致静脉穿刺困难.因此熟练掌握静脉穿刺技巧,不仅减轻了患儿的痛苦,又保证了治疗与抢救的需要.现将如何提高烧伤患儿头皮静脉穿刺成功的几点体会报道如下.     

股静脉穿刺置管在大面积烧伤治疗中的应用价值

目的探讨股静脉穿刺置管在大面积烧伤治疗中的应用价值。方法对73例大面积烧伤患者采用中心静脉导管针穿刺股静脉置管并留管。结果股静脉穿刺置管成功率高，导管保留时间长，并发症少，能很好地解决大面积烧伤患者输液困难的难题及开放静脉营养供给的通道。结论股静脉穿刺置管适合于大面积烧伤的补液治疗及静脉营养补充。     

两种小儿手背静脉穿刺方法的对比

目的提高小儿手背静脉穿刺成功率，减轻患儿的痛苦，保证医疗计划顺利进行。方法将120名1．5～6岁需静脉输液的患儿，随机分为2组：试验组和对照组，每组60人，均采用手背静脉输液，试验组穿刺前先固定患儿手背，对照组采用传统法，比较2种穿刺方法的首次穿刺成功率，及输液外漏率。结果试验组首次穿刺成功率明显高于对照组，液体外漏率低于对照组，结果经统计学处理，具有显差异。结论患儿手背穿刺前，采用先将其手背固定法，可以提高首次穿刺的成功率，减少液体外漏率，提高护士的工作效率，减轻患儿的痛苦。     

The use of EMLA cream to decrease venipuncture pain in children

Venipuncture is one of the most painful medical procedures for a child, and it is one of the most frequently performed. This literature synthesis reviews evidence for the use of eutectic mixture of local anesthetics (EMLA) cream to reduce the pain children experience during venipuncture. EMLA cream was compared with placebo, iontophoresis, and amethocaine cream and was found to be an effective local anesthetic for pediatric venipuncture pain during both intravenous cannulation and phlebotomy.     

Pediatric burns

The burned child requires a management that is different from that employed in the burned adult because of physiologic and psychological dissimilarities, although basic principles of management are the same. Particular problems and treatment of the burned child are highlighted.     

Ketamine. A solution to procedural pain in burned children.

Our experience has shown ketamine to be a safe and effective method of providing pain relief during specific procedures in burned children. It renders high doses of narcotics unnecessary and offers children the benefit of general anesthesia without the requirement of endotracheal intubation and a trip to the operating room. The response of parents and staff to the use of ketamine has been positive. Parents often experience feelings of guilt following injury to a child and are eager to employ methods that reduce their child's pain. So far, no parent has refused the administration of ketamine; some have even asked that it be used during subsequent procedures on their child. With adequate pre-procedure teaching, parents are prepared for the possible occurrence of emergent reactions and can assist in reorienting the child during recovery. Staff have found that the stress of doing painful procedures on children is reduced when ketamine is used. The procedures tend to be quicker and the predicament of working on a screaming, agitated child is eliminated. At the same time, nursing staff have had to get used to the nystagmic gaze of the children and accept that these patients are truly anesthetized even though they might move and talk. Despite the success we and others have had with ketamine, several questions about its use in burn patients remain unanswered. The literature does not answer such questions as: Which nursing measures reduce the incidence of emergent reactions? How many ketamine anesthetics can safely be administered to one individual? How does the frequency of administration relate to tolerance in a burn patient? Are there detrimental effects of frequent or long-term use? Clearly, an understanding of these questions is necessary to determine the safe boundaries of ketamine use in burn patients. Ketamine is not a panacea for the problem of pain in burned children. But it is one means of managing procedural pain, which is, after all, a significant clinical factor in treatment and recovery.     

A school reentry program for burned children. Part I: Development and implementation of a school reentry program

Sustaining a burn injury is a devastating and painful experience. After acute concerns have been dealt with, continued support of the child and family is important in achieving a smooth return to normal activities. Reports from burned patients for whom physical therapy was a concern identified a need for physical therapy involvement in school reentry to facilitate a resumption of normal school routine. Physical therapy involvement in school reentry has been successful and rewarding with a reasonable commitment of manpower. Utilization of personnel in the administrative structure of state and local school systems promoted the acceptance of the program by local school personnel. Although this program is designed to meet the needs of burned children, the goals of the school reentry program may meet similar needs of children with other chronic illnesses.     

Multidisciplinary approach to working with burn victims of child abuse

Successful outcomes in abuse cases are dependent upon close coordination of professional hospital staff with referring agencies including child protective services and the legal and judicial systems. A four-year retrospective study of 369 pediatric burn patients admitted to our Burn/Trauma Center was completed to: (1) assess demographic factors of patients and families that differentiate cases of child abuse from cases of children burned as a result of accidental injury, and (2) determine the impact of a multidisciplinary team approach to working with abused children and their families during the course of hospitalization. When medical evaluation reveals the possibility of child abuse, a social work assessment, including a developmental history of the child and psychosocial assessment of the family, is crucial. In addition, physicians must be well versed in the gathering of evidence for potential utilization by the legal system. This includes the obtainment of photographs and detailed documentation of the burn injury. A plan of evaluation and the effective coordination of services during hospitalization and following discharge have proven essential to meeting the best interests of the child.     

两种操作方式对静脉滴注七叶皂苷钠致疼痛的效果观察

目的:探讨减轻静脉滴注七叶皂苷钠所致疼痛的护理方法。方法:对230例患者采用自身对照比较,即连续2d在患者左右手对称部位各静脉穿刺1次,两次分别采用常规固定加局部热敷和翻转针柄固定加中药包外敷。结果:采用翻转针柄固定加中药包外敷法患者疼痛发生率明显低于常规固定加局部热敷法(P<0.01)。结论:翻转针柄固定加中药包外敷能显著减少静脉滴注七叶皂苷钠所致疼痛的发生率。     

Auditory brainstem response in auditory assessment of acute severely burned children

The burn population often requires ototoxic drugs in the treatment of infection. Previous investigations indicate that cochlear damage and auditory impairment may result from this medical therapy. In recent years, the auditory brainstem response (ABR) has assumed an important role in pediatric auditory assessment. We describe a test protocol for ABR assessment in the severely burned child. In a series of 69 acute severely burned children, 13% showed evidence of auditory deficit by the ABR. Based on our experiences, we recommend the inclusion of routine auditory evaluations, including ABR, in the diagnosis and rehabilitation of these children.     

静脉穿刺后两种不同拔针方式的对比性研究

目的比较静脉穿刺后两种不同拔针方法的优缺点。方法将108例普通头皮针穿刺后的患者随机采用A、B两种不同拔针方式。A组拔针为：输液完毕关闭输液夹,迅速拔出针头。B组拔针为：输液完毕折住头皮针软管迅速拔出针头,对两组的临床资料进行比较分析。结果B组拔针方式明显优于A组,两组比较差异有显著意义（P〈0．001）。结论输液完毕折住头皮针软管迅速拔出针头是首选拔针方式。     

Venipuncture versus central venous access: A comparison of methotrexate levels in pediatric leukemia patients

Patients receiving methotrexate (MTX) therapy for treatment of acute lymphocytic leukemia (ALL) consistently have venipuncture MTX levels drawn twice during each hospitalization. The purpose of this study was to compare MTX levels drawn from central venous catheters (CVCs) with those drawn by venipuncture. A convenience sample of 14 pediatric patients was used, with a total of 33 peak levels and 33 trough level sample pairs collected. Venipuncture and CVC levels were compared by using the paired t-test and analyzing the peak and trough data pairs separately. Results confirmed there was no difference in MTX level results (peak, p = .502; trough, p = .114). However, the CVC trough levels would have changed clinical management for 5 of the 33 patients. Therefore, it is recommended that all MTX levels be drawn from the CVC but that trough MTX levels that would alter clinical management be verified by a venipuncture sample. This method will safely minimize the number of venipunctures for children with ALL.     

Needlestick injuries, short peripheral catheters, and health care worker risks

Percutaneous exposure (PCE) and mucocutaneous exposure (MCE) to blood and blood-containing body fluids pose risks to health care workers worldwide. Although PCEs have been greatly reduced in the United States, they have not been eliminated and continue to be a significant problem worldwide. MCE seems to be a much smaller problem than PCE; however, the data are limited and confusing. Venipuncture procedures can easily be associated with PCE, but there are no published reports of MCE occurring during insertion, use, and removal of peripheral catheters. This integrative, systematic literature review identifies the risks associated with venipuncture and the insertion of short peripheral catheters.