新生儿不同穿刺部位静脉输液安全性对比  

Comparison of Safety of Intravenous Infusion at Different Puncture Sites in Neonates

作　　者：宋芳 李崎[1] SONG Fang;LI Qi(Department of Neonatal Intensive Care Unit,the First Affiliated Hospital of Nanchang University,Nanchang 330006,China)

机构地区：[1]南昌大学第一附属医院新生儿重症监护室,南昌330006

出　　处：《实用临床医学（江西）》2018年第2期77-79,共3页Practical Clinical Medicine

摘　　要：目的探讨新生儿三种常用穿刺部位静脉输液的安全性。方法选择首次进行输液且需长期(>7d)静脉输液及无皮肤损伤的新生儿492例,分别采用头皮静脉(152例,头皮静脉组)、四肢浅静脉(172例,四肢浅静脉组)、腋静脉(168例,腋静脉组)进行输液,比较3组输液外渗、皮下血肿、静脉炎发生率,皮肤意外损伤率、留置针留置时间、一次穿刺成功率及非计划拔管率。结果 3组输液外渗、皮下血肿、皮肤意外损伤、静脉炎发生率,留置针保留时间、一次穿刺成功率和非计划性拔管率比较差异均有统计学意义(P<0.05)。腋静脉组较其他2组穿刺难度最大,一次性穿刺成功率低,但留置针保留时间长,输液外渗、非计划拔管率低,静脉炎、皮下血肿、皮肤意外损伤发生率更少(P<0.05);四肢浅静脉组使用3M自粘弹力绷带固定,较其他2组非计划拔管率降低,留置时间延长(P<0.05)。结论新生儿输液时,应根据患儿实际情况选择合适部位进行穿刺,医护人员应不断提高操作技能,对于输液时间<7d的患儿可优先考虑四肢浅静脉穿刺置管后弹力绷带加固。Objective To investigate the safety of intravenous infusion at three commonly used infusion sites in neonates.Methods A total of 492 newborns without skin damage received the first long-term infusion(>7 days)via scalp vein(viascalpvein group,152 cases),peripheral vein(peripheral vein group,172 cases),or axillary vein(axillary vein group,168 cases).Infusion extravasation,subcutaneous hematoma,skin injury,phlebitis,needle indwelling time,first attempt success rate and unplanned extubation rate were compared among three groups.Results Compared with viascalpvein group or peripheral vein group,puncture difficulty and needle indwelling time were increased,but first attempt success rate,unplanned extubation rate and incidence of infusion extravasation,phlebitis,subcutaneous hematoma and skin injury were decreased in axillary vein group(P<0.05).In group B,the use of 3M self-adhesive elastic bandage reduced the unplanned extubation rate,extended needle indwelling time,but increased the incidence of accidental skin injury(P<0.05).Conclusion Puncture site should be appropriately chosen according to the actual situation and manipulative skill should be constantly improved for neonatal infusion treatment.In addition,the elastic bandage should be used for the fixation of superficial vein catheter in infants receiving infusion treatment for shorter than 7 days.

关 键 词：新生儿 静脉输液 头皮静脉 四肢浅静脉 腋静脉 安全性 

分 类 号：R473.72[医药卫生—护理学]