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Clinical application

Safety hazards and preventive measures of microinjection pump in children’s rehydration fluid

High precision injection pumps are widely favored in clinic because of their high accuracy, strict control of infusion speed and maintenance of effective drug concentration in the blood. Microinjection vegetables are mainly used in neonatal infusion and somatostatin application in pediatric surgery, and there are still some safety risks in long-term application.

1. Security risk analysis

1.1 Failure of precision injection pump

The failure of precision injection pump is mainly due to inaccurate speed and delay of blocking alarm. The above reasons are mainly caused by improper maintenance, the application of high-viscosity drugs in micro dishes, resulting in increased friction resistance with the tube rail, and inaccurate calculation of drip rate. In addition, the empty needle size of the micro pump and the compliance of the extension tube can affect the calculation of drip speed and the alarm delay.

1.2 Venous return

In the process of intravenous infusion, the extension tube falls off, the tee tube is not tightly connected, and the arteriovenous damage can cause venous blood return. Some scholars also believe that the infusion speed is too slow, the pipe is discounted, the extension tube is too long, and the infusion liquid is not high enough, which can cause venous blood return.

1.3 Pipeline Blockage

(1) Forget to open the tee switch during the infusion; (2) The fluid infusion is too slow, which leads to cell agglutination in and out of the needle, blood clot formation, and blockage of the hair needle head; (3) After suspending micro-injection for various reasons, forget to start the precision injection pump, resulting in venous blood clotting or needle blood clotting; (4) The chemical reaction of the drug causes the sediment to block the tube.

1.4 Phlebitis

In general, the higher the concentration of liquid injected by the injection pump, the higher the possibility of phlebitis and venous sclerosis. In the “Standard of Nursing Practice for Infusion Therapy” organized and published by the American Society for Intravenous Infusion Nursing (INS), it is proposed that liquids or drugs with a p H value lower than 4.3 or greater than 11 are not suitable for peripheral intravenous infusion. However, in the rescue process of serious diseases in children, due to the difficulty of establishing other pipelines, the condition is urgent, and the infusion is forced to cause phlebitis.

1.5 Drug exosmosis

The reasons are related to the loose connection of the micropump tube and the displacement of the venous catheter. When the injection speed of micro pump is slow, if the local swelling of deep vein puncture is not detected in time, drug extravasation may lead to local tissue necrosis

Step 2 Discuss

With the gradual increase in the scope of application of micro-injection pump, the frequency of application, micro-injection pump adverse accident reports gradually increased, the causes of its occurrence can be roughly divided into two categories, one is the instrument itself failure, the second is improper human operation, so reduce the micro-injection pump adverse accident, should focus on the above two aspects of hands, to ensure the safety of children. Develop preventive measures for different security risks, mainly including the following points.

2.1 Reduce microinjection pump failures

(1) In the process of daily application of micro-injection pumps, strictly implement the quality control standards for the use of micro-injection pumps; (2) Establish a micro injection pump guarantee card, record in detail the name of the micro pump instrument, department number, manufacturer, origin and product information, warranty time; (3) Establish a registration system for the transfer and actual use of micro-injection pumps. After the application of micro-injection pumps, the responsible person shall check and accept them to ensure the good condition of micro-injection pumps. After receiving them, the management personnel of micro-injection pumps shall strictly implement the storage system of micro-injection pumps.

2.2 Prevent venous blood return

(1) For drug infusion with less strict administration speed, press the Fast button immediately after the occurrence of venous return blood, and quickly flush the venous return blood into the human blood vessel; (2) Connect the syringe with.9% sodium chloride injection at the needle and slowly push the blood back to the person; (3) After the needle blood clot appears, the syringe can be extracted first, and after ensuring that the pipeline is smooth, the injection of ○ 9% sodium chloride injection is flushed into the tube and then resumed.

2.3 Prevent pipe clogging

(1) Strengthen the inspection, the itinerant nurses strengthen the inspection of the use of children’s micro-pump during the infusion process, ensure that the pipeline is smooth, not discounted, and prevent the pipeline bending and blocking caused by children’s hyperactivity; (2) Strengthening drug compatibility learning; (3) The medicine should be followed by the person

Observe carefully for 15 min to determine whether there is drug precipitation in the pipeline; (3) In view of needle blood clots and tube clotting caused by slow infusion rate of some drugs, it is recommended to use a 20 ml syringe or increase the unit drug concentration of enzymes to improve the injection rate; (4) Strengthen the training related to the operation of micro-pumps, organize relevant assessments regularly, promote nurses to fully grasp the performance of micro-pumps and relevant precautions, and comprehensively improve the business knowledge of micro-pumps.

2.4 Prevention of phlebitis

(1) Before puncture, vascular veins with good elasticity, unobtrusive reflux, thick diameter and high puncture success rate should be selected to avoid damage to the vascular intima caused by repeated puncture;
(2) When the pH value is large or small, the central vein tube can be selected;
(3) For some drugs that are easy to cause phlebitis, a micro-injection pump with 0.9% sodium chloride injection can be selected to carry liquid continuous drops to reduce the unit drug concentration, reduce vascular stimulation, and reduce phlebitis.

3. 5 Drug exosmosis

(1) Closely observe the local adverse reactions of intravenous infusion, whether they are accompanied by abnormal conditions such as redness and exosmosis, especially in deep vein puncture, it is necessary to ensure that the skin and dressing around the puncture mouth are clean and dry, and the deep vein puncture tube is properly and firmly fixed by transparent application. During daily shift change, the inspection of the tee joint is strengthened to confirm whether the tee joint is firmly connected. The fixation of the deep venous catheter was observed and recorded every 2 hours. Once drug extravasation was found, drug infusion was stopped immediately and intravenous puncture was re-selected. (2) Strengthen drug management. Infusion of high-risk drugs not only increases the probability of drug extravasation, but also leads to necrosis of local tissues after extravasation, so it is very important to strengthen infusion management of high-risk drugs. To establish and improve the management system of high-risk drugs, high-risk drugs are uniformly marked in red, the allocation and use of high-risk drugs are standardized, and standardized metering dishes are used in the allocation and injection process to ensure the accurate dose of drugs.