Medical Equipment Icu Automatic Electronic Chemotherapy Portable Iv Infusion Pump

Clinical application

Problems and nursing countermeasures in ICU application of microinjection pump

Microinjection pump is an instrument used to pump a small amount of medicine liquid into the human body with a small amount of liquid body. It has the characteristics of accurate, uniform and continuous pumping, and has become a common instrument used in ICU to treat critically ill patients. From January 2002 to April 2008, the ICU of our hospital used microinjection pumps to inject vasoactive drugs, antistatic drugs, pancreatin, pituitarin, atropine, naloxone and other drugs in more than 2,300 patients, with the longest use time of 20 days. Micropump has achieved good therapeutic effect in controlling blood pressure, controlling blood sugar and ensuring the optimal blood drug concentration, but it also causes some dangerous factors that cannot be ignored, such as not skilled operation procedures, tube removal, and instrument interruption of pumping. It will now be used and stored
In some of the problems further analysis, and put forward the corresponding nursing policy, in order to improve the rescue power and nursing quality, to ensure the safety of patients.

1. Existing problems and analysis
1.1 Irregular operation procedures, not familiar with the practice of individual nurses, especially nurses who just entered the ICU, are not skilled in the procedure of micro-injection pump operation, do not proceed according to the procedure, and lack of setting for a certain link. In addition, the various kinds of micro injection pumps currently used include domestic micro injection pumps, and the interface used is mostly indicated in English, which creates certain obstacles for nurses to grasp its performance, use methods and steps as soon as possible, thereby affecting the use of the function, resulting in delayed use of medicine and delayed treatment.
1.2 Accessories of micro-injection pump do not match the amount of liquid injected by the micro-injection pump is small, and the sensitivity is high. The mismatch of accessories often affects the spiritual sensitivity of the micro-pump. If the size of the disposable syringe is not suitable, the needle clamp will not be fixed firmly. Lead to needle slip or drug liquid remaining more and the instrument will start to alarm, in addition, if the use of the extension tube is too soft can make the venous access blocked, but the micro-pump due to sensitivity and failed to report the alarm, resulting in the impact of drug pumping.
1.3 Drug measurement units and calculation units are not uniform. At present, there are two commonly used clinical dose units: ptg/(kg·min) and g/(kg·h). . However, different hospitals have different calculation methods on how to rationally allocate drugs and timely and conveniently adjust the concentration of drugs pumped into them. Some methods are complicated and error-prone to calculation, which is inconvenient for drug dose adjustment, easy to cause inaccurate measurement, and not suitable for rescue treatment.
1.4 Do not treat the blood return during the use of micro-injection pump as an individual nurse who lacks professional knowledge and does not understand the patient’s condition and the effects of pumped drugs. When blood return occurs in the pipeline of micro-injection pump, it usually occurs when the injection device is changed at the beginning or during the use of micro-injection pump. If the nature and dosage of the injection are not considered, the use of fast-forward key treatment for blood return in the blind eye or the traditional method of accelerated injection with normal saline will lead to excessive amounts of drugs entering the patient’s body in a short time, resulting in undesirable consequences.
1.5 Drug leakage The drugs used in micro-injection pumps are mostly blood duct active drugs, with high drug concentration and irritation, and the use of micro-pump for a long time. Once the drug is leaked to the subcutaneous tissue, it can cause local blood vessels to contract strongly and cause tissue necrosis or increase the permeability of blood vessels, resulting in subcutaneous congestion and phlebitis.
1.6 Tube blocking for a long time to pump a very small amount of liquid medicine, if the use of a single vein channel, when the patient agitation, cough, sputum suction, it is easy to cause tube blocking.
1.7 The nurse’s sense of responsibility is not strong, and the micro-injection pump has a sensitive automatic alarm, including insufficient power supply alarm, residual alarm, liquid medicine pump alarm, blocking alarm, and improper contact between the syringe and the driver alarm, which make the nurse rely on the alarm when using the micro-pump. Inspect and check the situation of each pipe connector from time to time, and consider it as small
Pump does not alarm is in normal operation. As a result, the extension tube, tee joint or infusion needle connection fell off, and the infusion site swelling were not found and treated in time.
1.8 The micro-injection pump management is not perfect, non-standard continuous and long-term use of micro-injection pumps, no regular maintenance and debugging, resulting in mechanical failure and can not be used normally. In addition, during and before the use of the cleaning instrument, the thruster and power plug of the micro-pump are glued with medicine, other liquids and dust, which can easily affect the injection speed of the drug pump and cause the risk of leakage.
2. Policy
2.1 Good command of the performance of the micro-injection pump The micro-injection pump is equipped with a storage battery, which can be used continuously for 2-5h when it is transferred to the patient after charging, and can be freely charged when connected to AC power. The domestic WZ-50 injection pump can be selected from 0.01-0.99ml/h. The pumping range of the Japanese Telmo injection pump can be selected from 0.1 to 1200ml/h, and the syringe is usually selected with a disposable 5Oral syringe. Micro injection pump has a sensitive alarm system, including pipeline pressure, blocking, slide and syringe separation, margin, low battery capacity alarm, etc., to master and identify various alarm display and processing methods.
2.2 Standardize the operation steps of micro-injection pump ① Explain the work to the patient before use, strictly implement the system of three checks and seven pairs, and configure the liquid to comply with the principle of sterile operation; ② Fix the micro-pump on the support, turn on the AC power and turn on the power supply, check the power supply and instrument performance of the micro-pump; (3) Use a 50ml injector to absorb the liquid medicine and connect the extension tube, put it in the needle clamp of the micro-pump after exhaust, and fix it firmly; (4) The extension tube is connected with the static pulse channel, select the pump speed according to the doctor’s advice, press the start button “STAT” to see the injection light flashing, that is, the injection starts, and the micro-pump enters the working state; ⑤ At the end of the use of micro-pump, press the stop button first, disconnect the extension tube from the venous channel, turn off the power, sort out and clean the syringe and micro-pump. And do a good job of micro pump disinfection.
2.3 Precautions to master the use of micro-injection pumps ① nursing staff should practice and master professional knowledge and drug use and improper reaction, true adherence to medical advice, accurate conversion of special drugs; ② Strictly implement the handover system, the micro-pump should indicate the name of the drug, the dosage, the configuration time, the pump rate, etc., and the handover shift should be done to the three clear, that is, oral clarity, written clarity, bedside clarity, and strictly prevent the occurrence of wrong accidents. (3) Strengthen the inspection, pay attention to observe whether the infusion pipeline is smooth after the drug pump is injected, whether the drug liquid is leaking, leaving the tube, whether the blood tube is walking toward the rope red line, especially when turning over the patient, draining the back, and suction, especially pay attention to the pipeline situation, once the trace pump alarm occurs, find out the cause in time. And do the corresponding treatment; (4) Properly handle the blood return of the tube, replace the syringe or the patient’s agitation or cough has blood return in the pipeline, do not press the fast-forward key to handle the blood return, use another syringe to draw the liquid back, and then flush it with physiological saline, and remove the blood liquid in the extension tube, and connect it after adjusting the trace pump; ⑤ During the application period, the pump drug can not be interrupted at will, the drug is prepared in advance, and the replacement is immediately when the residual alarm light is on. The replacement action should be rapid and accurate, and the signs of life are closely monitored before and after the replacement of vasoactive drugs; Strengthen the maintenance of micro-pump, set the time to check the performance of the instrument, so that after the use of clean and clean dust, especially the thruster and track, needle clamp, to use cotton swab dipped in gasoline after scrubbing, and then dry with water. If the display device is not bright after the micro pump is connected to the power supply, the pump speed is wrong, and the alarm is out of order, it is strictly prohibited to use it for patients, and it should be repaired in time.
2.4 A simple coefficient was used to convert drug dose and pump speed. (1) A 5Oral syringe was used to calculate the common formula: total drug dose = patient body weight (kg)× coefficient (k); ② The commonly used drugs such as blood duct active drugs are divided into three categories according to the dose of administration, one category: dopamine, dopphenbutylamine, two categories: sodium nitroprusside, glycerin nitrate, ritase
D, three classes: epinephrine, norepinephrine, isoproterenol, constant number (k) : 1 class is 3, 2 class is 0.3, 3 class is 0.03; ③ The total drug dose calculated by the above formula is diluted to 50ml with normal saline or glucose. For example, the injection rate of micro-pump is adjusted to lml/h, which is equivalent to the administration rate of 1Fg/(kg·rain), such as the weight of the patient
50kg, dopamine 5~g/kg·min, therefore, the total dose of the drug =50(kg)×3=150mg, 150mg of dopamine (equivalent to 15m1) was added to the biological salt water 35 ~ 50nil, and the injection speed of the micro-pump was adjusted to 5ml/h. This is equivalent to the rate of administration of 5 “g/(kg·rain). Other drugs are calculated in the same way; (4) Clinical application proved that this method is simple, fast and easy to learn, and only needs to be calculated based on the patient’s weight, which is worthy of application and promotion. ‘
2.5 Prevention of infection to strengthen the concept of asepsis, strictly aseptic operation, tee and extension tube replacement every day, syringes for one-time use, deep venous tube placement daily dressing change, puncture points paste transparent dressing, pump tube, tee cover with sterile towel.
2.6 Strengthen the responsibility of nursing staff The condition of ICU patients is complex and changes quickly, most patients need to use micro-injection pump to maintain medication, so that although the use of micro-injection pump is convenient, fast and time-saving, but a slight error in operation may cause serious consequences, and even endanger the life of patients. Especially when using vasoactive drugs, insulin, atropine and other drugs, they must be used under close supervision, so nurses must have a high sense of responsibility, strict requirements on themselves, strengthen business learning, improve business water level, and ensure the safety and effectiveness of drugs.