During venipuncture, the thumb and forefinger of the right hand hold the upper and lower surfaces of the needle handle, and after puncturing the skin, the thumb and forefinger hold the front and rear surfaces of the needle handle, which has high puncture success rate and mild pain for patients. Because in the initial stage of needle insertion, the contact area between the upper and lower surfaces of the hand-held needle handle is large, the force is uniform, the needle insertion is stable, the needle insertion speed is fast, the pain action time is short, and the patient's pain is light. After the needle pierces the skin, the thumb and forefinger hold the front and back of the needle handle, exposing the tail of the needle bar, which is convenient for observing venous blood return and avoiding puncturing blood vessels.
2. Venous puncture of different patients
For those whose blood vessels are thick and obviously easy to be fixed, the needle should be inserted at an angle of 20 from the front or side; For those who have few subcutaneous fat veins and are easy to slide, it is easy to succeed to tighten the skin with the left hand to fix the blood vessels and quickly enter the skin from the right side of the blood vessels at a 30 angle. For patients with dehydration or insufficient blood vessel filling, first use hot compress to dilate blood vessels, and the needle quickly enters the skin at an angle of 25 from the front, and then gently stir the skin. When the needle is inserted 1/4, the needle inclines slightly downwards, and then the vein is picked up to slowly put the needle in place, so that the upper and lower blood vessel walls are separated to avoid puncturing the blood vessel. For patients with edema, the thicker blood vessels should be selected, and the thumb should be pressed along the blood vessels to expose them, and the needle should be inserted quickly after disinfection; The patients with scalp venipuncture used a 5-angle straight puncture, and after entering the skin, they slowly sneaked in the direction of blood vessels, and succeeded after seeing blood return.
3. Simple blood transfusion method
Conventional clamping regulator after infusion and exhaust. The front end of the infusion tube at the lower part of the regulator is folded back, and 0.2 ml or 0.5 ml of liquid at the extrusion front end is fixed and folded back. After the puncture needle enters under the skin, loosen and fold back, and puncture the blood vessel according to the conventional method. Once it penetrates the blood vessel, you can see a rapid blood return. If there is no blood return in the blood vessel, you can squeeze the plastic tube of the scalp needle distally by hand to increase the negative pressure in the scalp and see obvious blood return.
4. Non-fist puncture method
When the tourniquet is tied, the back of the patient's hand naturally stretches upward, and the nurse's palm is downward, firmly grasping the root and finger of the patient's finger, with the thumb and forefinger on both sides of the back of the patient's hand, tightening the skin of the back of the hand, and selecting blood vessels for puncture, with the puncture angle of 5 ~ 15. This method exposes blood vessels obviously and is easy to puncture successfully.
5. Pressing method after needle drawing
The needle eye of skin and the needle eye of blood vessel are often not at the same point during venipuncture, and the distance between them is related to the angle of needle insertion and the thickness of subcutaneous fat. Therefore, when the needle is pulled out after infusion, the cotton swab is directly pressed on the blood vessel in parallel, and the tip of the cotton swab exceeds the proximal end of the skin needle eye 1 ~ 2 cm, so that the skin needle eye and the blood vessel needle eye are simultaneously pressed. Don't pull out the needle when pressing the blood vessel hard, because the pressing force and the acute angle of the needle tip will produce shear force when pulling out the needle quickly, which will lead to mechanical damage of cutting off the blood vessel. Instead, gently press the skin, quickly pull out the needle and then press it slightly for 2 ~ 3 minutes to reduce the occurrence of subcutaneous bleeding. After venipuncture in the elbow, let the patient straighten his forearm and press the cotton swab parallel to the blood vessel for 3 ~ 5 minutes. Don't bend his elbow to stop the bleeding. So as not to form subcutaneous congestion.
6. Damage to blood vessel wall caused by different needle insertion lengths.
Through clinical observation, venipuncture in the same part of the same body, the same drug, the needle enters the blood vessel for a short time, which has little damage to the blood vessel, long service life of the blood vessel and little pain response of the patient, and vice versa. This is mainly due to the local mechanical damage to the blood vessel wall caused by injection. The longer the needle enters the blood vessel, the larger the area of mechanical stimulation and damage to the blood vessel wall, the more serious the damage to the blood vessel wall, the more red blood cells and their plasma components exude, and the more obvious the blood vessel congestion is. Because a large number of vascular endothelial cells are damaged and collagen is exposed, it is easy to stimulate thrombosis and thrombosis polarization and block the lumen. It is suggested that the length of the needle entering the vein should be reduced as much as possible on the premise that the needle can be firmly fixed after blood transfusion. Especially for patients with critical diseases, chronic diseases and tumors, long-term infusion chemotherapy has important clinical use value for prolonging the service life of patients' veins, relieving patients' pain and preventing phlebitis.
7. "S" type fixing method
Scalp venipuncture can be fixed with "S" type, that is, after the puncture shows blood return, it is fixed with 4 tapes (0.8×7cm). The first adhesive tape is attached horizontally to fix the needle handle, and the second adhesive tape is fixed after passing through the needle handle downwards. One end of the third adhesive tape is horizontally attached to the needle eye of the skin, and the other end is horizontally attached to the scalp needle plastic pipe, so that the scalp needle plastic pipe is fixed on the left or right side of the needle handle. One end of the fourth adhesive tape is horizontally attached to the third adhesive tape to overlap and fix the scalp acupuncture plastic pipe, and the other end is horizontally attached to the downward bent plastic pipe of the scalp acupuncture and skin to fix the scalp acupuncture plastic pipe into an S-shape. Its characteristics are: (1) forms two bends, with large buffering force; (2) the curvature of bending is small, and the lateral force of the needle is small; (3) Two fixed points are added to the needle, and the needle with more fixed points has good stability. This method conforms to the mechanical principle, is simple to operate, easy to fix and has a good effect. It is an ideal scalp vein puncture and fixation method.
To sum up, these skills can make venipuncture as painless and slightly painful as possible, improve the success rate of hitting the nail on the head, avoid mechanical and chemical damage to blood vessels, and make infusion technology develop in a fast, accurate and safe direction, which is worth popularizing and applying.