有创血压监测护理常规

有创血压监测护理常规 有创动脉血压监测护理常规 一、原理及方法 有创血压(IBP)是将动脉导管置于动脉内直接测量动脉内血压的方法。IBP监测系统包括二个组件,电子系统和充液导管系统。穿刺成功后将动脉导管与充液导管系统相连,然后通过换能器将充液系统与电子监测系统相连接,调零后即可直接测量动脉血压,此测量为持续的动态变化过程,不受人工加压、减压、袖带宽窄及松紧度的影响,准确直观,是ICU重要的监测手段。 二、适用范围 1,各类危重患者和复杂大手术及有大出血手术的, 2,严重低血压、休克、严重的周围血管收缩和其他血流动力学不稳定疾病需反复测量血压的,或者无创血压难以检测的, 3,严重高血压、创伤、心梗、心衰、MODS、心肺复苏术后等, 4,需要应用血管活性药物的患者。 5,需反复采取动脉血标本作血气分析的患者。 三、禁忌症 1,穿刺部位或其附近存在感染, 2,凝血功能障碍,,对于已经使用抗凝剂的患者,最好选用浅表切处于机体远端的血管,。 3,患有血管疾病的病人,如脉管炎, 4,手术操作涉及同一部位的, appearance of the weld appearance quality technical requirements of the project must not have a molten metal stream does not melt the base metal to weld, weld seam and heat-affected zone surface must not have cracks, pores, defects such as crater and ash, surface smoothing, weld and base metal should be evenly smooth transition. Width 2-3 mm from the edge of weld Groove. Surface reinforcement should be less than or equal to 1 + 0.2 times the slope edge width, and should not be greater than 4 mm. Depth of undercut should be less than or equal to 0.5 mm, total length of the welds on both sides undercut not exceed 10% of the weld length, and long continuous should not be greater than 100 mm. Wrong side should be less than or at 0.2T, and should not be greater than 2 mm (wall thickness mm t) incomplete or not allow 7.5 7.5.1 installation quality process standards of the electrical enclosure Cabinet surface is clean, neat, no significant phenomenon of convex, close to nature, close the door. 7.5.2 Cabinet Cabinet face paints no paint, returned to rusted, consistent color. 7.5.3 uniform indirect gap from top to bottom, slot width <1.5mm 7.5.4 adjacent Cabinet surface roughness is 0. 7.5.5 the cabinets firmly fixed, crafts beautiful. 7.5.6 Cabinet surface gauge, switch cabinet mark clear, neat, firm paste. 7.5.7 Terminal row of neat, is reliable, the appearance is clean and not damaged. 7.5.8 cables neat and clean, solid binding, binding process in appearance. 7.5.9 the first cable production firm, crafts beautiful, clear signage does not fade. 7.5.10 fireproof plugging tight, no cracks and pores. 7.6 7.6.1 of the standard electrical wiring quality technology cable a, the multi-core wire bunch arrangement should be parallel to each other, horizontal wire harness or wire should be perpendicular to the longitudinal multi-core wire bunch. The distance between the wire harness and wire harness symmetry, and as close as possible. B-core wiring harness into round, multi-core wire bunch used g wire binding, fastening 5,ALLEN试验阳性者禁忌行桡动脉穿刺测压。 四、IBP与NIBP测量值比较 无论是正常血压者还是高血压者,间接测压法,NIBP,所得的收缩压结果均较实际值低,在正常血压者约为5-10mmHg,在高血压者约为10-20mmHg,危重病人特别是休克病人,无创血压NIBP可能提供不可靠的较高的血压值,收缩压自主动脉、肱动脉至桡动脉及足背动脉逐渐升高,舒张压逐渐降低,所以对于危重患者,IBP的值更为准确直接。 五、动脉内置入导管的部位及方法 ,一,备物,合适的动脉导管、充满抗凝液体带有开关的压力连接管、压力换能器、压力袋、电子监护仪。 ,二,部位,常用于桡动脉、股动脉、腋动脉、肱动脉、足背动脉,其中首选桡动脉,其次为股动脉。 ,三,置管方法,以经皮桡动脉穿刺置管法为例 1.用物准备 2.患者准备 ,1,向患者解释操作目的和意义,以取得其配合。 ,2,Allen试验阴性者,可行桡动脉置管。 ,3,以桡动脉穿刺处为中心,常规备皮、消毒。 3.穿刺与置管 ,1,固定位置,患者取平卧位,前臂伸直,掌心向上并固定,腕部垫一小枕手背屈曲60度。 core wire bunch arrangement should be parallel to each other, horizontal wire harness or wire should be perpendicular to the -plugging tight, no cracks and pores. 7.6 7.6.1 of the standard electrical wiring quality technology cable a, the multiproof ding process in appearance. 7.5.9 the first cable production firm, crafts beautiful, clear signage does not fade. 7.5.10 fire7 Terminal row of neat, is reliable, the appearance is clean and not damaged. 7.5.8 cables neat and clean, solid binding, bin. 7.5.. 7.5.5 the cabinets firmly fixed, crafts beautiful. 7.5.6 Cabinet surface gauge, switch cabinet mark clear, neat, firm pastesistent color. 7.5.3 uniform indirect gap from top to bottom, slot width <1.5mm 7.5.4 adjacent Cabinet surface roughness is 0d, connificant phenomenon of convex, close to nature, close the door. 7.5.2 Cabinet Cabinet face paints no paint, returned to rustenot allow 7.5 7.5.1 installation quality process standards of the electrical enclosure Cabinet surface is clean, neat, no sigte or er than 100 mm. Wrong side should be less than or at 0.2T, and should not be greater than 2 mm (wall thickness mm t) incomple, total length of the welds on both sides undercut not exceed 10% of the weld length, and long continuous should not be greatand should not be greater than 4 mm. Depth of undercut should be less than or equal to 0.5 mm 3 mm from the edge of weld Groove. Surface reinforcement should be less than or equal to 1 + 0.2 times the slope edge width,-evenly smooth transition. Width 2 uld beaffected zone surface must not have cracks, pores, defects such as crater and ash, surface smoothing, weld and base metal sho-cal requirements of the project must not have a molten metal stream does not melt the base metal to weld, weld seam and heatappearance of the weld appearance quality technicore wire bunch used g wire binding, fastening-core wiring harness into round, multi-core wire bunch. The distance between the wire harness and wire harness symmetry, and as close as possible. B-multi longitudinal2 ,2,定位,确定穿刺点,确定桡骨径突位置,向尺侧移动1cm后,向近心端移动0.5cm,触及桡动脉搏动最强的部位后,再向近心端移动0.5cm为穿刺点。 ,3,穿刺与置管,常规消毒皮肤,戴无菌手套,铺无菌巾,套管针与皮肤呈30度角进针,见血后将套管针放低,与皮肤呈10度角,再将其向前推进1-2mm,用手固定针芯,将外套管送入桡动脉内并推至所需深度,一定不能有阻力,,拔出针芯前压迫血管近心端,松开后见血流通畅,迅速连接导管,打开开关,冲管,防止凝血。 ,4,固定,局部再次消毒后无菌敷料粘贴,胶布固定。 ,5,调零测压,旋转三通旋钮,关闭动脉通道,使传感器压力通道和大气相通,此时换能器的高度应于心脏在同一水平,按监护仪上较零键,当屏幕上显示0/0时表示零点校正完毕。旋回三通按钮,监护仪上会立即出现压力曲线和数字,表示较零成功。 六、动脉内压力图形的识别与分析 1.正常动脉压力波形,正常动脉压力波分为升支、降支和重搏波。 is 0. 7.5.5 the cabinets firmly fixed, crafts beautiful. 7.5.6 Cabinet surface gauge, switch cabinet mark clear, neat, firm p , consistent color. 7.5.3 uniform indirect gap from top to bottom, slot width <1.5mm 7.5.4 adjacent Cabinet surface roughnessrustedo significant phenomenon of convex, close to nature, close the door. 7.5.2 Cabinet Cabinet face paints no paint, returned to e or not allow 7.5 7.5.1 installation quality process standards of the electrical enclosure Cabinet surface is clean, neat, nompletgreater than 100 mm. Wrong side should be less than or at 0.2T, and should not be greater than 2 mm (wall thickness mm t) inc.5 mm, total length of the welds on both sides undercut not exceed 10% of the weld length, and long continuous should not be and should not be greater than 4 mm. Depth of undercut should be less than or equal to 0 3 mm from the edge of weld Groove. Surface reinforcement should be less than or equal to 1 + 0.2 times the slope edge width,-ld be evenly smooth transition. Width 2uaffected zone surface must not have cracks, pores, defects such as crater and ash, surface smoothing, weld and base metal sho-heatechnical requirements of the project must not have a molten metal stream does not melt the base metal to weld, weld seam and appearance of the weld appearance quality tcore wire bunch used g wire binding, fastening-core wiring harness into round, multi-core wire bunch. The distance between the wire harness and wire harness symmetry, and as close as possible. B-dinal multilongitucore wire bunch arrangement should be parallel to each other, horizontal wire harness or wire should be perpendicular to the -roof plugging tight, no cracks and pores. 7.6 7.6.1 of the standard electrical wiring quality technology cable a, the multiirepbinding process in appearance. 7.5.9 the first cable production firm, crafts beautiful, clear signage does not fade. 7.5.10 f 7.5.7 Terminal row of neat, is reliable, the appearance is clean and not damaged. 7.5.8 cables neat and clean, solid binding, aste.3 升支表示心室快速射血进入主动脉,至顶峰为收缩压,正常值为100-140mmHg,降支表示血液经大动脉流向外周,当心室内压力低于主动脉时,主动脉瓣关闭与大动脉弹性回缩同时形成重搏波。之后动脉内压力继续下降至最低点,为舒张压,正常这60-90mmHg.从主动脉到周围动脉,随着动脉管径和血管弹性的降低,动脉压力波形也随之变化,表现为升支逐渐陡峭,波幅逐渐增加,因此股动脉的收缩压要比主动脉高,下肢动脉的收缩压比上肢高,舒张压所受的影响较小,不同部位的平均动脉压比较接近。 2.圆钝波,波幅中等降低,上升和下降支缓慢,峰顶圆钝,重搏切迹不明显,常见于心肌收缩功能低下或血容量不足。 3.低平波的上升和下降支缓慢,波幅低平,常见于低血压休克和低心排综合征。 multi longitudinalcore wire bunch arrangement should be parallel to each other, horizontal wire harness or wire should be perpendicular to the -plugging tight, no cracks and pores. 7.6 7.6.1 of the standard electrical wiring quality technology cable a, the multiproof ding process in appearance. 7.5.9 the first cable production firm, crafts beautiful, clear signage does not fade. 7.5.10 fire7 Terminal row of neat, is reliable, the appearance is clean and not damaged. 7.5.8 cables neat and clean, solid binding, bin. 7.5.. 7.5.5 the cabinets firmly fixed, crafts beautiful. 7.5.6 Cabinet surface gauge, switch cabinet mark clear, neat, firm pastesistent color. 7.5.3 uniform indirect gap from top to bottom, slot width <1.5mm 7.5.4 adjacent Cabinet surface roughness is 0d, connificant phenomenon of convex, close to nature, close the door. 7.5.2 Cabinet Cabinet face paints no paint, returned to rustenot allow 7.5 7.5.1 installation quality process standards of the electrical enclosure Cabinet surface is clean, neat, no sigte or er than 100 mm. Wrong side should be less than or at 0.2T, and should not be greater than 2 mm (wall thickness mm t) incomple, total length of the welds on both sides undercut not exceed 10% of the weld length, and long continuous should not be greatand should not be greater than 4 mm. Depth of undercut should be less than or equal to 0.5 mm 3 mm from the edge of weld Groove. Surface reinforcement should be less than or equal to 1 + 0.2 times the slope edge width,-evenly smooth transition. Width 2 uld beaffected zone surface must not have cracks, pores, defects such as crater and ash, surface smoothing, weld and base metal sho-cal requirements of the project must not have a molten metal stream does not melt the base metal to weld, weld seam and heatappearance of the weld appearance quality technicore wire bunch used g wire binding, fastening-core wiring harness into round, multi-core wire bunch. The distance between the wire harness and wire harness symmetry, and as close as possible. B-4 4.不规则波波幅大小不等,常见于心律失常患者。 5.高尖波波幅高耸,上升支陡,重搏切迹不明显,舒张压低,常见于高血压病和主动脉瓣关闭不全。 6.影响波形准确性的因素, ,1,降低波形,空气、管路打折、管路过软 ,2,放大波形,管路过长,>120cm,、三通过多 ,3,传感器位置,传感器应与右心房在同一水平位置,过高则血压下降,过低则血压升高。 七、临床护理 1.动脉测压管的各个接头连接处要旋紧,防止脱开或渗漏,妥善 , consistent color. 7.5.3 uniform indirect gap from top to bottom, slot width <1.5mm 7.5.4 adjacent Cabinet surface roughnessrustedo significant phenomenon of convex, close to nature, close the door. 7.5.2 Cabinet Cabinet face paints no paint, returned to e or not allow 7.5 7.5.1 installation quality process standards of the electrical enclosure Cabinet surface is clean, neat, nompletgreater than 100 mm. Wrong side should be less than or at 0.2T, and should not be greater than 2 mm (wall thickness mm t) inc.5 mm, total length of the welds on both sides undercut not exceed 10% of the weld length, and long continuous should not be and should not be greater than 4 mm. Depth of undercut should be less than or equal to 0 3 mm from the edge of weld Groove. Surface reinforcement should be less than or equal to 1 + 0.2 times the slope edge width,-ld be evenly smooth transition. Width 2uaffected zone surface must not have cracks, pores, defects such as crater and ash, surface smoothing, weld and base metal sho-heatechnical requirements of the project must not have a molten metal stream does not melt the base metal to weld, weld seam and appearance of the weld appearance quality tcore wire bunch used g wire binding, fastening-core wiring harness into round, multi-core wire bunch. The distance between the wire harness and wire harness symmetry, and as close as possible. B-dinal multilongitucore wire bunch arrangement should be parallel to each other, horizontal wire harness or wire should be perpendicular to the -roof plugging tight, no cracks and pores. 7.6 7.6.1 of the standard electrical wiring quality technology cable a, the multiirepbinding process in appearance. 7.5.9 the first cable production firm, crafts beautiful, clear signage does not fade. 7.5.10 f 7.5.7 Terminal row of neat, is reliable, the appearance is clean and not damaged. 7.5.8 cables neat and clean, solid binding, aste.is 0. 7.5.5 the cabinets firmly fixed, crafts beautiful. 7.5.6 Cabinet surface gauge, switch cabinet mark clear, neat, firm p 5 固定,防止穿刺针和测压管脱落。 2.换能器零点校正,应保证换能器与心脏水平位置一致,以保证测定数值的准确,交换病人体位时始终保持换能器与心脏水平一致。 3.为保证动脉测压管的通畅应用肝素盐水定时冲洗,加压气袋的压力要大于300mmHg。 4.当动脉波形出现异常、低钝、消失时,考虑动脉穿刺针处有打折或血栓堵塞现象。处理,揭开皮肤保护膜,若有打折调至正常,若有堵塞应先抽回血再进行冲洗,防止凝血块冲入动脉内,并消毒待干后贴上皮肤保护膜。 5.动脉测压管内严禁进气,应定时检查管道内有无气泡。 6.定时观察穿刺肢体的血运情况,肢体有无肿胀、颜色、温度异常、局部不宜包扎过紧,以免发生肢端坏死,。 7.为了防止感染,每次抽血标本时,严格无菌操作。 8.保证动脉穿刺点的局部干燥,若有渗血应及时更换皮肤保护膜,消毒穿刺点,范围应大于皮肤保护膜的范围。 9.当病人病情平稳,不需要测压时应及早拔除测压管,拔管时局部压迫10分钟,观察无渗血时,用无菌纱布及弹力绷带加压包扎。 10.拔除的动脉测压管应放入医疗垃圾袋内。 八、预防并发症 1.严防动脉内血栓形成 除以肝素盐水持续冲洗测压管道外,尚应做好以下几点。 ,1,每次经测压管抽取动脉血后,均应立即用肝素盐水进行快 ding process in appearance. 7.5.9 the first cable production firm, crafts beautiful, clear signage does not fade. 7.5.10 fire7 Terminal row of neat, is reliable, the appearance is clean and not damaged. 7.5.8 cables neat and clean, solid binding, bin. 7.5.. 7.5.5 the cabinets firmly fixed, crafts beautiful. 7.5.6 Cabinet surface gauge, switch cabinet mark clear, neat, firm pastesistent color. 7.5.3 uniform indirect gap from top to bottom, slot width <1.5mm 7.5.4 adjacent Cabinet surface roughness is 0d, connificant phenomenon of convex, close to nature, close the door. 7.5.2 Cabinet Cabinet face paints no paint, returned to rustenot allow 7.5 7.5.1 installation quality process standards of the electrical enclosure Cabinet surface is clean, neat, no sigte or er than 100 mm. Wrong side should be less than or at 0.2T, and should not be greater than 2 mm (wall thickness mm t) incomple, total length of the welds on both sides undercut not exceed 10% of the weld length, and long continuous should not be greatand should not be greater than 4 mm. Depth of undercut should be less than or equal to 0.5 mm 3 mm from the edge of weld Groove. Surface reinforcement should be less than or equal to 1 + 0.2 times the slope edge width,-evenly smooth transition. Width 2 uld beaffected zone surface must not have cracks, pores, defects such as crater and ash, surface smoothing, weld and base metal sho-cal requirements of the project must not have a molten metal stream does not melt the base metal to weld, weld seam and heatappearance of the weld appearance quality technicore wire bunch used g wire binding, fastening-core wiring harness into round, multi-core wire bunch. The distance between the wire harness and wire harness symmetry, and as close as possible. B-multi longitudinalcore wire bunch arrangement should be parallel to each other, horizontal wire harness or wire should be perpendicular to the -plugging tight, no cracks and pores. 7.6 7.6.1 of the standard electrical wiring quality technology cable a, the multiproof 6 速冲洗,以防凝血。 ,2,管道内如有血块堵塞时应及时予以抽出,切勿将血块推入,以防发生动脉栓塞。 ,3,动脉置管时间长短也与血栓形成呈正相关,在患者循环功能稳定后,应及早拔出。 ,4,防止管道漏液,如测压管道的各个接头应连接紧密,压力袋内肝素生理盐水袋漏液时,应及时更换,各个三通应保持良好性能等,以确保肝素盐水的滴入。 2.防止气栓发生 在调试零点,取血等操作过程中严防气体进入桡动脉内造成气栓形成。 3.远端肢体缺血 引起远端肢体缺血的主要原因是血栓形成,其他如血管痉挛及局部长时间包扎过紧等也可引起。血栓的形成与血管壁损伤、导管太硬太粗及置管时间长等因素有关,监护中应加强预防,具体 措施 《全国民用建筑工程设计技术措施》规划•建筑•景观全国民用建筑工程设计技术措施》规划•建筑•景观软件质量保证措施下载工地伤害及预防措施下载关于贯彻落实的具体措施 如下。 ,1,桡动脉置管前需做Allen试验,判断尺动脉是否有足够的血液供应。 ,2,穿刺动作轻柔稳准,避免反复穿刺造成血管壁损伤,必要时行直视下桡动脉穿刺置管。 ,3,选择适当的穿刺针,切勿太粗及反复使用。 ,4,密切观察术侧远端手指的颜色与温度,当发现有缺血征象如肤色苍白、发凉及有疼痛感等异常变化,应及时的的拔管。 ,5,固定置管肢体时,切勿行环形包扎或包扎过紧。 7.5.7 Terminal row of neat, is reliable, the appearance is clean and not damaged. 7.5.8 cables neat and clean, solid binding, aste.is 0. 7.5.5 the cabinets firmly fixed, crafts beautiful. 7.5.6 Cabinet surface gauge, switch cabinet mark clear, neat, firm p , consistent color. 7.5.3 uniform indirect gap from top to bottom, slot width <1.5mm 7.5.4 adjacent Cabinet surface roughnessrustedo significant phenomenon of convex, close to nature, close the door. 7.5.2 Cabinet Cabinet face paints no paint, returned to e or not allow 7.5 7.5.1 installation quality process standards of the electrical enclosure Cabinet surface is clean, neat, nompletgreater than 100 mm. Wrong side should be less than or at 0.2T, and should not be greater than 2 mm (wall thickness mm t) inc.5 mm, total length of the welds on both sides undercut not exceed 10% of the weld length, and long continuous should not be and should not be greater than 4 mm. Depth of undercut should be less than or equal to 0 3 mm from the edge of weld Groove. Surface reinforcement should be less than or equal to 1 + 0.2 times the slope edge width,-ld be evenly smooth transition. Width 2uaffected zone surface must not have cracks, pores, defects such as crater and ash, surface smoothing, weld and base metal sho-heatechnical requirements of the project must not have a molten metal stream does not melt the base metal to weld, weld seam and appearance of the weld appearance quality tcore wire bunch used g wire binding, fastening-core wiring harness into round, multi-core wire bunch. The distance between the wire harness and wire harness symmetry, and as close as possible. B-dinal multilongitucore wire bunch arrangement should be parallel to each other, horizontal wire harness or wire should be perpendicular to the -roof plugging tight, no cracks and pores. 7.6 7.6.1 of the standard electrical wiring quality technology cable a, the multiirepbinding process in appearance. 7.5.9 the first cable production firm, crafts beautiful, clear signage does not fade. 7.5.10 f7 4.局部出血血肿 穿刺失败及拔管后要有效地压迫止血,尤其对应用抗凝药的患者,压迫止血应在5min以上,并用宽胶布加压覆盖。必要时局部用绷带加压包扎,30min后予以解除。 5.感染 动脉置管后可并发局部感染,严重者也可引起血液感染,应积极预防。 ,1,所需用物必须经灭菌处理,置管操作应在严格的无菌技术下进行。 ,2,置管过程应加强无菌技术管理 ,3,加强临床监测,每日监测体温4次,查血象1次。如患者出现高寒战,应及时寻找感染源。必要时,取创面物培养或做血培养以协助诊断,并合理应用抗生素。 ,4,置管时间一般不应超过7d,一旦发现感染迹象应立即拔除导管。 . 7.5.. 7.5.5 the cabinets firmly fixed, crafts beautiful. 7.5.6 Cabinet surface gauge, switch cabinet mark clear, neat, firm pastesistent color. 7.5.3 uniform indirect gap from top to bottom, slot width <1.5mm 7.5.4 adjacent Cabinet surface roughness is 0d, connificant phenomenon of convex, close to nature, close the door. 7.5.2 Cabinet Cabinet face paints no paint, returned to rustenot allow 7.5 7.5.1 installation quality process standards of the electrical enclosure Cabinet surface is clean, neat, no sigte or er than 100 mm. Wrong side should be less than or at 0.2T, and should not be greater than 2 mm (wall thickness mm t) incomple, total length of the welds on both sides undercut not exceed 10% of the weld length, and long continuous should not be greatand should not be greater than 4 mm. Depth of undercut should be less than or equal to 0.5 mm 3 mm from the edge of weld Groove. Surface reinforcement should be less than or equal to 1 + 0.2 times the slope edge width,-evenly smooth transition. Width 2 uld beaffected zone surface must not have cracks, pores, defects such as crater and ash, surface smoothing, weld and base metal sho-cal requirements of the project must not have a molten metal stream does not melt the base metal to weld, weld seam and heatappearance of the weld appearance quality technicore wire bunch used g wire binding, fastening-core wiring harness into round, multi-core wire bunch. The distance between the wire harness and wire harness symmetry, and as close as possible. B-multi longitudinalcore wire bunch arrangement should be parallel to each other, horizontal wire harness or wire should be perpendicular to the -plugging tight, no cracks and pores. 7.6 7.6.1 of the standard electrical wiring quality technology cable a, the multiproof ding process in appearance. 7.5.9 the first cable production firm, crafts beautiful, clear signage does not fade. 7.5.10 fire7 Terminal row of neat, is reliable, the appearance is clean and not damaged. 7.5.8 cables neat and clean, solid binding, bin8