討論區

靜脈注射標準流程理戴手套這項放進去嗎?

凡是可能會接觸或暴露於病患的血體液風險都需要戴上手套，所以ON IV是當然的囉!!

優碘的消毒時間2分鐘大家有相關的文獻嗎?

剛好這2各問題這篇文獻都有說到喔!!

Guidelines for the Prevention of Intravascular Catheter

加油!!

For short peripheral catheters, good hand hygiene before catheter insertion or maintenance, combined with proper aseptic technique during catheter manipulation, provides protection against infection. Good hand hygiene can be achieved through the use of either a waterless, alcohol-based product (69) or an antibacterial soap and water with adequate rinsing (70). Appropriate aseptic technique does not necessarily require sterile gloves; a new pair of disposable nonsterile gloves can be used in conjunction with a "no-touch" technique for the insertion of peripheral venous catheters. However, gloves are required by the Occupational Safety and Health Administration as standard precautions for the prevention of bloodborne pathogen exposure.

Compared with peripheral venous catheters, CVCs carry a substantially greater risk for infection; therefore, the level of barrier precautions needed to prevent infection during insertion of CVCs should be more stringent. Maximal sterile barrier precautions (e.g., cap, mask, sterile gown, sterile gloves, and large sterile drape) during the insertion of CVCs substantially reduces the incidence of CRBSI compared with standard precautions (e.g., sterile gloves and small drapes) (22,71). Although the efficacy of such precautions for insertion of PICCs and midline catheters has not been studied, the use of maximal barrier precautions also is probably applicable to PICCs.

In the United States, povidone iodine has been the most widely used antiseptic for cleansing arterial catheter and CVC- insertion sites (72). However, in one study, preparation of central venous and arterial sites with a 2% aqueous chlorhexidine gluconate lowered BSI rates compared with site preparation with 10% povidone-iodine or 70% alcohol (73). Commercially available products containing chlorhexidine have not been available until recently; in July 2000, the U.S. Food and Drug Administration (FDA) approved a 2% tincture of chlorhexidine preparation for skin antisepsis. Other preparations of chlorhexidine might not be as effective. Tincture of chlorhexidine gluconate 0.5% is no more effective in preventing CRBSI or CVC colonization than 10% povidone iodine, as demonstrated by a prospective, randomized study of adults (74). However, in a study involving neonates, 0.5% chlorhexidine reduced peripheral IV colonization compared with povidone iodine (20/418 versus 38/408 catheters; p = 0.01) (75). This study, which did not include CVCs, had an insufficient number of participants to assess differences in BSI rates. A 1% tincture of chlorhexidine preparation is available in Canada and Australia, but not yet in the United States. No published trials have compared a 1% chlorhexidine preparation to povidone-iodine.

 

 

各項指引之建議分類如下

      第一類：極力 推薦之措施。強力建議於所有醫院；有良好的臨床實驗或流行病學數據強力支持。

      第二類：中度 採用措施。強力建議於所有醫院；有臨床實驗或流行病學數據支持，及有強有力的理論基礎為依據。

      第三類：輕度 採用措施。建議提供給多家醫院；經由臨床或流行病學研究而獲得的建議。

      第四類：不建議採用的措施。未解決的問題；此措施無足夠的證據或結論。

      靜脈留置導管之適用範圍：靜脈注射應只使用在治療與檢查需要時，不需使用時，立即拔除留置導管。(第一類)

      醫護人員在插動靜脈注射導管前，應洗手(Cutdowm)前應採消毒性洗手。(第一類)。通常一般性洗手即已足夠，但插中心靜脈導管和靜脈切開

      選擇適當注射部位：在成人上肢靜脈注射較下肢合適。(第一類)

      注射前，應先使用消毒劑，以環行方式(第一類) ，由內而外擦拭注射部位。

      先以75%Alcohol消毒30秒後，再用Alcohol Better Iodine 消毒皮膚三十秒以上，最後以75% Alcohol擦拭清晰，以便注射。對Iodine敏感之病患，可只使用75% Alcohol消毒三十秒以上。(第一類)

      當建立動脈及中央導管時(第一類) ，應戴無菌手套，執行技術。

      不要常規使用動靜脈血管切開術做為導管插入的方法。(第一類)

 

      注意導管置放周圍有無紅、腫、熱、壓痛，有無膿液出現，或功能不良，若有以上情形導管應予拔除。(第一類)

      若無感染情況發生，輸液導管，注射部位，留置針，及無菌敷料應每隔72小時更換。(第一類)

      周邊靜脈注射部位：須特別記錄，成人以選擇上肢為宜，應避免注射於下肢或鼠蹊部或患側。當注射於上肢外時，應儘早拔除或更換。(第一類)

      如因緊急插入導管而無菌技術未嚴謹者，在病情許可時應立即更換。(第三類)

      注射部位，輸液導管及無菌敷料，遭受污染，或感染發生時應立即更換。(第一類)

 

 

本研究發現嚴格執行優碘消毒時間足 30秒之原發性血流感染 率為1.2 0 / 00 ，未嚴格執行者感染率為4.27 0 / 00 。而本加護病房因中心靜脈導管 廣泛性被使用而導致原發性血流感逐年增加，在民國86-89年高居榜 首，經過本研究的努力，91年度已降                                        希望能幫忙您的問題              晚安  

                                                              郭大媽 20110311