A. Tie two tourniquets method
A tourniquet is tied on the elbow joint and one at the point of the wrist joint at each point of the inner joints to perform venipuncture in the elbow fossa to obtain blood, which is more effective than tying a tourniquet. For some children who cannot actively clench their fist to cooperate, it can replace clenching the fist, while the local vascular filling is satisfactory. This method is not only suitable for children, but also for adult patients due to wasting, unfixed blood vessels, non-filling, hypotonia, failure and inability to clench fist. And on this basis, it is expanded to intravenous infusion of the dorsum of the hand (one tourniquet is tied at the point of Neiguan of the wrist joint and the other at the first knuckle of 2~5 fingers), the dorsum of the foot (one tourniquet is tied at 6 cm above the inner ankle of the ankle joint and the other at the first knuckle of 2~5 fingers), and the dorsum of the foot (one tourniquet is tied at 6 cm above the inner ankle of the ankle joint and the other at the small head of 1~5 metatarsals), for Patients with obvious edema and obesity who are difficult to perform venipuncture, two tourniquets, about 15cm apart above and below, are used to bind the limb, and after 1min, the following one tourniquet is loosened, at which time the indigo veins are seen in the area, which is convenient for puncture.
Second, easy to see back blood method
The application of disposable infusion set has the disadvantage of not easily returning blood or returning less blood after the scalp needle enters the blood vessel, which affects the success rate of venipuncture. Easy to see back blood method, one is the regulator high adjustment method, that is, the regulator is placed immediately under the lower end of the Mao Fei’s drip tube, the second is the regulator high adjustment infusion bottle low method, that is, the regulator in high adjustment based on the infusion bottle hanging on the infusion rack adjustment knob, the success rate are high. It is believed that these two methods, as the infusion tube is filled with liquid and the position of the liquid bottle is lowered, have a certain siphoning effect; the regulator is placed in a high position, and the margin to bear back blood in the infusion tube is increased, so once the scalp needle enters the blood vessel, the blood is easily returned to the syringe.
Third, local vasodilation method
(1) external vasodilator method: for patients with peripheral veins not obvious and vascular spasm puncture difficulty, use cotton swab dipped in 1% nitroglycerin on the back of the hand, and wet heat compress local 3min or so, superficial small veins fill up rapidly, confirmed by clinical observation and instrument detection, this method can make the diameter of the veins increase significantly, vascular filling degree is enhanced, and no allergic reaction occurs. With a cotton swab dipped in the appropriate amount of atropine injection, coated the skin of the puncture local 8-12 times, 2-5min later, the local superficial vein expansion filling revealed, no adverse effects and consequences, but infants and children, glaucoma, patients with cardiovascular disease, and high fever convulsions, irritable people caution to use. With 2% scopolamine, the local skin is wiped 4 times, and no adverse reactions occur in patients with poor vascular elasticity, brittleness, and fine vessels, or difficulty in seeing and puncturing.
(2) Heat application method: local heat application can increase the local tissue temperature, improve blood circulation, vasodilatation, and venous vascular filling exposure. The success rate of the local puncture method with hot compresses was higher than that of the conventional method in patients with traumatic and hemorrhagic shock. For finger and toe vein puncture, and for patients with pediatric diarrhea resulting in poor circulation and collapsed veins that are difficult to puncture, it is advocated that the combination of the heat application method can help improve the success rate of puncture.
Fourth, non-clenched fist puncture method
In the conventional method, when performing venipuncture, the patient is asked to clench his fist and release it only after success. In the case of dorsal hand vein puncture, it is recommended that the punctured hand should be placed naturally, and the nurse should fix the patient’s hand with the left hand into a cup-like hand with the back of the palm empty, which can make the blood vessel protrude from the area and easy to puncture, in addition, the patient should be asked to clench the fist, and then let the fist be half clenched (the fist is empty) for a few seconds, or be asked to clench and release the fist repeatedly. The repeated clenching and unclenching of the fist can make the interphalangeal muscles contract and promote the return of blood to the heart, and the dorsal vein of the hand fills up obviously. The skin on the back of the hand is highly tense, which compresses the blood vessels and deflates the lumen, making it easy to penetrate the vessels after entering the needle. Local slow seepage, fat phenomenon, while the above phenomenon is less common when not clenched fist, reducing the patient’s pain, improve the efficiency of work, worth promoting the use.
V. Remedial methods after puncture
After piercing the blood vessel during venipuncture, the hemostasis is remedied by the method of finger pressure on the piercing site, that is, after the hole pierces the blood vessel, the needle is slowly withdrawn outward, when there is a return of blood to stop, immediately finger pressure on the piercing site, while loosening the tourniquet and fixing the needle handle with 1 piece of adhesive tape. First, finger heavy pressure for about 1s, then open the infusion regulator, finger lightly press to liquid can slowly through shall prevail, observe about 1min no extravasation can stop pressure, tape fixed needle, adjust the number of drops. It is believed that this method is especially suitable for infants and young children, the elderly and patients who cannot easily find blood vessels. This method is further supplemented by the fact that after piercing the blood vessel, the needle should not stop after withdrawing the blood back, but should also advance the needle a little more, so that the needle exceeds the piercing site, which can avoid leakage. When making venipuncture, the infusion needle should leave 1/4 length of the needle pedicle outside the skin, in order to realize the remedy after piercing the blood vessel.
Six, the choice of needle angle
The angle of needle in the textbook for venipuncture is 20°, in order to achieve the purpose of easy to enter the needle and improve the success rate of puncture, according to the research, the general patient puncture can choose 45° or close to 45° into the needle; for the elderly shallow small vein puncture, can choose 35° into the needle; for the finger (toe) dorsal vein puncture, choose 10-15° into the needle; for the elderly vascular wall is thick, hard, easy to roll patients, choose more than 40° For pediatric scalp vein, dorsal hand and foot superficial vein, finger (toe) direction vein, choose 10~45° inlet, elbow vein, saphenous and small saphenous vein, choose 20~30° inlet. Increasing the angle between the needle and the skin can reduce the pain caused by the needle or achieve painless injection, which is related to the pressure on the skin during injection, the distribution of skin vascular nerves and the structural characteristics of the skin.
Seven, painless injection puncture method
Most of the skin nerve fibers are distributed in the epidermis, and the nociceptive receptors are distributed in a dotted pattern, with 25 contacts and 100~200 pain points on the back of the hand, so the patient is very sensitive to pain during venipuncture. Studies have shown that the pain is lightest when the vein is punctured near the ulnar side, while the pain is most pronounced when the vein is punctured near the radial side, which may be related to the nerve distribution, skin relaxation and tension size. The method of reducing the pain of needle entry can also make use of the sharpness of the needle tip edge, with the bevel slightly to the left when puncturing, to reduce the cutting and tearing of the needle tip on the tissue, in order to reduce pain and reduce tissue damage.
VIII. Retrograde puncture
For long-term infusion, poor vascular conditions, puncture difficulties of patients, can make full use of the terminal blood vessels of the extremities, using the retrograde puncture method of the dorsal veins of the hands and feet, the advantages of which are good blood return, the number of drops is not limited, does not affect blood flow, can make up for the shortcomings of the finger and palm joints to the heart puncture is not easy to fix, the use of this method must choose the dorsal vessels of the hands and feet, and should not choose the small veins of the fingers and toes upward blood return, so there is no traffic branch. Retrograde puncture will cause blood pooling and make the puncture fail.
Nine, fixation method
Venipuncture fixation method is an important part of the whole infusion process, according to the mechanics and aesthetics principle, it is more standard to use one side of the rolling method, that is, first paste one side of the skin, and then tighten the tape to the opposite side of the skin, so that the tape can be in a tense state to ensure that it does not loosen, and proper fixation can prevent the needle from piercing the vein, and also prevent microorganisms from being brought into the tissue by the loose needle tip.
X. Needle extraction method
The incorrect technique of compressing the puncture site when pulling the needle or the short compressing time is one of the main causes of subcutaneous bruising, and the poor revealing of the vein after subcutaneous bruising, and the mechanization of the hematoma compressing the vessel when the bleeding volume is large, which makes the vessel easy to adhere to the surrounding tissues and makes the vessel unable to continue to use. Therefore, correct needle extraction is one of the important measures to protect the distal peripheral veins. When pulling out the needle, the finger belly should be pressed flatly on the small dressing covering the puncture site along with the vein, and the scope of compression should be centered on two puncture points of skin and vessel wall, and should be larger than two puncture points, and the needle tip should be pulled out and pressed on the puncture site immediately for 2min~5min, which generally does not cause subcutaneous bruising. Pulling out the needle tip while pressing the puncture site can cause local pain or damage to the vessel wall. The different methods of holding the needle handle during needle extraction can cause different vascular injuries, painful reactions and perivascular bruising. At present, it is believed that the up-and-down method of needle extraction with the thumb and index finger holding the needle handle is significantly better than the anterior and posterior edge method of needle extraction with the thumb and index finger holding the needle handle, and the difference between the two is significant. The up-and-down method fixes the needle handle during needle extraction and applies the same pressure, which can keep the needle tip parallel to it in the lumen and significantly reduce the mechanical cutting injury to the vessel caused by the needle blade.
The success rate of venipuncture is not only related to the skillfulness of the operator, but its stable emotion and good psychological state are also the keys to improve the success rate of venipuncture. The poor psychological state of nursing staff is one of the main causes of venipuncture failure, so nursing staff should have good psychological quality, not be disturbed by external factors, maintain a stable mood and good psychological state at work, gain the trust and cooperation of patients, and standardize their nursing behavior in order to effectively improve the success rate of venipuncture.