Causes and treatment of phlebitis occurring with amiodarone
I. Analysis of the causes.
(A) Stronger drug irritation.
Since amiodarone hydrochloride itself has an acidic PH value, intravenous application has a strong stimulating effect on local blood vessels, which exceeds the stress capacity of vascular buffering, increases vascular permeability, changes local metabolism and osmotic pressure, and affects the normal metabolism and function of vascular intima, thus making it easy for phlebitis to occur.
(B) no strict implementation of aseptic operation.
1, disposable scalp needle venipuncture, not according to the requirements of the puncture point as the center outward disinfection range diameter 5cm;
2.When puncturing with indwelling venous needles, the disinfection range did not reach the required 8cm.
3.The skin is not thoroughly disinfected when puncturing and still left with dirt.
4, indwelling needle use with transparent adhesive fixed, local skin sweat will not send out, adhesive paste replacement is not timely caused by pollution and bacteria.
(C) the puncture vessel selection is unreasonable.
1.Select too small veins (amiodarone hydrochloride is more irritating to small vessels and easy to produce phlebitis).
2, the choice of superficial venous cannula needle when the diameter of the vessel is too small (the smaller the vessel warp, the higher the incidence of its placement reaction, such as two in one more increase the possibility of phlebitis.)
3, choose the lower limb vein infusion, because the lower limb vein has a valve, blood flow is slow, the drug in the lower limb stay longer than the upper limb, easy to form phlebitis.
(iv) Drug extravasation.
1, drug extravasation has harm to the blood vessel wall, and it is easy to cause phlebitis, plus amiodarone has irritation more increase the possibility of phlebitis. The causes of drug extravasation are as follows.
A, unskilled nursing staff, repeated puncture damage to the vein, can cause extravasation of the drug
B. Needle displacement in the course of infusion, resulting in a part of the needle bevel outside the vessel, resulting in extravasation of the drug
C, no blood return or poor blood return after puncture, no longer want to tie a needle, with the idea of trying, the actual puncture is not successful, resulting in extravasation of drug during infusion
D, various reasons to enhance the permeability of the vessel wall, such as infection, vascular endothelial damage, increased venous pressure, etc., resulting in extravasation of the drug.
E. There is drug residue at the tip of the needle when the needle is inserted, and the infuser switch is not completely closed when the needle is withdrawn.
(E) Amiodarone hydrochloride maintenance amount of liquid concentration Cmax>2mg/ml, drip rate Vmax>2mg/min
Second, solution measures
(I) Reduce the adverse factors causing phlebitis
1.Concentration Cmax<2mg/ml and drip rate Vmax<2mg/min for maintenance amount (used according to "Amiodarone Application Guideline", phlebitis can be easily avoided)
2.Strictly aseptic operation and abide by technical specifications to prevent contamination.
3.Select more upper limb vessels, try to use thicker and more elastic vessels for puncture, and choose central venous catheter for Cmax≥3mg/ml
4.Shorten the time of intravenous medication, and give oral medication as early as possible.
5.Avoid repeated punctures, make sure that the puncture is successful and the input is unobstructed before continuing drug administration.
6.Strengthen the rounds during the infusion process, pay attention to the observation of local abnormalities such as drug extravasation, redness and swelling, etc. and deal with them in time.
(ii) Strengthen communication with patients.
1.Before using amiodarone, introduce its effects and adverse reactions, precautions to patients in order to obtain their cooperation, enhance their protection awareness and reduce extravasation of the drug.
2.When the patient has phlebitis causing redness, swelling, pain and other discomfort and limb movement restriction, listen to the patient and comfort him/her, instruct him/her to elevate the affected limb, explain to him/her the effectiveness of local medication, eliminate tension, relieve mental stress and actively cooperate with treatment.
(C) Local care.
1. For patients with mild symptoms of redness, swelling and hardness, wipe the local skin with 0.25% jell iodine cotton balls 3 times a day, and the symptoms will disappear automatically.
2, for patients with heavy symptoms, single with 1 ~ 5% sodium sulfite solution scrubbing, 3 ~ 5 times a day; or 50% of magnesium sulfate wet hot compress, the use of hyperosmotic effect, promote local tissue edema subsidence
3, the use of sodium sulfite or magnesium sulfate and glycerin into glycerin sodium sulfite or glycerin magnesium sulfate emulsion sustained treatment of peripheral phlebitis is effective, the treatment time is significantly shorter than the single use of sodium sulfite or magnesium sulfate
4, with potato sliced or mashed paste on the affected area, can treat phlebitis caused by amiodarone; potato has the role of anti-inflammatory, blood circulation and blood stasis, swelling and pain relief
5, with Chinese medicine rhubarb 15g, 15g of honeysuckle, plantain 10g decoction 100ml of concentrated solution to apply rinse, three times a day, willing to take orally, the effect is better.