Prevention and treatment of common complications of fluid therapy

By | March 31, 2012

Prevention and treatment of complications of fluid therapy (1) injury: subclavian vein catheterization with pneumothorax, subcutaneous emphysema, the possibility of brachial plexus injury. The reason is that the puncture occurred unskilled work order will fail. To avoid these complications, the operator must grasp the essentials of serious, detailed and accurate operation. If the unskilled, it can be carried out with a 20 needle puncture, puncture successful, then the needle with a catheter in accordance with the direction and depth of needle piercing the subclavian vein gently, and then follow the rules and properly for processing.
Prevention and treatment of complications of fluid therapy (2) infection and toxemia services: common causes of phlebitis of service, service can cause severe toxemia or septicemia.
1) Reason: intubation contamination or wound infection; Enter the solution pollution; vein thrombosis.
2) control measures: intubation in strict compliance with aseptic technique, select the irritation of the catheter tube and slip the first storm. Operating gentle, not to damage the vein intima. Do not close the port catheter tube wall, requiring back open. catheter incision site daily with the population and shy wine, alcohol disinfection, dressing properly protected. If it is found at the entrance to catheter infections, especially fungal infections, it is timely extubation. More available to control the fungus after extubation, no special treatment. catheter once inserted into the fixed not at liberty to pull out or if that poor infusion, the syringe pump can be used, if not back to the blood is mostly the catheter obstruction, it is timely extubation, can not wash or try and use. Extubation when the suction side by side pulling an empty needle. generally not blood or blood from the catheter and other supplies, in order to avoid fibrin calm and promote thrombosis. Heparin was added per liter of solution 10-15mg can prevent clotting, the day the amount of not more than 60mg, surgery to stop bleeding or clotting mechanism is not completely impaired disabled. Enter the solution must be carried out under strict sterile conditions, prepared, with the closed device input. Microporous seeps through the products and infusion pump input, do not use the general open-infusion. If there is blood infection or phlebitis of service, shall be promptly use of effective antibiotics. If the blood culture positive for the fungus may be temporarily administered, the general shift in the negative after extubation. Only to positive cases, before considering the selection of antibiotics for treatment, such as amphotericin B. If the patient is comparatively good general condition, the treatment of oral fungal infections under control. In case of phlebitis around the incision and drainage should be, and sometimes skin still need to ligation of the vein has been removed. Otherwise, it is difficult to control the systemic infection. If the patient has symptoms such as fever of unknown etiology should be considered when the possibility of a catheter infection, catheter removal should immediately carry out its bacterial culture, while providing broad-spectrum antibiotics, and then bacterial culture and sensitivity test results choose to use antibiotics.
Prevention and treatment of complications of fluid therapy (3) Air embolism: a higher incidence of internal jugular vein and subclavian vein catheterization cases. May also occur in some cases have been losers in the replacement fluid infusion, the attention of the air is not caused by inhalation. Operating procedures should be strictly and keep vigilant to avoid air embolism. Replacement of infusion, the catheter can be placed on a level below the heart to reduce the air out of the properly handled.
(4) hyperglycemia with hyperosmolar coma non-self with the disease: uniform input per kilogram of body weight per hour glucose. Adult body weight by 50kg, that is a day for the port input 500-600g, the amount of blood sugar disease still does not occur, the occurrence of elevated blood glucose due to the input due to excessive or too fast, more than the above load. Patients can adapt to the general start with a small start, gradually increase the level of control of urine maintained at 0-1 is appropriate, if the urine more than ten in ten is not high blood glucose, insulin can be applied to a small film. The amount of glucose 6-8g per ordinary film 1U insulin calculated by adding the solution to the infusion or intramuscular injection. If you can control the level of urine in the 0-4, after the increase may not increase the amount of glucose, insulin dose film. 4-5 days later, when the raw film has been able to self-insulin, the insulin can be gradually reducing the membrane until the disabled. Blood glucose in clinical practice sometimes up to 500_1500mg/dl, causing severe diuretic and solute of hypertonic dehydration, and even coma patients, but by the same physical examination was negative. The scenario is often not the simple sugar too much or too fast input the reason, but because of other reasons, such as induced by trauma, infection, liver failure, uremia, shy gland dysfunction, complex surgical trauma Yu causes, effects the metabolism of glucose in the body and use. Aberdeen infusion of such patients when the nutrient solution, increasing from a small start, and ground for urine and blood sugar check wow. Such as high blood sugar, diabetes treatment principle gives the film according insulin. Hyperglycemia in patients with a serious threat to life, in order to urgently reduce blood sugar, insulin IOOD ordinary film available adding an appropriate amount of glucose in the intravenous drip and given water and make a lot of bait, to correct the dehydration, the transfer of glucose to the cells, if necessary ATP and the addition of auxiliary unlucky A. Sometimes patients with hyperglycemia is due to be excited that there are hidden the results of diabetes, such patients might have paid disease, its treatment with diabetes. Disable the high nutrition before, should be gradually reduced slowly to prevent the occurrence of hypoglycemia due to stop too quickly.
(5) catheter accident: In addition to and ectopic embolization, there are reports of people breaking the heart catheterization and pulmonary veins or the occurrence of power can not pull out the tangle, to stimulate blood vessel or within the endocardium meningitis occurs, but also punctured heart disease cardiac tamponade occurred . Measures for the prevention of: carefully chosen for quality intravenous catheter intubation. If there are quality problems are not reluctant to use. To ensure the catheter does not break during use, the catheter with skin and put a needle connected with a protection device, can also be a special temporary use of local materials, ensure safe use. After the application of catheter fluoroscopic X-ray photograph or location, make the appropriate adjustments, the catheter is not placed in the heart room to avoid entanglement, complications such as endocarditis. extubation if obstacles can not be forced, can first understand the situation with the X-ray photograph after the line treatment. In the case of X-ray knot in the trial before the next move gently, until the self. the catheter tip should be rounded and smooth, not cut slope, if carefully and have avoided the accident situation.
Prevention and treatment of complications of fluid therapy (6) Allergy and loss of appetite: a small number of patients and its metabolites in hydrolyzed protein allergy skin type, the occurrence of braised, nausea, vomiting, or even asthma symptoms, such as cracking and other allergy trial isopropyl invalid, hydrolyzed protein should be discontinued in favor of amino acids. Most patients in the application of intravenous hyperalimentation after loss of appetite, its causes, Department of gastric juice, fluid secretion was inhibited membrane results. Of nutritional supplements do not need those from the gastrointestinal tract may be consider
ed. If still part of the oral, could be the main nutrient input on the night in order to reduce the impact of the day on anorexia. Infusion started at 1 – 2 days, some patients heart rate, the Department of hypertonic blood volume expansion caused due, do not need special treatment, can gradually adapt. However frail the infusion speed should slow down, especially the elderly and heart disease.

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