动静脉采血技术-实习生岗前培训PPT课件

The Third Affiliated Hospital of ChongQing Medical University动脉采血技术动脉采血技术中心中心ICU李巧云李巧云The Third Affiliated Hospital of ChongQing Medical University主要内容1动脉采血操作规程2动脉采血注意事项3了解专用动脉采血器The Third Affiliated Hospital of ChongQing Medical University操作目的操作目的v抽取动脉血进行血气分析，是客观反映呼吸衰竭的性质和程度，判断有无缺氧和二氧化碳潴留的最好方法v指导氧疗、机械通气各种参数的调节The Third Affiliated Hospital of ChongQing Medical University 专用动脉采血器专用动脉采血器喷雾态钙平衡（修饰）肝素锂喷雾态钙平衡（修饰）肝素锂针帽、胶塞针帽、胶塞先进的孔先进的孔石装置石装置The Third Affiliated Hospital of ChongQing Medical University护士准备：护士准备：衣帽整洁、衣帽整洁、修剪指甲、修剪指甲、洗手洗手操作前准备The Third Affiliated Hospital of ChongQing Medical UniversityThe Third Affiliated Hospital of ChongQing Medical UniversityThe Third Affiliated Hospital of ChongQing Medical University足背动脉足背动脉股动脉股动脉桡动脉桡动脉 肱动脉肱动脉 部位选择部位选择The Third Affiliated Hospital of ChongQing Medical UniversityAIIen，s试验试验The Third Affiliated Hospital of ChongQing Medical University采集采集步骤步骤测体温测体温拔针、摇匀拔针、摇匀按压按压穿刺穿刺固定动脉固定动脉预设容量预设容量消毒消毒选择穿刺选择穿刺部位部位The Third Affiliated Hospital of ChongQing Medical University充分混匀充分混匀The Third Affiliated Hospital of ChongQing Medical University注意事项注意事项2.立即送检3.填写血气分析申请单时，要写清病人床号、姓名、住院号、体温及氧浓度。4.消毒面积应大于5CM，严格无菌操作，避免医源性感染，注意自身防护。5.穿刺部位应当压迫5-10min,至不出血为止。6.吸痰后待血氧饱和度升至正常再取血，避免影响检查结果。7.如未见回血，退出穿刺处到皮下,不用完全拔出，根据动脉搏动重新调整穿刺位置进针直到看到鲜血。The Third Affiliated Hospital of ChongQing Medical University静脉采血技术静脉采血技术中心中心ICU李巧云李巧云The Third Affiliated Hospital of ChongQing Medical University主要内容主要内容静脉采血前准备静脉采血前准备1静脉采血操作规程静脉采血操作规程2注意事项注意事项3The Third Affiliated Hospital of ChongQing Medical University操作目的操作目的全血标本：全血标本：测定血沉、血常规及血液中某种物质如血测定血沉、血常规及血液中某种物质如血糖、糖、尿素氮、肌酐、尿酸、肌酸、血氨的含量尿素氮、肌酐、尿酸、肌酸、血氨的含量血清标本：血清标本：测定肝功能、血清酶、脂类、电解质等测定肝功能、血清酶、脂类、电解质等血培养标本：血培养标本：培养检测血液中的病原菌培养检测血液中的病原菌The Third Affiliated Hospital of ChongQing Medical University护士准备护士准备The Third Affiliated Hospital of ChongQing Medical University饮食饮食体位体位活动活动坐位、卧位患者准备患者准备勿食油腻或含高蛋白的食物、禁烟禁酒空腹8-10h避免剧烈运动15-30MinThe Third Affiliated Hospital of ChongQing Medical University用物准备用物准备安尔碘、棉签、采血针安尔碘、棉签、采血针2个、止血带、垫枕、个、止血带、垫枕、弯盘、采血管、医嘱单、检验条码、利器弯盘、采血管、医嘱单、检验条码、利器盒、胶布、速干手消毒液、标本架、治疗盒、胶布、速干手消毒液、标本架、治疗巾巾The Third Affiliated Hospital of ChongQing Medical UniversityThe Third Affiliated Hospital of ChongQing Medical University选择血管选择血管最佳穿刺部位最佳穿刺部位第一选择肘正中。第一选择肘正中。第二选头静脉。第二选头静脉。第三选贵要静脉。第三选贵要静脉。第四选手背静脉。第四选手背静脉。The Third Affiliated Hospital of ChongQing Medical University不宜选择的血管不宜选择的血管 切除乳房同侧手臂切除乳房同侧手臂水肿、淋巴水肿部位水肿、淋巴水肿部位擦伤或血肿部位擦伤或血肿部位正在输液一侧的手臂正在输液一侧的手臂硬化、栓塞静脉硬化、栓塞静脉绑扎石膏的手臂绑扎石膏的手臂有疤痕、皮肤过敏、外伤部有疤痕、皮肤过敏、外伤部位位手臂上有导管、瘘管或血管手臂上有导管、瘘管或血管移植移植糖尿病患者足部糖尿病患者足部The Third Affiliated Hospital of ChongQing Medical University采血管的选择The Third Affiliated Hospital of ChongQing Medical University各种采血管的采集量各种采血管的采集量紫色紫色血常血常规、交叉配血、血型、交叉配血、血型鉴定、定、2ML黑色黑色血沉血沉至刻度至刻度线蓝色色凝血凝血至刻度至刻度线或无或无负压橙色橙色肝功、肝功、肾功、血糖、血脂、功、血糖、血脂、电解解质、心肌、心肌酶谱3-5ML红色色乙肝两乙肝两对半、梅毒、甲胎蛋白、甲功、半、梅毒、甲胎蛋白、甲功、C肽3-5ML绿色色血氨血氨5MLThe Third Affiliated Hospital of ChongQing Medical University静脉采血操作步骤准备用物，床旁准备用物，床旁核对核对解释说明，准备体位解释说明，准备体位选好血管，消毒待干选好血管，消毒待干再次核对再次核对穿刺抽血穿刺抽血拔针，按压，拔针，按压，核对，核对，及时及时送检送检The Third Affiliated Hospital of ChongQing Medical University摇匀管帽管帽颜色色翻翻转次数次数蓝色色3-4红色色5-8绿色色8紫色紫色8黑色黑色8The Third Affiliated Hospital of ChongQing Medical University标签的正确粘贴标签的正确粘贴The Third Affiliated Hospital of ChongQing Medical University常见溶血原因注射器、针头或容器不干燥注射器、针头或容器不干燥消毒液消毒液未待干未待干压脉带压脉带捆扎时间过久、淤血过久应捆扎时间过久、淤血过久应当当1min穿刺不畅，损伤组织过多穿刺不畅，损伤组织过多抽血速度太快或太慢抽血速度太快或太慢抗凝血混匀时，震荡力过大抗凝血混匀时，震荡力过大血液血液存放存放时间过长时间过长The Third Affiliated Hospital of ChongQing Medical University1、如一次穿刺失败，重新穿刺需、如一次穿刺失败，重新穿刺需更换部位及注射器更换部位及注射器。2、采全血标本时，将血液注入有抗凝药的试管内，立即、采全血标本时，将血液注入有抗凝药的试管内，立即摇匀使血液与抗凝药混匀，避免血液凝固。摇匀使血液与抗凝药混匀，避免血液凝固。3、需空腹采血时，应、需空腹采血时，应提前通知提前通知患者。患者。4、严格无菌操作，检查培养基、严格无菌操作，检查培养基5、一般血培养取血量为一般血培养取血量为5ml，亚急性细菌性心内膜炎患者，亚急性细菌性心内膜炎患者，为提高阳性率，采血量曾至为提高阳性率，采血量曾至10-15ml.6、严禁在输液、输血的针头处抽取血标本。严禁在输液、输血的针头处抽取血标本。7、注意采集顺序。、注意采集顺序。8、按血管走向按压止血！、按血管走向按压止血！注意事项The Third Affiliated Hospital of ChongQing Medical University按压方式按压方式The Third Affiliated Hospital of ChongQing Medical University