总结1例严重创伤患者骨髓腔输液外渗的护理体会。针对患者病情危重、紧急抢救、肱骨骨折体征不典型,致肱骨骨髓腔输液外渗的难点问题,采取快速识别外渗,紧急处置;超声引导抽吸渗液,精准局部封闭;药物交替外敷,减轻肿胀;精准评估肢体,识别进展。经过7 d积极的治疗与护理,患者肢体肿胀消退。出院随访2个月,恢复良好。
To summarize the nursing experience of intraosseous infusion extravasation in a patient with severe trauma. Aiming at the critical condition of the patient,emergency rescue,atypical signs of humerus fracture leading to humerus intraosseous infusion extravasation,the key nursing measures included rapid identification of extravasation and emergency treatment,ultrasound-guided suction of exudate,accurate partial closure,alternate external application of drugs to reduce swelling,accurate assessment of limbs and identification of progress. After 7 days of active treatment and nursing,the swelling of the patient's limb subsided. After 2 months of follow-up after discharge,the patient recovered well.
[1] Ritchlin C,Adamopoulos IE.Go with the flow-hidden vascular passages in bone[J]. Nat Metab,2019,1(2):173-174.
[2] Monsieurs KG,Nolan JP,Bossaert LL,et al.European resuscitation council guidelines for resuscitation 2015:section 1. executive summary[J]. Resuscitation,2015,95:1-80.
[3] Hazinski MF,Nolan JP,Aickin R,et al.Part 1:executive summary:2015 international consensus on cardiopulmonary resuscitation and emergency cardiovascul care science with treatment recommendations[J]. Circulation,2015,132(16 suppl 1):S2-S39.
[4] Kawano T,Grunau B,Scheuermeyer FX,et al.Intraosseous vascular access is associated with lower survival and neurologic recovery among patients with out-of-hospital cardiac arrest[J]. Ann Emerg Med,2018,71(5):588-596.
[5] 杨旻斐,王卫芬,王海虹,等. 骨髓腔输液患者液体外渗的危险因素分析[J]. 中华急危重症护理杂志,2022,3(2):140-144.
Yang MF,Wang WF,Wang HH,et al.Risk factors of extravasation in patients with intraosseous infusion[J]. Chin J Emerg Crit Care Nurs,2022,3(2):140-144.
[6] David V,Christou N,Etienne P,et al.Extravasation of noncytotoxic drugs[J]. Ann Pharmacother,2020,54(8):804-814.
[7] 王飒,封秀琴,张茂,等. 骨髓腔输液通路临床应用护理专家共识[J]. 中华急危重症护理杂志,2020,1(4):362-370.
Wang S,Feng XQ,Zhang M,et al.Expert consensus on nursing clinical application of intraosseous infusion access[J]. Chin J Emerg Crit Care Nurs,2020,1(4):362-370.
[8] Gorski LA,Hadaway L,Hagle ME,et al.Infusion therapy standards of practice,8th edition[J]. J Infus Nurs,2021,44(1S Suppl 1):S1-S224.
[9] 达克沃斯,布朗代尔.临床笔记:骨科学[M]. 4版. 刘培来,译.济南:山东科学技术出版社,2014:37.
Duckworth T,Blundell CM.Lecture notes orthopedics and fractures[M]. 4 edition. Liu PL. Jinan:Shandong Science and Technology Press,2014:37.
[10] 林惠华,黄少娅,陈雪真,等. 土豆片外敷与50%硫酸镁湿敷治疗碘对比剂静脉外渗疗效比较[J]. 广东医学,2013,34(18):2905-2906.
Lin HH,Huang SY,Chen XZ,et al.Comparison of curative effect of potato pieces external application of and 50% magnesium sulfate wet application on iodine contrast agen venous extravasation[J]. Guangdong Med J,2013,34(18):2905-2906.
[11] 靳英辉,赵晨,甘惠,等. 化疗性静脉炎护理干预效果的网状Meta分析[J]. 护理学杂志,2016,31(4):85-90.
Jin YH,Zhao C,Gan H,et al.Effect of nursing interventions on chemotherapeutic phlebitis:a network Meta-analysis[J]. J Nurs Sci,2016,31(4):85-90.
[12] 张斯琪,曾臣红,陈冲,等. 如意金黄散的现代研究进展[J]. 中成药,2018,40(2):411-415.
Zhang SQ,Zeng CH,Chen C,et al.Modern research progress of Ruyi golden yellow powder[J]. Chin Tradit Pat Med,2018,40(2):411-415.
[13] 孙红. 静脉导管常见并发症临床护理实践指南[J]. 中华现代护理杂志,2022,28(18):2381-2395.
Sun H.Clinical nursing practice guidelines for common complications of venous catheter[J]. Chin J Mod Nurs,2022,28(18):2381-2395.
