讲述外周静脉留置针操作评估内容（外周静脉留置针评估）

Most patients need at least one peripheral intravenous cannula (also referred to as intravenous atheter) (PIVC) during their hospital stay for IV fluids and medications, b clood products or nutrition.

大多数患者在住院期间至少需要一个外周静脉留置针(也叫做静脉导管)(PIVC)，以便静脉输液及药物治疗，输送血制品或是营养液。

PIVC complications are common but they can be prevented or minimised by routine assessment. This article discusses the key points of PIVC assessment.

PIVC并发症是很常见的，但是通过常规评估是可以预防和减少并发症的，本文将论述PIVC评估的要点。

Is an IV Cannula Needed？

静脉留置针是必要的吗？

Does the patient need this PIVC?

患者需要这个PIVC吗？

Many PIVCs are left in without orders for IV fluids or medications (Limm et al. 2013; New et al. 2014).

在没有静脉输液或是药物治疗的情况下，很多患者的PIVC也依然会保留在体内。(Limm et al.2013;New et al.2014).

Some patients end up with two, three or even more concurrent PIVCs, despite only needing one in most cases (New et al., 2014). And there are even reports of patients being discharged home with an IV in place because no one noticed it was there! (TracyVaRN 2011)

有些患者同时保留两个，三个甚至更多个PIVC，尽管大多数情况下只需要一个(New et al.2014).甚至有报道说病人出院回家了还带着静脉留置针，因为没有人注意到他手上还有留置针(TracyVaRN 2011)。

PIVCs are often left in ‘just in case’ the patient might need it. But any IV cannula leads directly to the bloodstream and can be a source of infection (Zingg & Pittet, 2009).

PIVC通常都是给有可能需要的患者的，但是任何静脉留置针与血液直接相通，成为感染源。(Zingg &Pittet,2009).

PIVCs often become blocked, kinked or dislodged, so make sure the cannula is still working each shift.

PIVC经常会出现堵塞，扭曲或是脱落，所以在每次治疗时要确保留置针还依然可用。

You can assess PIVC function with two simple questions:

你可以带着两个简单的问题来评估PIVC的功能：

1.Does the IV flush easily?

静脉冲管是否畅通无阻？

2.Does the IV fluid flow easily?

静脉输液流畅吗？

Resistance or failure to flush or flow indicates the PIVC might be kinked or blocked, or could have migrated out of the vessel (INS 2016; Goossens 2015).

冲管或是输液时有阻力或是根本无法进行时，那说明这个PIVC可能扭曲或是堵塞了，或是已经脱离血管了(INS2016；Goossens 2015).

Is the Cannula Tolerated by the Patient?

病人能适应这个留置针吗？

Provide explanations and education about the treatment, and check the patient/family’s understanding. Ensure the patient knows why the PIVC is in, and encourage them to speak up if there are any problems, such as pain, leaking, swelling, etc.

做好宣教工作，解释使用静脉留置针的必要性，取得患者/家属的理解。确保患者知道为什么要植入PIVC，告知他们如果有任何问题就及时提出来，例如穿刺点疼，导管有泄漏，手臂肿胀等。

The PIVC should not be painful. Pain is an early symptom of phlebitis (inflammation of the vein), and means that the PIVC is not working well and should be removed (Ray-Barruel et al., 2014). If the patient still needs an IV, and their veins are fragile, consider the insertion of a different device, such as peripherally inserted central catheter (Chopra et al. 2015; Moureau et al. 2012).

PIVC一般不会给人带来疼痛感。疼痛感是静脉炎的早期症状，这意味着PIVC不可用，应该拔除(Ray－Barruel et al,2014).如果患者依然需要静脉输液，并且他们的静脉还比较脆弱的情况下，考虑插入另一种静脉工具，如外周静脉中心静脉导管(Chopra et al.2015;Moureau et al.2012).

An Irish study found that patients were seven times more likely to have a PIVC left in, unused, when they did not know why it was there (McHugh et al., 2011).

爱尔兰的一项研究发现，当患者不知道留置针为什么要留在体内时，有70%的患者不同意使用PIVC(McHugh et al，2011).

Involving the patient and family empowers them to voice their concerns, and prompts nurses to address problems and remove unused PIVCs.

这需要提高患者及其家属对PIVC的认识，在某些情况下提醒护士拔除不使用的PIVC。

Is the Cannula Appropriately Dressed and Secured?

留置针是否合适，安全？

Transparent polyurethane or sterile gauze and tape dressings are both recommended (Marsh et al. 2015). Polyurethane dressings are convenient, as they allow visibility of the IV site and can remain in place up to 7 days. Gauze and tape dressings work well for diaphoretic patients, but they should be changed every 2 days.

推荐使用透明聚氨酯或无菌纱布和胶带敷料(Marsh et al.2015)，聚氨酯敷料是很方便的，因为它们可以见于静脉表明并能够保留7天。纱布和胶带敷料更适用于出汗的病人，但是要两天一换。

Dressings must be clean, dry and intact to prevent microbial contamination of the site. Change the PIVC dressing if it becomes damp, loose, or visibly soiled, and secure the PIVC and infusion tubing with tape, net or bandage, leaving the site visible (INS 2016).

敷料一定要干净，干燥及完整，以防止微生物污染皮肤。如果PIVC开始发潮，松散，或是有明显的污渍，那么应立即更换。用胶带，网或是绷带固定PIVC，保留一定的可见皮肤即可(INS 2016).

Hospital audits show 25% of PIVC dressings are not clean, dry and intact (New et al. 2014; Alexandrou et al. 2015). This increases the risk of infection and cannula dislodgement. A poorly secured PIVC encourages infection, as cannula movement in the vein can allow migration of organisms along the cannula and into the bloodstream (Marsh et al, 2015).

医院检查所示有25%的PIVC敷料不干净，不干燥，不整洁(New et al.2014;Alexandrou et al.2015).这增大了留置针走针和感染的风险。一个不太安全的PIVC会增大感染风险，因为静脉内的留置针可以活动，一些生物体就会随着留置针的活动而进入血液(Marsh et al,2015).

Any Signs of Infection?

感染有什么征兆吗？

PIVCs are so common it’s easy to forget they pose an infection risk.

PIVC是如此的普遍常见，以至于很容易忘记它们会造成的感染风险。

This can be reduced by strict hand hygiene before and after touching the device, the dressing or any lines and connectors.

在接触留置针，敷料或是任何线条及连接器后，通过严格的手卫生是可以降低感染风险的。

Aseptic non-touch technique when connecting lines is essential (INS, 2016). Needleless connectors should be scrubbed for 15 seconds and allowed to dry before accessing (Moureau & Flynn, 2015).

当给患者上治疗时，无菌操作技术是必备的(INS,2016).没有针的连接器应该在15秒内进行擦洗，并在接入前擦干(Moureay&Flynn,2015).

Don’t forget about possible bloodstream infection. If a patient has signs of systemic inflammatory response syndrome (low or high temperature, elevated heart rate, elevated respiratory rate, low or high white blood cell count), any invasive device is a possible cause (Shah et al. 2013), and insertion sites should be examined for inflammation or purulence. If a patient shows signs of infection with no obvious source, consider removing the PIVC.

不要忘了还有血夜感染的可能性。如果病人有全身炎症反应综合征(低体温或高体温，心率高，呼吸急促，白细胞或低或高)，任何植入体内的设施都是有可能造成这种现象的(Shah et al.2013),应该检查穿刺点是否有炎症或是化脓现象。如果患者表现出无明显原因的感染征兆，那么考虑移除PIVC吧。

Any Other Complications?

还有其他并发症吗？

Unfortunately, up to 40% of PIVCs have complications, stop working, or fall out before treatment completion (Wallis et al. 2014).

不幸的是，在完成治疗之前，因堵塞等任何原因导致PIVC不可用或是脱落，高达40%PIVC有并发症(Wallis et al.2014).

Cannula failure often means painful and time-consuming replacement of the PIVC, which can be tricky, especially for paediatrics, the elderly, and those with a lack of viable veins.

置管失败往往导致病人痛苦，使护士花费更多的时间进行PIVC更换，这可能会非常棘手，特别是对于儿科和老年科，还有那些静脉血管不好的病人。

Many hospitals have implemented phlebitis scales to improve PIVC assessment. Phlebitis scales are not well-validated and are not recommended (Ray-Barruel et al., 2014). While phlebitis is a concern, catheter failure is more often caused by occlusion, infiltration or accidental removal (Wallis et al., 2014).

很多医院已经实施了静脉炎量表来提升PIVC评估。静脉炎量表不好验证，所以并不推荐。虽然静脉炎是令人担忧的问题，但置管失败更多的是由于堵塞，渗透或意外移除引起的(Wallis et al,2014).

Common IV Cannula Complications:

常见的静脉留置针并发症：

Phlebitis (inflammation of the vein) is characterised by one or more of the following: pain, redness, swelling, warmth, a red streak along the vein, hardness of the IV site, and/or purulence

静脉炎有以下一种或是多种情况存在：疼痛、皮肤发红、肿胀、静脉走向的红条索状、穿刺点发硬、化脓等。

Infiltration is the leakage of a non-vesicant solution into the surrounding tissues, causing pain and swelling

渗透是一种非发泡剂渗漏在周围组织引起的疼痛和肿胀

Extravasation is the migration into the tissues of a vesicant medicine or fluid, such as chemotherapy. This can be severely painful and cause major tissue trauma

外渗是一种向发泡药物或液体组织的转移，比如化疗。这可能会引起严重的疼痛感以及造成主要的组织创伤。

Thrombosis or thrombophlebitis is the formation of a clot in the vessel, often caused by the cannula moving around in the vein and aggravating the vessel wall

血栓或血栓性静脉炎是血管中的血凝块形成的，通常是因为留置针在血管中移动导致血管壁加厚所致。

Nerve damage can occur during PIVC insertion. If the patient complains of a sharp pain shooting up the arm, or ongoing numbness or tingling of the extremity, the cannula should be removed immediately

在植入PIVC期间可能会发生神经损伤。如果病人苦诉手臂刺痛，或是持续麻木或是肢体刺痛，应立即移除留置针。

Partial or complete dislodgement of the PIVC indicates it is no longer in the vessel and must be removed

PIVC的局部或是整体异位这表明它已经脱离血管，必须马上移除。

Early detection and treatment of complications can prevent long-term consequences.

尽早发现和治疗并发症可以防止留下疑难杂症或是后顾之忧。

If infiltration or extravasation is suspected, stop the infusion, disconnect the tubing, and attempt to aspirate the residual drug from the device.

如果怀疑有渗透或是外渗，那么停止输液，断开导管，并试着吸出留置针内的残留药物。

If the site is warm, swollen or painful, elevate the limb on a pillow, seek medical advice, and apply hot or cold packs as tolerated (Doellman et al., 2009). Offer paracetamol, unless contraindicated. Continue to assess regularly, and document your assessment and actions, and the patient’s response.

如果穿刺周围有发热，肿胀或疼痛，应咨询静脉治疗专家，并用热敷或是冰敷做紧急处理(Doellman et al,2009).若无禁忌症，可使用对乙酰氨基酚。继续定期评估，记录所做的处理，以及病人的反应。

Finally, remember that post-infusion phlebitis can occur up to 48 hours after a PIVC has been removed (Webster et al., 2015), so it’s important to assess old IV sites, as well as current sites.

最后，请记住，在移除PIVC后48小时内可能会发生静脉炎(Webster et al,2015),所以评估静脉穿刺部位和发生炎症的部位是很重要的。

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