超声引导下进行桡动脉穿刺撤出针芯时采用三指指压法阻断喷血的效果观察

Observation on the effect of blocking blood ejection by three-finger pressure in ultrasonic guided radial artery puncture withdrawing needle core

目的观察在超声引导下进行桡动脉穿刺撤出针芯时使用三指指压法阻断喷血的临床疗效。方法回顾分析2020年10月1日至12月30日东阿县人民医院重症医学科收治的50例需接受桡动脉穿刺置管进行有创血流动力学监测患者的临床资料。所有患者均在超声引导下采用三指指压法以阻断桡动脉穿刺撤出针芯时喷血的发生,全程在超声引导下进行桡动脉穿刺,监测导管进入血管情况以及导管尖端位置情况,穿刺成功后缓慢置入动脉导管,超声探查动脉导管尖端位置,并在超声引导下用食指按压住动脉导管尖端1 cm处,中指按压住动脉导管尖端部位,无名指按压住动脉穿刺导管前段动脉血管,缓慢撤出针芯,连接固定测压装置进行有创血流动力学监测。结果桡动脉穿刺撤出针芯时在超声引导采用三指指压法的50例患者均未发生桡动脉导管尾翼喷血,在留置针尾翼无血迹的状态下连接压力传感器进行有创血流动力学监测。结论桡动脉穿刺撤出针芯时在超声引导下采用三指指压法可以有效阻断撤出针芯时桡动脉喷血,有利于桡动脉穿刺部位的换药维护以及保持穿刺部位的清洁,减少医源性感染的发生,便于临床开展和实施。

Objective To observe the clinical effect of using three-finger pressure method to block the spurting blood during the withdrawal of the needle core or stylet in performing puncture of radial artery under the guidance of ultrasound.Methods The clinical data of 50 patients who needed radial artery puncture and catheterization to carry out invasive hemodynamic monitoring in the department of critical care medicine of Dong'e County People's Hospital from October 1 to December 30,2020 were analyzed retrospectively.All patients were treated with ultrasound-guided three-finger pressure method to block the spurting blood during the withdrawal of needle core or stylet in radial artery puncture.The whole process of performing radial artery puncture was under the guidance of ultrasound,and the situation of catheter entering the blood vessel and the position of the catheter tip were monitored by ultrasound.After the successful puncture,a catheter was slowly inserted into the artery,and its tip position was detected by ultrasound,and under the guidance of ultrasound,the index finger was used to press on the 1 cm catheter segment before its tip,the middle finger to press on the tip,and the ring or anonymous finger to press on the radial artery vessel before the catheter tip,the core was slowly withdrawn,and then the manometry device or pressure sensor was connected and fixed for invasive hemodynamic monitoring.Results All the 50 patients using ultrasound-guided three-finger pressure method to block the spurting blood during the withdrawal of needle score in the performance of radial artery puncture were successful,no blood staining was seen at the tail wing of the indwelling needle,and under this status,the pressure transducer or sensor device was connected to proceed the invasive hemodynamic monitoring.Conclusion Under the ultrasound-guidance,the three-finger pressure method applied in the performance of radial artery puncture can effectively block the spurting blood during the withdrawal of stylet,that is beneficial to the maintenance of dressing exchanges and clean at the arterial puncture site,thus in turn the opportunity of occurring iatrogenic infection is decreased and clinically the measure is easy to practice and develop.