新生儿桡动脉采血止血方案的制订及应用

Applying pressure on puncture site after neonatal radial artery sampling:guidance and its application/TENG

目的通过制订新生儿桡动脉采血止血方案(以下简称"方案"),规范护士桡动脉采血止血方法 ,提高按压止血效率,减少采血后不良反应的发生率。方法运用文献检索、问卷调查和临床实践相结合的方法,就按压材料、姿势、力度和时间制订方案,采用纯棉非织造布片进行"三明治式点赞法"按压,基于收缩压的力度持续按压5 min。对护士进行培训后实施方案,采用一次止血成功率、掌部SpO2下降率、皮肤穿刺点失血率、皮下出血率进行效果评价。结果应用方案后,新生儿桡动脉采血一次止血成功率由69.89%上升至97.80%、掌部SpO2下降率由18.28%下降至5.49%、皮肤穿刺点失血率由35.48%下降至6.59%、皮下出血率由33.33%下降至9.89%。结论新生儿桡动脉穿刺后应用本研究方案可有效止血。

Objective To develop a guidance for applying pressure on puncture site after neonatal radial artery sampling (hereinafter referred to as the "guidance"),in order to standardize the procedure,improve the efficiency of compression,and reduce the incidence of complications after radial artery blood sampling. Methods Using literature review,questionnaire investigation and clinical practice,a standardized guidance was established with regard to dressing material,operator's finger position,pressure intensity and duration. All nurses were trained to apply a "sandwich" point pressure with non-woven pure cotton fabric over puncture site for 5 minutes, based on neonatal systolic blood pressure. To evaluate the effectiveness of the guidance, success rate of hemostasis, degree of palm pulse oxygen desaturation during compression,and bleeding rate of puncture site or subcutaneous tissue were documented. Results After applying the guidance,success rate of hemostasis rose from 69.89% to 97.80%,palm desaturation rate fell from 18.28% to 5.49%,puncture site bleeding rate fell from 35.48% to 6.59%,and subcutaneous hemorrhage rate fell from 33.33% to 9.89%. Conclusion The application of our guidance after neonatal radial artery sampling can effectively achieve hemostasis.