1例血友病甲伴抑制物患儿应用无痛技术行经外周静脉穿刺中心静脉导管置入术的护理体会

Nursing strategy of a child with hemophilia A and inhibitors undergoing painless peripherally inserted central catheter implantation

本文总结1例血友病甲伴抑制物的低龄患儿应用无痛技术行经外周静脉穿刺中心静脉导管(PICC)置管的护理体会。血友病患儿置入PICC术前需综合评估患儿病情、年龄、配合程度等方面,对患儿进行科学合理的疼痛干预,选择最优的麻醉方案;置入的静脉导管应选择满足治疗方案的最小规格导管;手术或有创治疗前需检验凝血因子水平,根据检测结果行替代治疗;采用钝性分离方式送入导管替代传统扩皮方式,有助于提高置管成功率,减少出血量,提高患儿舒适度。

To investigate the safety and nursing measures of peripherally inserted central catheter(PICC)implantation in a young child with hemophilia A accompanied with inhibitors,using painless techniques and various ways to prevent bleeding.Before PICC implantation,child with hemophilia was comprehensively evaluated in terms of condition,age and degree of cooperation,and scientific and reasonable pain interventions were carried out to select the optimal anesthesia scheme.The minimum size catheter that met the treatment plan was selected for the inserted venous catheter.Before surgery or invasive treatment,the level of coagulation factors was measured,and alternative treatment according to the test results were taken.Passively separating catheter instead of traditional skin expanding method could reduce the amount of bleeding during catheter insertion.Compared with conventional local anesthesia,the amount of blood loss was significantly reduced,and the comfort and safety of catheterization were significantly increased.For children with low age or low degree of cooperation,especially those with hemophilia with coagulation disorder,the application of painless techniques and multiple ways of bleeding prevention can significantly improve the success rate of PICC catheterization and reduce the amount of bleeding during catheterization.