UA110326U - METHOD OF CATHETERIZATION OF PERIPHERAL VEINS - Google Patents

Abstract

Method for catheterization of peripheral veins by treatment of antiseptic section of skin over vein, fixation of vein, puncture of skin and wall of vein in direction of blood flow with needle with plastic cannula-catheter, removal of needle from vein, introduction of infusion cannula-catheter into vein by method connection of the infusion system. For puncture choose an external jugular vein, which is fixed with a finger on the 1- clavicle, the needle is introduced when the patient is offered to perform a Valsalva maneuver, making a strong exhalation with the mouth and nose clamped, and as a catheter use infusion cannula Yu-FLEX®.

Description

The useful model belongs to medicine, more precisely, to intensive care and anesthesiology, and can be used in diagnosis, surgery, resuscitation and therapeutic treatment of diseases requiring venous catheterization.

Punctures and catheterizations of peripheral and central veins are among the most common manipulations in practical medicine. In one year, more than 500000000 peripheral and more than 15000000 central venous catheters are installed in the world. Venesection is currently used extremely rarely (Pyr:/Lymly.pedidlylivlLiiapez 01 osu/apevi27/apevi.pit).

In the comparative assessment of the use of peripheral and central veins, in most cases, preference should be given to the first. Of course, in some cases, catheterization of central veins is either more rational or cannot be replaced by catheterization of peripheral veins at all (measurement of central venous pressure, installation of a pacemaker, etc.). However, in situations of extreme urgency, when it is necessary to immediately start infusion therapy (shock, massive blood loss, severe trauma at the pre-hospital stage, etc.) and in case of damage to the central veins, priority is given to the use of peripheral veins.

Peripheral subcutaneous veins of the upper extremities are most often catheterized: veins of the elbow bend, veins of the back of the hand, forearm and shoulder. Peripheral subcutaneous veins of the lower extremities are used much less often. In small children, subcutaneous veins of the head can be used for intravenous administration.

Intravenous catheters for installation in peripheral veins are intended for long-term intravenous infusion. Usually - more than 3 days, when the need for repeated infusions arises. Externally, the catheter is an individually packaged product that has a transparent top made of thin plastic through which the catheter is visible and the needle inside. After the vein is punctured, the needle is removed, and the catheter, not the needle, remains in the vessel. The patient or medical staff can move the arm with the catheter without worrying about damaging the vein. The length of stay of such a catheter in the vein is determined by the material from which it is made, the measures taken to care for the catheter and the solutions that are infused.

The method of catheterization of the peripheral veins of the upper extremity by treating the area of the skin above the vein with an antiseptic and applying a tourniquet to the extremity is known to be the closest to the claimed method in terms of the essence and the achieved technical result.

Zo for fixing and filling the vein, puncturing the skin and the vein wall in the direction of blood flow with a needle with a polyethylene cannula, removing the needle from the vein, inserting an infusion cannula-catheter into the vein by the "catheter on a needle" method and connecting the infusion system (V.P. Sukhorukov,

A.S. Berdykyan, S.L. Zpstein. Puncture and catheterization of veins. - St. Petersburg: 000 "Saint-Petersburg Medical Publishing House". 2001. - P. 3-5). According to the known method, the closest analogue, the limb whose peripheral veins are catheterized must be motionless and in a position convenient for the operator: the arm is fully extended, and a special pillow or a towel folded several times is placed under the elbow. 1-2 minutes before the puncture, a tourniquet - a rubber tube 10 cm above the intended puncture site in a stretched state - is applied to the limb (through the fabric) and tied. The patient is offered to squeeze and spread the fingers of the hand. At the same time, the vein can be felt well under the skin. A needle connected to a plastic cannula-catheter is inserted into a vein in the direction of blood flow. The cannula is grasped with three fingers.

After the skin is punctured, the cannula is inserted into the blood vessel. The appearance of blood in the cannula chamber indicates that the tip of the cannula has entered the vein. The needle is fixed, and the plastic part of the cannula is slowly pushed all the way into the vein. The needle is removed, the vein is pinched to reduce bleeding, and the infusion system is connected. The upper port of the cannula is used for bolus infusions, and the side port is used for continuous infusions (Fig. 1). Intravenous "catheter on a needle" for peripheral veins brand 1721 MedisagefF according to the closest analogue (Fig. 1) consists of a needle, a plastic cannula with upper and side ports and a plug. If the cannula is no longer used for infusion, then a heparin solution is injected into it to prevent thrombosis and closed by twisting the cap. The cannula is fixed with a bandage to prevent the development of "mechanical" phlebitis due to irritation of the vessel by the moving cannula.

The disadvantages of the known method-the closest analogue are: - lack of injection access to the peripheral veins of the limbs in case they are unsuitable for catheterization (damage due to numerous interventions, phlebitis, etc.), and the search for a new access complicates and prolongs the procedure; - in an emergency situation, when traditional venous access is difficult or impossible, doctors immediately proceed to the puncture of central veins (subclavian vein or internal jugular vein), which increases the invasiveness of the manipulation and increases its risk;

- lack of additional venous access for the anesthesiologist if necessary in an emergency during surgery, since catheterization of the ulnar vein as an additional venous access prevents the surgeon from working; - during catheterization of peripheral veins, the contact of medical personnel with the patient's blood is inevitable, which creates a danger for the latter of infection with viruses of hepatitis, AIDS, etc.; - the risk of developing "mechanical" phlebitis after repeated and unsuccessful attempts at catheterization due to the lack of comfort for the work of medical personnel and comfort for the patient; - the presence of unsuccessful attempts and the chance of a through puncture of the vein; - frequent mechanical damage to the catheter.

The basis of the useful model is the task of catheterization of peripheral veins by selecting for this the external jugular vein (m. didiagiv ekhiegtta) (ZYAV), the infusion cannula-catheter U-FLEXF, improving the catheter insertion procedure to ensure the simplicity and speed of the procedure, reducing the invasiveness of the manipulation and reducing the risk of damaging the vein, quickly obtaining additional venous access during surgery, safety and comfort for the medical staff and the patient during catheterization, minimizing the number of unsuccessful attempts and through puncture of the vein. Compared with the known method, the frequency of development of phlebitis is reduced three times, the frequency of mechanical damage to the catheter is 2.57 times, the number of cases of contact of medical personnel with the patient's blood is 19.6 times.

The problem is solved by the method of catheterization of peripheral veins by antiseptic treatment of the area of the skin above the vein, fixing the vein, piercing the skin and the vein wall in the direction of blood flow with a needle with a plastic cannula-catheter, removing the needle from the vein, inserting the infusion cannula-catheter into the vein using "catheter on a needle" and connection of the infusion system.

What is new in the created method is that for punctuation, the ZYAV is chosen, which is fixed with a finger 1-2 cm above the clavicle, the needle is inserted when the patient is offered to perform a maneuver

Valsalva, making a strong exhalation with a pinched mouth and nose, and an infusion cannula U-FLEXF is used as a catheter).

There is a causal relationship between the set of features of a useful model and the technical result that can be achieved during its implementation.

There are practically no reports on the wide use of venous access for catheterization of ENT as venous access in the domestic literature. The most frequent indications for catheterization

A manifestation of the use of the method developed by the authors in medical practice was the absence of peripheral veins of the upper extremities suitable for catheterization. One of the common reasons for this is interventional damage to peripheral veins in people with opium (injection) drug addiction. Since ZYAV is located under the skin on the lateral surface of the neck - an inconvenient place for auto-injections of drug addicts, it is always in an intact state. It is especially important to choose a PID in situations of excessive emergency, when it is necessary to immediately start infusion therapy (shock, massive blood loss, severe trauma at the pre-hospital stage, an emergency situation during a surgical operation, etc.).

When providing medical care to patients from the high-risk group (patients with AIDS, hepatitis

In and C, unexamined patients) the most pressing problem is the safety of medical personnel. Safety is the most important modern requirement for catheterization of peripheral veins.

However, in case of catheterization of peripheral veins according to the known method - the closest analogue, with the use of an intravenous "catheter on a needle" brand 170 for peripheral veins

MedisageFf (of the Venflon type) it is inevitable that medical personnel come into contact with the patient's blood, which creates a danger for the latter of infection with hepatitis viruses, AIDS, etc., because when the needle is removed from the vein after its puncture, the infusion cannula-catheter is inserted into the vein and when the infusion system is connected, blood necessarily flows from the vein onto the patient's skin, often splashing. Since the venipuncture is performed "blindly", there is the presence of unsuccessful attempts and the chance of a through puncture of the venipuncture and frequent mechanical damage to the catheter. After repeated and unsuccessful attempts at catheterization due to the lack of comfort for the medical staff and comfort for the patient, there is a risk of developing "mechanical" phlebitis.

The comparative effectiveness of the proposed method of catheterization of peripheral veins and the known method - the closest analogue - was studied on 127 patients with various conditions of peripheral veins of the upper extremities. The average age of 127 patients was 27.5243.5 years, the average length of stay in the hospital was 622 days. Depending on the used methods of catheterization of peripheral veins, 127 patients were divided into two groups. In the first group (I), which included 53 patients, manipulations were carried out according to the claimed method, and in the second group (II) of 74 patients - according to the known method, the closest analogue. Group I patients were not suitable for intravenous interventions of the peripheral veins of the upper extremities due to their interventional lesion, which was an indication for the choice for catheterization of the PID. In this group, a U-FLEXF infusion cannula manufactured by the company Yuriia-Pharm (Ukraine) was used as a catheter.

Patients of the II group underwent catheterization of the peripheral veins of the upper extremities (lateral and medial subcutaneous veins of the hand, u. serpais ei m. Vaviiis) with the help of a cannula-catheter brand 172 Medisagetb (Venflon type), as provided by the known method-the closest analogue.

Observations and research data are entered in the table.

Table

Comparative effectiveness of the proposed method of catheterization of peripheral veins (group I) and the known method-the closest analogue (group II)

Comparative

The data of the research efficiency, n-53 n-74 times

Note: " - p«e0.05.

As can be seen from the table, the efficiency of catheterization according to the claimed method significantly exceeds that according to the closest analog method. A significant feature of the development is the successful combination of a selected peripheral vein (PSV) and a peripheral vein catheterization device. According to the claimed method, the U-FLEXF catheter-cannula (Fig. 2) is used, which consists of a guide needle (2) with a protective membrane (1) and a handle for holding. The guide needle through the extension tube (4) with the clamp (3) is connected to two ports (5) - Luer connectors with a puncture membrane.

The procedure for installing the U-FLEXF catheter-cannula is "bloodless", because it excludes the contact of medical staff with the patient's blood. According to the research data (table), contact with blood decreased 19.6 times (by 33.4 95) (p«0.05). The presence of a silicone protective membrane (1) in the body of the cannula (prevents blood leakage during puncture, absorbs blood residues) and a silicone port for injections (5) on the flexible lead (4) makes the cannula absolutely safe in terms of contact with the patient's blood, which contains hepatitis C or AIDS viruses. The guide needle (2) allows you to choose a convenient puncture angle. In addition, due to the flexible lead, it allows manipulation of infusion access without the risk of developing "mechanical" phlebitis, which increases the level of patient safety and the comfort of the work of medical personnel. The clamp (3) instantly prevents blood flow.

An important difference and advantage of the claimed method is the presence of a hemocontrol window (ZMAVT-51I OT) in the U-FLEXF catheter - a hole near the tip of the needle (Fig. 3). Thanks to it, as soon as the cannula enters the vein, the blood colors the cannula due to the capillary effect. Thus, the number of unsuccessful attempts is reduced and the chance of a puncture through the vein is minimized.

Installation of the U-FLEXF catheter is faster and easier than the closest analogue, because

It is equipped with a silicone valve (5) in case infusions are temporarily not performed. And according to the closest analog method, in this case, it is necessary to twist a stopper equipped with a thread, which does not exclude the inflow of blood during the twisting period. In addition, according to the known method, it is necessary to apply a tourniquet and a special pad, squeeze and spread the fingers of the hand.

Advantages of catheterization of peripheral veins according to the claimed method: - simplicity, speed and minimal invasiveness of the manipulation; - absence of severe complications (through puncture of the vein, phlebitis, etc.); - permanent visual control (without sonography); - low risk of personal injury; - lack of contact of the medical staff with the patient's blood; - comfort for the patient and medical staff; - a small amount of mechanical damage to the catheter; - quick additional venous access during surgery;

- low cost of consumables.

The proposed method of catheterization of peripheral veins is carried out as follows.

The patient is laid horizontally on his back, his arms lie along the body, the head end of the table or couch is lowered 10-15". The patient's neck is extended, turning his head to the side opposite to the puncture site. The doctor stands on the side of the patient's head. A visual assessment of the PID is carried out using the Valsalva maneuver. The maneuver consists in the patient's attempt to exhale forcefully with his mouth and nose pinched. Puncture and catheterization are carried out in aseptic conditions, the skin above the vein is treated with an antiseptic. The vein is squeezed above the puncture site with a finger (1-2 cm above the collarbone), as a result which causes its filling and better contouring.

FLEXO) The cut of the needle during puncture is directed upwards, and the needle itself - along the course of the vessel. The cannula is held at an angle of 15-30" to the surface of the skin (depending on the depth of the vein). The puncture is performed in the place where the vein is best seen. As soon as the cannula enters the vein, the blood due to the capillary effect colors the U-FLEXF cannula. The needle is fixed with one hand (it is motionless), and with the other hand, push the catheter until it is completely under the skin and remove the needle. After installation, apply an aseptic bandage and fix it to the skin with adhesive tape.

An example of implementation of the claimed method. Patient M., 33 years old, with a diagnosis: pregnancy PI, 40 weeks, 2nd future childbirth, 1st period of childbirth. Chronic viral hepatitis C. Injection drug addiction.

Peripheral vein catheterization is indicated for medical treatment. During the examination, the patient was found to have an interventional lesion of the peripheral veins of the upper and lower extremities due to the use of injection drugs. A decision was made to catheterize the ENT. The patient was placed on the couch horizontally on her back, arms along the body, the head end of the couch was lowered to 107. The patient's neck was stretched, turning her head to the left side (opposite to the puncture site). The vein was clamped with a finger 1-2 cm above the collarbone, while the patient was asked to exhale forcefully with her mouth and nose pinched (Valsalva maneuver). After the generally accepted aseptic processing of the operative field, puncture and catheterization of the ZYAV was performed with a cannula Yu-

FLEXO) After placing the catheter, an aseptic bandage was applied. One puncture was performed.

There was no contact of the medical staff with the patient's blood. The duration of the cannula in the vein was 58

From hours. Patient M. was in the maternity ward for two days. Venous inflammation (phlebitis) was not detected.

Claims (1)

USEFUL MODEL FORMULA Method of catheterization of peripheral veins by antiseptic treatment of the area of the skin above the vein, fixing the vein, piercing the skin and the vein wall in the direction of blood flow with a needle with a plastic cannula-catheter, removing the needle from the vein, inserting the infusion cannula-catheter into the vein by the "catheter on needles" and the connection of the infusion system, which differs in that the external jugular vein is chosen for punctuation, which is fixed with a finger 1-2 cm above the clavicle, the needle is inserted when the patient is asked to perform the Valsalva maneuver, making a strong exhalation with a pinched mouth and nose , and the infusion cannula U-FLEXF is used as a catheter. B. I am J Fig. 1