Guided reading

What are the common clinical problems during microinjection pump therapy? How to solve it?

The microinjection pump is an instrument for accurately, constant, constant speed, and continuous pumping of drugs into the human body. It has the advantages of simple operation, stable flow rate, easy adjustment, compactness and portability. With the advancement of medical technology, microinjection pumps have been widely used in clinical practice. Application, such as pumping somatostatin, insulin, sodium nitroprusside and other drugs.

During the clinical use of the microinjection pump, because the microinjector has its own alarm prompt function, it can detect problems in time and remind the staff to adjust and deal with it to prevent the occurrence of dangerous accidents, which leads to a strong dependence on nursing staff. , The management and inspection of the microinjection pump are relatively neglected, which increases the incidence of the patient's drug liquid extravasation, the extension tube and the connection of the joint are not tightly connected, etc., which affects the treatment effect.

What are the common clinical problems during microinjection pump therapy? How to solve it?

The connection between the extension tube and the tee tube/indwelling needle is loose

case

The interface of the extension tube used in the department is not a screw joint, which makes it easier to come out. Due to the patient's irritability, turning over, and the connection is not tight, the extension tube of the micro pump often comes out of the indwelling needle/tee tube, causing the liquid to leak into the On the bed unit, even after a large area is soaked, it is only discovered by the nursing staff or escorts.

Nursing countermeasures

When using the micropump, tightly connect the syringe, extension tube, and intravenous access to prevent it from falling off. Patients are treated with microinjection pumps. Nursing staff need to check whether the infusion pipeline is damaged or loose during ward rounds. In particular, it is necessary to check the connection parts of the pipeline to prevent looseness. Check the condition of the tee regularly. If the connection part is found to be loose, replace the tee and extension pipe and fix them properly. Instruct the patient to avoid pulling it out during rollover or activity.

Improper handling of blood return during the use of the micropump

case

Patient 1, male, with upper gastrointestinal bleeding, the doctor ordered NS48ml + somatostatin 3mg to be pumped at 4ml/h. Due to the patient's physical exertion, the blood returned to the extension tube. The nurse pressed the fast-forward button to push the blood in the extension tube back into the blood vessel. The patient subsequently developed nausea.

Patient 2, male, high blood pressure, BP 210/98mmHg, the doctor ordered NS40ml + Yaninging 50mg to be pumped at 5ml/h, the blood returned to the extension tube due to the loose connection of the extension tube, the nurse pressed the fast forward button to push the blood in the extension tube back into the blood vessels, and then the patient experienced a sudden drop in blood pressure.

Nursing countermeasures

When venous blood return is found, different measures should be taken according to the nature of the drugs used and the amount of blood returned, such as somatostatin, insulin, sodium nitroprusside, norepinephrine and other drugs. When extending the infusion tube, it is necessary to replace the extension tube, and do not push it directly, otherwise it may cause the drug to be administered too quickly and cause adverse consequences. If somatostatin is injected too quickly, nausea, dizziness, facial redness, and fever may occur. If the insulin cable is injected too quickly, hypoglycemia may occur, manifested as sweating, palpitations, and fatigue. Rapid injection of nitroglycerin can cause headache, dizziness, and orthostatic hypotension. Too much potassium chloride can cause pain, cardiac arrest, etc.

Micro pump not functioning properly

case

Patient 1: Disconnect the power supply of the microinjection pump and go to the toilet. When the power supply is reconnected, the microinjection pump automatically resets, and its speed returns to zero, but the patient did not notice that the liquid did not enter the blood vessels normally for a period of time after that.

Patient 2: The micro-pump itself failed and the medicinal solution did not enter, but it was not discovered in time, resulting in the entire night shift medicinal solution did not enter the blood vessels.

Patient 3: After the nursing staff connected the microinjection pump for the patient, they forgot to start it until the patient found out.

Nursing countermeasures

1. Strengthen the sense of responsibility of nurses. It is not because the micro-pump has an automatic alarm prompt, which leads to a psychological dependence. It is believed that the micro-pump is functioning normally if it does not alarm. Patients who use the microinjection pump continuously for a long time need to check regularly to avoid the situation that the microinjection pump does not work properly.

2. Regularly check the performance of the microinjection pump. After use, pay attention to keep the micro pump clean. If the cover of the pump is damaged, the display is not bright when connected to the power supply, there is an error in the speed regulation, the alarm is out of control, etc., it is strictly prohibited to use it for patients, and it needs to be repaired in time.

3. Strengthen health education, improve patients' correct cognition of micropumps, improve nursing compliance and self-management ability, and avoid patients' improper behavior of self-regulation and movement of micropumps.

extravasation

case

Patient, male, liver cirrhosis, blood pressure 77/46mmhg at 08:50, NS46ml + norepinephrine 8mg, pump speed 2ml/h, the patient's skin at the puncture site was found to be purple-red at the time of shift, stop the infusion immediately, magnesium sulfate wet compress, Xi Liao Appropriate topical application.

The microinjection pump uses a linear peristaltic pump as the power source. When the liquid is extravasated, the machine is still running normally, so the liquid will continue to extravasate until the local pressure at the extravasation reaches the alarm limit.

If the nurses do not inspect the injection site in time and observe the injection site carefully, they will not be able to detect and prevent the extravasation of the drug in time.

In addition, most of the pump-controlled drugs are high-concentration or vasoactive drugs, and the local intravascular drug concentration is high and irritating, which is more likely to lead to phlebitis and even local tissue necrosis.

Nursing countermeasures

1. Before using the micropump, first select the appropriate blood vessel. Choose a thick, straight, elastic, non-slip, and easy-to-fix and easy-to-observe site for venipuncture, and try to avoid puncture and infusion in the lower extremities.

2. Strengthen inspections and strictly change shifts. At each inspection, the infusion site should be observed by the methods of "one look", "two touch" and "three contrasts" to observe whether there is extravasation, swelling, local color and temperature, and whether there is a cord-like red line in the direction of blood vessels. If the above situation occurs, the infusion should be stopped immediately and the puncture site should be replaced in time.

3. Instruct patients and their families to notify the medical staff in time for treatment if there is pain and swelling at the puncture site and abnormal sensation of the puncture limb.

Microinjection pump rate adjustment error

case

The patient, female, had upper gastrointestinal bleeding, the doctor ordered NS40ml + losec 40mg, the pump speed was 8ml/h, and the rate of losec was found to be 80ml/h when the shift was handed over, and the pumping was about to be completed. However, due to the nature of the Losec drug itself, it did not cause adverse consequences. If it were other drugs, the consequences would be unimaginable.

The operator is not familiar with the speed setting key, the speed setting key is operated incorrectly, the speed is not changed in time after changing the medicine, or even the speed setting is changed by unintentional touch, which can cause the medicine to enter the body too much or not enough.

Nursing countermeasures

Strengthen business training, strengthen the work responsibility of nursing staff, be familiar with the performance of micro-pumps, standardize operation, strictly hand over shifts, closely inspect wards, and deal with problems in a timely manner. In particular, high-risk drugs should be inspected every 0.5 to 1 hour to find out whether there is any abnormality in time.

Have you encountered any of these problems in your clinical work?