Critically ill patients have the characteristics of severe disease, rapid development, and many complications. Therefore, it is often necessary to use various drugs for clinical treatment. Because different drugs have different speed requirements, with the continuous development of clinical diagnosis and treatment and nursing technology, people have invented micro-injection pumps to meet this special demand. It can not only control the speed of the drug, but also ensure uniform injection. And it can deliver the required injection volume to critically ill patients on demand. Since then, microinjection pumps have been widely used in clinical practice.

The micro-injection pump is an integrated product of light, machine and electricity. It is composed of a microcomputer control system and a micro-propulsion system. It can control the infusion flow stably and evenly. With the rapid development of medical technology, microinjection pumps are widely used in clinical practice, which greatly reduces the workload of medical staff and improves the accuracy of infusion speed [1].

The micro-injection pump has the advantages of timing, high precision, stable flow rate and less liquid consumption. Nursing staff can control at any time, and the operation is simple and convenient. During use, they can adjust the speed of drug injection in time according to the needs of the patient's condition, accurately grasp the dosage of the drug, and maintain the drug concentration continuously, thereby reducing the fluctuation of drug concentration in the body due to the difficulty in controlling the infusion speed. On the one hand, the microinjection pump can greatly reduce the daily workload of nurses and improve work efficiency, and on the other hand, it can better cooperate with doctors in rescue [2].

How to operate

3.1 Use a disposable sterile syringe (selected according to the dosage) to draw the required dose and concentration of the drug, connect the pump tube, exhaust the air, and indicate the starting time, bed number, name, drug name, concentration, and dose on the syringe. ,speed.

3.2 Install the micropump in a stable position, loosen the knob of the micropump, push the slide, and install the syringe correctly and connect it to the venous access. The needle of the syringe must be inclined downward, so that a small amount of air in the syringe can remain in the syringe, and at the same time, it is convenient to observe the remaining liquid medicine and whether the micro pump is in normal working condition.

3.3 Turn on the power, turn on the switch, the micro pump system starts to detect automatically, set the required speed, press the START button, and the automatic bolus starts. Yellow light flashes.

3.4 To change the injection speed, press the STOP key to reset the speed, and then press the START key to start injecting the new pump speed.

3.5 Press the STOP button at the end of the injection, turn off the switch, remove the syringe, and wipe the micropump clean for use.

Problems that are prone to occur when using

4.1 Drug extravasation

If drug extravasation occurs during the bolus injection, the alarm system of the micropump will not reflect it. If positive and correct measures are not taken in time, serious consequences will occur.

4.2 Phlebitis and venous sclerosis

Indwelling needle puncture is generally performed during micropump administration, and the drug concentration is relatively high, and the risk of phlebitis and venous sclerosis is also high.

4.3 Venous return

It is related to factors such as too slow speed, too long or folded and twisted extension tube, and simultaneous injection of dual channels. In the process of drug pumping, the patient experiences venous blood return, and the blood coagulates in the infusion needle to form a thrombus, and as the blood flows, the patient will experience pulmonary vascular embolism [3].

4.4 Needle blockage

Because the extension tube has a certain elasticity and a large capacity, after the needle is blocked, the micropump continues to deliver the liquid medicine, but the liquid medicine does not enter the blood vessels, but accumulates in the extension tube. When the pressure of the extension tube increases to a certain limit, the micropump alarms. , which is detrimental to critically ill patients.

4.5 Micro pump rate adjustment error

Because the operator is not familiar with the speed setting button, or the speed is not changed in time after changing the medicine, or in some cases, the speed setting is accidentally touched by others and the speed is changed, so that the medicine enters the body too much or not enough, resulting in adverse consequences.

4.6 Micro pump failure

It is manifested as inaccurate speed, running out of battery, and improper maintenance, not paying attention to the cleaning of the micro-pump, especially the high-viscosity liquid sticking to the friction between the propeller and the guide rail, which affects the accuracy of the speed.

4.7 Adverse reactions caused by drug incompatibility

In clinical practice, it is very common to insert 2-3 channels from the heparin cap of the venous indwelling needle to save the patient from the pain of repeated venipuncture. However, if the awareness of drug compatibility is not strong, especially for the compatibility of some new drugs and special drugs Insufficient understanding of the contraindications, when a variety of drugs are used in combination, the mistake of incompatibility between the drugs will be made, resulting in a reduction in the efficacy of the drug, and even toxic side effects.

Corresponding treatment measures

5.1 Strengthen inspection and observation

When pumping fluids with a microinjection pump, the patient should be inspected closely, and the local reaction of the drug should be closely observed, whether there is bleeding, exudation and local swelling. With or without blood swelling. Once drug extravasation is found, the bolus injection should be stopped immediately, the vein should be re-selected, and local treatment should be done to ensure the successful completion of the drug injection [4].

5.2 Explain the method of use, treatment purpose and precautions to patients and their families to prevent self-regulation.

5.3 Before using the micropump, the nursing staff should first select the blood vessel. Generally, the blood vessel is thick and straight, easy to fix and easy to observe for venipuncture. For elderly patients, try to avoid puncture and infusion in the lower limbs. Micropump infusion is a dedicated channel and does not share a blood vessel with other drugs [5].

5.4 When using micropump to inject drugs, the effect and reaction of the drug should be closely observed. If the blood pressure and heart rate change greatly for no obvious reason, the extension tube of the micro pump should be disconnected from the joint of the scalp needle to observe whether the blood vessel is unobstructed. When taking sodium phosphate, so as not to cause the patient's blood pressure to drop suddenly.

5.5 Strengthen the sense of responsibility, standardize the operation, be familiar with the performance of the micro-pump, correctly grasp the use method and the setting of each key, understand the precautions, and have a high degree of understanding of the common problems.

5.6 Strengthen the maintenance of the micro-injection pump When using, fix the micro-injection pump firmly on the infusion stand, clean and dust every day, and clean it in time after use, especially the friction between the propeller and the guide rail, use alcohol cotton swab to wipe it to remove dust, especially for The removal of the adhesion of the high-viscosity liquid ensures the normal use of the micro-injection pump.

During the rescue of critically ill patients, the application of microinjection pump can not only maintain stable blood drug concentration of patients, but also improve the efficiency of staff. Moreover, the phenomenon that the infusion speed is fast and slow and difficult to control caused by external interference is avoided. Therefore, it is very important to ensure the normal functioning of the micropump. When using the microinjection pump, the nursing staff should confirm that the operation is normal before leaving, so as to avoid negligence, which will greatly affect the treatment effect and even endanger the patient's life.

Author: Zou Shasha Instructor: Guo Longyan

Work unit: Xianyang Hospital of Yan'an University

references:

[1] Tang Feifei. Typical failures and safety management of microinjection pumps [J]. Medical Equipment, 2019, 32(01): 141.

[2] Yue Ming, Jiang Mi. Clinical nursing experience of using microinjection pump in cardiac surgery [J]. Electronic Journal of Practical Clinical Nursing, 2018,3(37):125.

[3] Hu Lianlian. Research progress on the prevention and treatment of venous blood return when the microinjection pump is pumping drugs at a low flow rate [J]. China Medical Device Information, 2020, 26(22): 17-18.

[4] Huang Chunxia. Targeted nursing effect of microinjection pump in cardiology patients [J]. Medical Equipment, 2019, 32(03): 193-194.

[5] Wang Fengdan. The application and nursing of microinjection pump in gastroenterology [J].