| BackgroundThe venepuncture is a common and importantmedical procedure, such as venous transfusion, intravenous injection,venous blood and blood transfusion, and venous transfusion is the more frequently-used administration route and also is the most important treatment method in clinic, which must be mastered by nurses. Since the 1940s, the intravenous infusion has been only applied to the critical patients initially, and now it is widely used in clinic and is still an important treatment in clinic.Today, though the importance of intravenous infusion in the clinic can not be replaced by the other forms of treatments, there are some shortcomings with intravenous infusion. First of all, as the initial link of vein puncture infusion,it is an invasive operation, which, to some extend, will bring patients, especially for children, pain and discomfort. It is also a kind of ordeal to children and even leads to dissatisfaction of the patient’s family.The repeated puncture not only let children feel pain, fear and anxiety, but also to the families.According to statistics by CMBA, in China, venous transfusion is mainly used more than 87% in hospitalization. As analyze, there are two main reasons:one is chemotherapy of the tumors after surgical operation is did in our department, why the infusion quantity of chemotherapeutics increases recently. The other, inorder to promote the illness recovery, doctors pay more attention to patients’nutrition, what leads to the usage of gamma-aminobutyric acid and human albumin rising up quickly. The infusion report of 2012 indicates that there are 13 billion infusion-bags,10 bags average.85% nurses spend 75% of the time on the infusion. Thus it can be seen that the amount of infusion directly influence the quantity and quality of nursing. A recent investigation indicates that 54% complaint of nursing from in-patients relates to infusion. As the complexity of skin structure such as adipose issue, skin pigment, depth of vessel and blood volume, leads to hinder the injection under perusal.With the development of the national conditions, most of those have one child in a family, once the child get illness, parents become anxiety and nervous, they demand that nurse must hit the nail only one time, which put mental stress on the nurses. In clinical nursing in pediatrics, because of the influence of various factors, the veinpuncture is especially difficult.Recently, blind puncture is even used in pediatric nursing, and the appearance of vessel decides the puncture success or failure. When taking an injection for the children with poor vessel condition, the ratio of failure is very high. Not only it increases children’s suffering, but also make nurses feel more stressful, even generate conflicts.Doppler ultrasonography is wildly used in medical profession, which can assess physiological characters of different blood flows by means of non-invasive methods. Doppler ultrasound test exploit the field of ultrasound diagnosis. Although, ultrasonic technique has a long history, in assisting venipuncture, especially in peripheral puncture of child, is not used wildly. Thus, exploring peripheral puncture via ultrasound test has great significance.Objectives1 To analyze the factors of affecting peripheral venipuncture for children, which can prevent complication.2 To explore the clinical feasibility of peripheral venous puncture in children with difficult puncture guided by ultrasound, and to guide clinical application.Client and method1 research object100 children of pediatric ward in a Three-A Grade Hospital from July,2014 to December,2015, who have poor vessel condition, that is nurses who have technically skill can not judge the size, curve and furcation and even can not location the vessel after touching. Children were randomly divided into experimental and controlled groups,50 per group.1.1 inclusive criteria①children with respiratory disease②6 to 12 months old③accommodating other therapy④integrated clinical data⑤ave a family member⑥families were willing to cooperate with the research.1.2 exclusive criteria①in a critical condition2 research method2.1 sampling methodAccording to the sequence number of hospital admission, this study was divided into experimental group and control group by using simple random sampling method.2.2 research toolTwo self-designed questionnaires have been used in the research. The first questuinaire includes patients’ general information, such as gender, age, weight and classification with difficulty assessment of vessel puncture, adopting Nie Leixia’s vessel classification with difficulty. The second questionaire is about the satisfaction level of the patient’s family. The questionaire refers to relevant domestic and foreign documents and materials. The nursing satisfaction evaluation standard is based on the Newcastle nursing satisfaction survey table (NSNS). Having consulted the vein infusion therapy research experts, pediatrics nursing experts, intravenous therapy clinical nurse specialist, we have the final questionaire designed. The questionaire has 9 items in total, including the limitation of patient family’s companion, the effectiveness of fixing, assessment of vessel, providing information, the way of explanation, degree of family trusting, working attitude and puncture technique, adopting Level 5 scoring assessment method:1 for great dissatisfaction,5 for great satisfaction. Total points is 45. The higher the score is, the higher level of satisfaction of the patient’s family is. The final results will be expressed in being very satisfied, satisfied and dissatisfied. The scale was tested by reliability and validity.2.3 participants’ training and data collectionMembers of the project group training:fixed a deputy director of the nurse, in school level scientific research training course, ultrasound-guided technology professional training. By the Department of the jurisdiction of 22 nurses, exclusion of 2 nurses in the round of training, training for 20 pediatric nurses. Take the full course of the form of ethical norms, the family of the patient’s informed consent right, investigation tools and survey methods to learn, master good communication skills. Take the face to face investigation, to explain the purpose of the investigation to the families of the patients, to obtain the other party’s permission, before the release of the venous puncture, after the recovery of the volume table.Intervention:With a randomized control method,100 patients who met the inclusion criteria were randomly divided into two groups:experimental group and control group. The control group is under traditional blind puncture, and the experimental group is under ultrasound-guided.Operation steps of ultrasound-guided children with peripheral venipuncture.Due to the vein puncture in children, often restless with, caused by the puncture site is not fixed. In addition, small vascular diameter, if ultrasound real-time guided puncture needle vertical puncture, easy to wear out the pipe wall, so this study selected ultrasound guided pre vascular location method. The operation steps are as follows:Firstly, fix the position of IV injection by family members, secondly, choosing the vessel:putting the ultrasound-guided equipment on the left side of the child, in order to apply convenience to operator. The operator fixed the foot with left hand, explored the great saphenous vein under ultrasonic probe around the ankles with right hand, through the moving probe, swept the great saphenous vein to make image on the point of the horizon. At this time, the point of the horizon is just the drop shadow of the great saphenous vein, which is the point of the puncture location. She must do it gently in order to avoid pressing the vessel flat, and than made a mark. Thirdly, puncture method:tying tourniquet 10cm above the point, disinfecting the skin. The operator must fix the foot all the time with left hand, according to the mark, adjust the angle of the needle and make a puncture, when the blood can be seen, pull the hose all into the vessel, exit the needle, remaining the hose.When the needle was mostly in the vessel, and we still couldn’t see the blood gushed from the vessel and didn’t have the feeling of zero resistance, quit the needle tip to the puncture point, an assistant would use a general ultrasound probe covered with sterile gloves, and confirm the position again, even made the probe guiding in the whole procedure if necessary. (see Figure 1-4)2.4 Evaluating indicatorBy hand using B. Braun 24g vein indwelling needle operation, and by peripheral vein indwelling is a trocar puncture success, recording two groups, the needle number, one-time puncture success rate, total success rate and complication occurrence rate and family satisfaction.3 Statistical methods(1) Adopting SPSS 13.0 to make statistical analisis, measurement data (age, body weight, number of puncture) would be used t-test, which consequence was analyzed in statistical description (±S).(2) Data of sociodemographic characteristics(gender,adiposity and grading of vessel) would be described as frequency and percentage.(3) Successful rate of first puncture, total successful rate, incidence of complication and family satisfaction of the two groups would be compared by chi-square test.Select inspection level as the alpha was 0.05, P<0.05 for the difference was statistically significant.Researchresults1 Included in the standard of 100 cases, there were diagnosis with respiratory infection in stable condition of two groups.From the aspects such as gender, age, body weight, diposity, grading of vessel and fixing the position of IV injection after statistics processing, there was no significant difference (P>0.05) and comparable between experimental group and control group.2 The experimental group has successfully finished intravenous indwelling. But in the control group, there were 45(90%) have successfully finished, of which,4 had more than 7 times puncture until success; 3 had been changed to have subclavian vein puncture as failure in many peripheral vein, whose number of needle, more than 15, wasn’t made by statistically analyses; 2 had failed in indwelling needle puncture more than 7 times, which caused family’s complaints and discharge, certainly wasn’t in statistics. The needle amount of experimental group were 1.2±0.4 while control group were 3.02±2.34.3Occurring rate of venipuncture’s complicationLeakage of venous transfusion within 24 hours, which was 0 in experimental group and 5 (10%) in control group.4 Degree of satisfactionThe result of the two groups satisfaction showed that, satisfaction 42, general satisfaction 8, dissatisfaction 0 in experimental group, total degree of satisfaction was 100%; satisfaction 17, general satisfaction 12, dissatisfaction 21 in control group, total degree of satisfaction was 58%.Conclusions1. Application of ultrasound-guided in peripheral venous puncture for children, could significantly increase successful rate of first puncture2. Application of ultrasound-guided in peripheral venous puncture for children, could significantly increase total successful rate3. Application of ultrasound-guided in peripheral venous puncture for children, could significantly increase degree of family satisfaction4. Application of ultrasound-guided in peripheral venous puncture for children, could effectively reduce the time of puncture5.Application of ultrasound-guided in peripheral venous puncture for children, could effectively reduce complication. |
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