輸液反應(yīng)及處理（Infusion reaction and treatment）

1、輸液反應(yīng)及處理（Infusion reaction and treatment）Transfusion reactioneditstatementThis entry may involve the content of the drug. Any recommendation on the use of drugs on the Internet can not replace the doctors orders.Transfusion reaction includes fever reaction, which is caused by factors such as heat sou

2、rce, drug, impurity, liquid temperature too low, liquid concentration too high and infusion speed too fast during intravenous infusion. The main clinical manifestations of fever, chills, chills, face and limbs cyanosis, and fever, body temperature is 4142 DEG C. Nausea, vomiting, headache, dizziness

3、, irritability, delirium, etc., can be severe coma, blood pressure drop, shock and respiratory failure and other symptoms leading to death. In the early or late days of fever, the amount of heat entering the body, the nature of the heat source and the individual tolerance of the patient vary.Catalog

4、1 infusion reaction and PreventionFever reactionHeart failure and pulmonary edemaPhlebitis?Air embolism2 common types of infusion reactionsPyrogen reactionThermal original reactionAnaphylaxis?Cell contamination causesCauses and precautions of infusion reaction in 3DrugQuality of infusion equipmentIn

5、fusion speedInfusion environmentPatient factorsCase analysis of 4 infusion reactionClinical dataCause analysisDiscussion5 the key to prevention and treatment lies in the cause1 infusion reaction and PreventioneditFever reaction1. causes of fever is common infusion reactions, often due to input pyrog

6、enicsubstance (impure bacterial protein or drug ingredients, dead bacteria, pyrogen free), infusion bottle cleaning and disinfection is not perfect or contaminated again; the input liquid disinfection, baoguanbushan modification; surface adhesion caused by sulfide and infusion tube.The 2. main sympt

7、oms of chills, chills and fever (mild fever often at about 38 DEG C, serious Gaoreda 40 - 41 DEG C), and accompanied by nausea and vomiting, headache, rapid pulse, general malaise and other symptoms.3. prevention methods(1) the light person can slow down the infusion speed, and pay attention to keep

8、ing warm (increase the cover or the hot water bag). Who shall immediately stop the transfusion; high fever with physical cooling, when necessary according to the instructions given anti allergic drugs or hormone therapy, acupuncture Hegu and neiguan.(2) the transfusion apparatus must do well the tre

9、atment of eliminating pyrogen.Heart failure and pulmonary edema1., because of the rapid drop speed, too much liquid input in the short term, the rapid increase in circulating blood volume, resulting in heavy heart burden.2. patients with symptoms of cough, shortness of breath, suddenly felt chest ti

10、ghtness, foamy bloody sputum; severe sputum by dilute nose emission, pulmonary rales, heart rate.3. prevention methods(1) infusion speed should not be too fast, the amount of input liquid can not be too much. Particular attention should be paid to the heart, the elderly and the children.(2) when the

11、 symptoms of pulmonary edema occur, the infusion should be stopped immediately, and the doctor should be informed to let the patient take the seat at the end and his legs droop, so as to reduce the venous return and reduce the burden on the heart.(3) according to the instructions given vasodilation,

12、 asthma, cardiac.(4) high flow oxygen inhalation, and the humidifying bottle water for 20% - 30% alcohol humidification after inhalation, to reduce alveolar surface tension of foam, the bubble disappear, so as to improve gas exchange in the lungs, relieve the symptoms of hypoxia.(5) the tourniquet s

13、hould be used to relax the limbs every 5-10 minutes if necessary. The tourniquet should be relieved gradually after the symptoms are relieved.Phlebitis1. because of long-term infusion of high concentration and strong irritant drugs, or placed strong irritant intravenous plastic tube too long caused

14、partial venous wall chemical inflammatory reaction; but also because during the operation of strict aseptic infusion caused local venous infection.2. symptoms along the vein to streak red, red, swollen, hot local tissue, sometimes accompanied by pain, chills, fever and other symptoms.3. prevention a

15、nd treatment methods to avoid infection, reduce the stimulation of the wall of the blood vessel principle.(1) strict implementation of aseptic operation, drugs that are irritating to the blood vessels, such as erythromycin, hydrocortisone and so on, should be fully diluted after application, and to

16、prevent drug overflow of blood vessels.At the same time, the injection site should be changed frequently to protect the vein.(2) raise the affected limb and brake, and apply hot compress with 95% alcohol or 50% Magnesium Sulfate.(3) traditional Chinese medicine topical or spirit of Ruyi Jinhuang pow

17、der, 2 times a day, 30 minutes each time.(4) ultrashort wave physiotherapy, with TDP therapeutic apparatus irradiation, 2 times a day, 30 minutes each time.Air embolism(18 pieces)1. because of the air in the transfusion pipe not drained, pipe connection is not tight, there is a pressure infusion and

18、 blood transfusion; nobody guard, dangerous air embolism occurred. The air entering the vein is first taken to the right atrium and then to the right ventricle. If the air is less, right ventricular pressure into the pulmonary artery, pulmonary artery and scattered, and finally to the capillary, so

19、there is less damage, such as air volume, air in the right ventricle to block the artery entrance, so that the blood can enter the pulmonary gas exchange, caused by lack of oxygen, leading the death of patients.2. patients feel abnormal chest discomfort, feeling of impending death, appears severe dy

20、spnea, cyanosis, electrocardiogram and myocardial ischemia and acute pulmonary heart disease change.3. prevention methods(1) the air must be drained out during transfusion. The nurses should observe closely and avoid leaving the patients in order to prevent the liquid from emptying.(2) the patient i

21、mmediately left decubitus and Trendelenburg position, this position can increase the intrathoracic pressure in the air, to reduce air into the vein, left lateral decubitus position can make pulmonary artery in the lower part of the right ventricle, the bubble to drift right ventricular apex, avoid p

22、ulmonary artery entrance from the heart beat the air is mixed, divided into small bubbles in the pulmonary artery.(3) oxygen inhalation(4) in the subclavian vein puncture and replacement of water, should be carried out in a patient or patient will hold breath, to prevent air suction, keep any operat

23、ion or change when the liquid silicon tube, can not let the silicon is communicated with the air cavity.Emergency treatment exercise of transfusion reactionEmergency treatment exercise of transfusion reactionEmergency treatment exercise of transfusion reactionEmergency treatment exercise of transfus

24、ion reaction2 common types of infusion reactionseditPyrogen reactionThe main reason is that bacterial endotoxin passes through the intravenous infusion agent into the body and accumulates more than the bodys tolerance, and then the pyrogen reaction occurs. The clinical symptoms of fever, chills, pal

25、e skin, mydriasis, elevated blood pressure, leukopenia; severe headache that accompanied by nausea and vomiting, coma, shock and even death.Thermal reactionDue to the similar pyrogen reaction caused by insoluble particles in infusion, it is mainly contaminated by production, storage, infusion equipm

26、ent, infusion operation process and infusion environment.AnaphylaxisIn addition to skin itching, erythema like rash and other general allergic reactions, clinical common allergic reactions like pyrogen reaction, difficult to distinguish from pyrogen reaction.Cell contamination causedAn acute bacteri

27、al infection, such as severe bacteremia or septicemia, caused by a cell or fungal contaminated fluid entering the body and causing severe acute bacterial infection.Causes and precautions of infusion reaction in 3editmedicine(1) large infusion: if the small cracks or caps loose during the storage, tr

28、ansportation and use of the infusion, it will cause air leakage and cause microbial contamination of the infusion. So we must carefully check before use. It is found that the infusion bottle mouth is loose, the bottle wall has fine crack and the brightness is not qualified, then it shall not be used

29、.(2) adding drugs: (1) the quality of the added drugs is not qualified, and it is easy to cause transfusion reaction. Qualified drugs must be used. (2) adding too large dose of drugs and too high concentration are easy to cause transfusion reaction. Drug concentration should be reduced. (3) adding d

30、rugs and infusion produces physical changes or decomposition and polymerization, which leads to the decrease of curative effect and leads to infusion reaction. Drug incompatibility should be avoided. The patients body temperature returned to normal after discontinuation of drug induced fever. Improp

31、er selection of large volume of injection should be mixed with Glucose Injection and diluted with intravenous drip, so it should not be mixed with physiological saline.The reason is that the combination of Chinese herbal medicine injection and physiological saline can produce a large number of insol

32、uble particles due to salting out effect, thus increasing the incidence of infusion reaction.(3) pyrogen cumulative: intravenous administration of bacterial endotoxin in vivo, when entering the pyrogen reaches a certain amount, which happened with pyrogen reaction. The compatibility of drugs should

33、be minimized when intravenous administration is given.(4) accumulation of particles: improper dispensing sequence can also increase particles, or even exceed the standard. Dispensing is polluted by air, dust particles are more, dispensing needles are too large, so that infusion rubber plug into the

34、infusion, resulting in increased infusion particles. The dispensing sequence should be changed, the dispensing room should be equipped with purification facilities, and the use of small needle matching liquid can reduce the particles in the infusion.Quality of infusion equipmentUnqualified disposabl

35、e syringes and disposable infusion sets are also the way to cause pyrogen contamination, and the qualified disposable articles must be used in clinic.Infusion speedWhen intravenous drip containing K +, Ca 2+, Mg 2+ plasma, such as rapid dripping, sensitive patients can cause transfusion reaction. Fo

36、r patients with weak or sensitive constitution, we must control the drip rate.Infusion environmentGenerally, in summer, when the temperature is hot and the air humidity is high, the liquid medicine is easy to be polluted by microorganism, which leads to the infusion reaction. Climate cold season, fo

37、r elderly patients or patients with weak constitution, can also lead to infusion reaction. Pay attention to the environmental temperature during transfusion.Patient factor(1) disease: Patients with inflammation, febrile diseases or weak constitution, immune disorders and other patients, can increase

38、 the reaction rate. After excluding the factors of drug and operation, it was diagnosed as the change of the development of the disease.(2) the age of the patients: the elderly patients, childrens immune function is low or incomplete, the sensitivity to bacterial endotoxin is increased, the proporti

39、on of infusion reaction is high, and the elderly, frail and young patients should be paid attention to when transfusion.(3) individual differences: different patients have different tolerance threshold to bacterial toxins, so pay attention to the infusion of sensitive patients.Case analysis of 4 inf

40、usion reactioneditTransfusion reaction is the abbreviation of transfusion adverse reactions. It is the general term of transfusion induced or adverse reactions associated with transfusion, and sometimes it is also called pyrogen reaction in clinic. But strictly speaking, pyrogen reaction is only par

41、t of the adverse reactions of transfusion. The most common transfusion reactions in clinic are fever, chills and vomiting caused by pyrogen reaction and heat like reaction, and other bacteria (bacteria, spores, fungi) pollution reactions, allergic reactions and other 1. This paper reports 69 cases o

42、f transfusion reaction with fever as the main manifestation, and discusses the causes and preventive measures.clinical dataIn 69 cases, 48 cases were male, 21 were female; aged 19-74 years old, average 50.5 + 15.5 years; 13 cases of intravenous injection of large liquid, large liquid + western medic

43、ine in 24 cases, 16 cases of traditional Chinese medicine preparation liquid + liquid + +, large preparation of traditional Chinese medicine Western medicine in 16 cases; large liquid dosing types 1-8, an average of 3.7 + 1.2, of which 31 cases of drug dosing 1-3, 4-5 15 cases, 6-8 10 cases of drug

44、dosing; the number of ampoules of 1-20 branch, average 6.6 + 2.2. When the reaction occurred, the infusion volume was 75-500mL, with an average of 203 + 35mL; the occurrence time was 15 minutes after the infusion, and 80 minutes at the latest 8 minutes, with an average of 35 + minutes. The reference

45、 diagnostic criteria are as follows: 1 infusion reaction after infusion in 15 minutes to 1 hours, have cold feeling, chills, fever or above 38 DEG C, the temperature in a few hours after the infusion was discontinued in normal, may be accompanied by nausea and vomiting, headache, waist and limbs joi

46、nt pain, pale and clammy skin, decreased blood pressure, shock and even death.Cause analysisThe factors of the occurrence of transfusion reaction is divided into four kinds, drug factors: it is found that the drug appearance changes (including transparency, color, floc, mouth loose, ampere fracture)

47、 or pyrogen and particulate infusion: exceed the standard; it is found that the infusion bottle, infusion syringe, pyrogen and particles exceed the standard of operation factors; the detection of the same batch of other drugs and infusion equipment and pyrogen particles are not exceed the standard a

48、nd no other quality problems.Patient factors: there was no other reason for the test. According to the analysis, 29 cases (42%) belonged to drug factors, 7 cases (10.1%) belonged to infusion apparatus, 27 cases belonged to operation factors (39.1), 6 cases belonged to patients (8.7%).discuss3.1 the

49、mechanism of pyrogen is a general term for the increase of body temperature. The generalized pyrogen includes bacterial pyrogen, endogenous polymeric pyrogen and its chemical pyrogen, etc. the pyrogen in pharmaceutics is usually the metabolite of microorganisms. It has been proved that pyrogen is ma

50、inly a kind of endotoxin, which is composed of lipopolysaccharides, phospholipids and proteins. The foreign particles is also an important cause of transfusion reaction, insoluble particles of foreign bodies such as rubber particles in intravenous infusion, insoluble inorganic salts, activated carbo

51、n particles and fibers, produced in the process of combination of particles and the infusion process without air filtration into the infusion of pathogens or dust, can cause heat the same reaction, phlebitis, granuloma, pulmonary edema, vascular embolism, allergic reaction etc. Produced by intraveno

52、us blood, stimulate the pituitary gland of central heating, causing fever reaction of 1, 2.3.2 prevention3.2.1 strictly check the infusion of drugs and infusion equipment before use, carefully check whether the bottle is clear, whether expired. Check whether the bottle cap is loose or not, and wheth

53、er there is any crack in the bottle body, bottle bottom and bottle label. Whether the liquid medicine has color change, precipitation, impurity and clarity change. Infusion equipment and storage of chemicals to be the exclusive service, according to the period of validity has used. Before using the

54、infusion device, we should carefully check whether the packing bag is damaged or not, and gently squeeze the plastic bag by hand to see if there is air leakage. The use of unqualified infusion apparatus 2, 3 is prohibited.3.2.2 improved therapeutic room environmental therapeutic room, according to t

55、he conventional ultraviolet light irradiation disinfection 1 hours per night, 2% peracetic acid 8ml/m3 per week, boiling fumigation 30min. Use 0.2% bleach powder or 1%84 disinfectant every day for 2 times in indoor, door and window, table, treatment vehicle and ground wet wipe. Monthly air bacteria

56、monitoring in therapeutic room 1 times. In the process of dispensing and transfusion, the therapeutic room and ward personnel flow should be reduced, and sweeping and sweeping beds should be avoided to reduce dust particles in the air. At present, the purification technology is the most effective wa

57、y to improve the cleanliness of the infusion environment air and ensure the quality of the infusion, such as the installation of purification room, laminar flow hood or use of super clean table for infusion dispensing.3.2.3 strict operating procedures, intravenous input process should strictly abide

58、 by the principle of aseptic operation, medical personnel in the intravenous infusion operation before effectively hand cleaning and disinfection. Improvement of ampoule sawing and disinfection, the ampoule with 0.5% saw strong iodine or 75% alcohol swabs after disinfection once broken, can achieve sterile, and the operation is simple, time-saving and labor-saving. The sterilization of the bottle neck and the skin puncture site should be thorough, the needle should be repla