內(nèi)科醫(yī)師規(guī)范化培訓(xùn)臨床問診檢查操作-胸腔穿刺給藥評(píng)分標(biāo)準(zhǔn)

胸腔穿刺給藥評(píng)分標(biāo)準(zhǔn),,,,,,

項(xiàng)目(分),,具體內(nèi)容和評(píng)分細(xì)則,,"滿分

(分)","得分

(分)",備注

準(zhǔn)備(10),,核對(duì)患者姓名、性別、年齡,,1,,

,,核對(duì)X線胸片或者胸部B超,,1,,

,,核對(duì)手術(shù)同意書，向患者交代胸腔穿刺及其注意事項(xiàng),,2,,

,,核對(duì)凝血功能和血常規(guī)檢查,,1,,

,,測(cè)量血壓、脈搏(口頭提到即可),,1,,

,,檢查準(zhǔn)備的物品,,1,,

,,對(duì)精神緊張者術(shù)前鎮(zhèn)靜(口頭提到即可),,1,,

,,胸腔穿刺藥物選擇,,2,,

體位(5),,"患者常規(guī)取坐位，面向椅背，雙手前臂平放于椅背上，前額伏于前臂上(不能坐

立者，取半臥位)",,5,,

定位(10),,胸部叩診,,3,,

,,選擇肩胛下角線第7~9肋間(半臥位者取腋中線第6~7肋間),,5,,

,,穿刺點(diǎn)標(biāo)記,,2,,

"消毒鋪巾

(10)",,洗手，戴口罩、帽子,,1,,

,,以穿刺點(diǎn)為中心，由內(nèi)向外環(huán)形消毒皮膚，直徑15cm,,1,,

,,絡(luò)合碘消毒3遍,,1,,

,,注意勿留空隙，棉簽不要返回已消毒區(qū)域,,1,,

,,檢查穿刺包消毒日期,,1,,

,,戴無菌手套,,1,,

,,檢查消毒指示卡,,1,,

,,核對(duì)包內(nèi)器械,,1,,

,,檢查穿刺針是否通暢,,1,,

,,鋪巾,,1,,

麻醉(5),,核對(duì)麻醉藥(2%利多卡因)并抽吸2ml,,2,,

,,"逐層浸潤

麻醉",皮丘,1,,

,,,垂直進(jìn)針,1,,

,,,回抽,1,,

"穿刺過程

(28)",,止血鉗夾住穿刺針的橡皮膠管,,1,,

,,穿刺針經(jīng)肋骨上緣垂直胸壁緩慢刺入,,1,,

,,連接50ml注射器，松開止血鉗，固定穿刺針,,1,,

,,抽吸直到見針筒內(nèi)有液體流出(抽不出無分),,15,,

,,抽吸中囑助手協(xié)助固定穿刺針，抽滿后，囑助手夾緊膠管,,2,,

,,"抽液量：首次不超過600ml,以后每次不超過1000ml",,3,,

,,抽液時(shí)詢問并觀察患者反應(yīng),,5,,

,,,,,續(xù)表,

項(xiàng)目(分),,具體內(nèi)容和評(píng)分細(xì)則,,"滿分

(分)","得分

(分)",備注

"胸腔給藥

(12)",,用注射器抽取藥液,,2,,

,,連接穿刺針后膠管，松開止血鉗，固定穿刺針,,1,,

,,回抽少量胸腔積液稀釋,,5,,

,,緩慢注入胸腔內(nèi)，推注后囑助手夾緊膠管,,1,,

,,給藥時(shí)詢問并觀察患者反應(yīng),,3,,

"術(shù)后處理

(10)",,拔針后按壓,,1,,

,,消毒穿刺點(diǎn),,1,,

,,覆蓋紗布，膠布固定,,1,,

,,交代術(shù)后注意事項(xiàng),,3,,

,,術(shù)后測(cè)血壓、脈搏并觀察患者反應(yīng),,4,,

人文關(guān)懷(5),,,,5,,

無菌觀念(5),,,,5,,

共計(jì),,,,100,,

"如嚴(yán)重違反無菌原則(以下任意一項(xiàng)或多項(xiàng)),在總分上扣除50分(請(qǐng)打鉤)

□穿刺前未消毒□穿刺前