兒科醫(yī)生規(guī)范化培訓(xùn)臨床操作-小兒骨髓穿刺術(shù)評(píng)分標(biāo)準(zhǔn)

表4-2-2小兒骨髓穿刺術(shù)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)患兒姓名、床號(hào)、性別,,2,,

,核對(duì)手術(shù)同意書，向家長(zhǎng)交代骨髓穿刺及其注意事項(xiàng),,2,,

,核對(duì)患兒凝血功能和血常規(guī)檢查,,2,,

,準(zhǔn)備穿刺包、手套、消毒液、彎盤、麻醉藥及干燥玻片,,2,,

,哭鬧或不合作者術(shù)前鎮(zhèn)靜,,2,,

體位(3),選擇合適體位,,3,,

定位(7),選定合適穿刺點(diǎn),,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2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

(10)",核對(duì)麻醉藥(2%利多卡因)并抽吸2ml,,2,,

,"逐層浸潤(rùn)

麻醉",皮丘,2,,

,,垂直進(jìn)針,2,,

,,骨膜多點(diǎn)麻醉,2,,

,,回抽,2,,

"穿刺

(35)",將骨髓穿刺針固定器固定在適當(dāng)?shù)拈L(zhǎng)度上,,2,,

,向骨面垂直進(jìn)針,,2,,

,針尖接觸骨質(zhì)時(shí)左右旋轉(zhuǎn)，緩緩鉆刺骨質(zhì),,2,,

,至阻力消失且穿刺針已固定在骨內(nèi),,4,,

,拔出針芯，接上干燥的10ml或20ml注射器，用適當(dāng)力量抽吸(抽不出無分),,15,,

,"骨髓吸取量以0.1~0.2ml為宜(如要抽取骨髓培養(yǎng)，則應(yīng)在留取骨髓計(jì)數(shù)和涂片

標(biāo)本后再抽取1~2ml)",,3,,

,抽吸時(shí)詢問并觀察患兒反應(yīng),,2,,

,涂片(應(yīng)見頭、體、尾),,2,,

,涂片可見細(xì)沙樣淺肉色骨髓小粒均勻分布,,3,,

,,,,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

"術(shù)后處理

(15)",抽吸完畢，將針芯重新插入,,1,,

,拔針后按壓,,1,,

,穿刺點(diǎn)消毒,,1,,

,覆蓋紗布，膠布固定,,1,,

,采集患兒外周血涂片3~5張送檢,,5,,

,交代術(shù)后注意事項(xiàng),,1,,

,整理用物,,5,,

人文關(guān)懷(5),,,5,,

無菌觀念(5),,,5,,

總分,,,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

□穿刺前未消毒□穿刺前未戴手套□