This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
第30卷第1期Mar. 31 2014 藥學雜誌 第118冊 67
預防及處置新生兒非化療藥外滲台北市立聯和醫院藥劑部藥師 陳偉立、陳立奇
台北市立聯和醫院中興院區藥劑科藥師 施李碧玉
摘要
嚴密監控周邊靜脈注射 (IV) 治療,是許多護士在新生兒重症加護病房 (NICU) 的
職責之一。但即使在嚴密照護下,新生兒或早產兒因皮膚較薄及血管尚未發育完全,
周邊靜脈治療仍然存在治療的風險,包括血腫、感染、靜脈炎、藥液浸潤和外滲。靜
脈輸液藥品從血管外滲到周圍組織,造成傷害可以波及到神經、肌腱和關節,輕則造
成注射部位腫脹疼痛,嚴重則可能造成肌肉壞死,需要外科進行清創、皮膚移植,甚
至截肢。良好的操作技術可以降低藥液外滲發生率,醫療人員應特別謹慎注意,但仍
可能發生藥液外滲的情形,因此希望藉由本文提供醫療人員及早處置之參考,以降低
因外滲而造成對病人嚴重傷害。
關鍵字: 藥液外滲、pH 值、滲透壓、處理原則、傷口照護、drug extravasation
壹、前言
藥液外滲,指輸注藥品經中央或週邊靜
脈給藥時,自血管內漏至周邊組織或由血管
滲出至周邊組織,可能會造成嚴重的局部組
織傷害而不得輕忽,特別是新生兒加護病房 (Neonatal Intensive Care Unit, NICU) 病人,因血管較小血流量較低,導致較少的血液可
1. Robin Clifton-Koeppel, MS, RNC, et al: Wound Care After Peripheral Intravenous Extravasation: What Is the Evidence? Newborn Infant Nurs Rev. 2006;6:202-11.
2. Doellman D, Hadaway L, Bowe-Geddes LA, et al: Infil-tration and extravasation: update on prevention and man-agement. Infus Nurs. 2009;32:203-11.
3. UpToDate Inc.: Extravasation injury from chemotherapy and other non-neoplastic vesicants. 2013: UpToDate on-line.
4. Sauerland C, Engelking C, Wickham R, et al: Vesicant extravasation, I: mechanisms, pathogenesis, and nursing care to reduce risk. Oncol Nurs Forum. 2006;33:1134-41.
5. Tiwari A, Haq AI, Myint F, et al: Acute compartment syn-dromes. Br J Surg. 2002;89:397-412.
6. Guyton AC, Hall JE. Regulation of acid-base balance. In: Guyton AC, Hall JE, eds. Textbook of Medical Physiol-ogy. 10th ed. Philadelphia, PA: WB Saunders; 2000;346-363.
7. Vesely TM, Stranz M, Masoorli S, et al: The diverse and conflicting standards and practices in infusion therapy. J Vasc Access Devices. 2002;7:9-25.
8. Hadaway L. Infiltration and extravasation: preventing a complication of IV catheterization. Am J Nurs. 2007; 107:64-72.
9. Subhani M, Sridhar S, DeCristofaro J. Phentolamine use in a neonate for the prevention of dermal necrosis caused by dopamine: a case report. J Perinatol. 2001;21:324-26.
10. Wong A, McCulloch L, Sola A. Treatment of peripheral tissue ischemia with topical nitroglycerin ointment in neo-nates. J Pediatr. 1992;121:980-83.
11. Lund C, Kuller J, Lane A, et al: Neonatal skin care:the scientific basis for practice. J Obstet Gynecol Neonatal Nurs. 1999;28:241-54.
12. Lund C. Prevention and management of infant skin break-down.Nurs Clin North Am. 1999;34:907-20.
74 THE JOURNAL OF TAIWAN PHARMACY Vol.30 No.1 Mar. 31 2014
臨 床 藥 物 治 療 學 Therapeutics of Clinical Drugs
Prevention and Management of Non-Chemotherapy Drugs Extravasation in
Department of Pharmacy Taipei City Hospital Zhongxing Branch2
Abstract
Close monitoring peripheral intravenous (IV) therapy is one of the duties of nurses in the neonatal intensive care unit (NICU). But even under the strict care, newborn or preterm children due to thinner skin and vascular not fully developed yet, peripheral intravenous therapy remains the treatment of risks, including hematoma, infection, phlebitis, infiltration and exudation of drugs. Intravenous drug from the extravasation into the surrounding tissue, causing injury can relate to nerves, tendons and joints, ranging from causing pain and swelling at the injection site, may result in severe muscle necrosis, requiring surgical debridement, skin grafts, and even amputation. Good operating techniques can reduce the incidence of drug-leakage, and medical personnel should be particularly careful attention.