Iodoforol injection (100ml; 74.1g) is a non-ionic contrast medium with no charge, low osmotic pressure, low chemical toxicity, and relatively safe in clinical applications. High-pressure intravenous iodivol is used for CT enhancement scanning, which has the characteristics of safety, reliability and good effect, which can not only find the missed part of the flat sweep, improve the detection rate of the lesion, but also facilitate the characterization of the lesion and improve the accuracy of tumor staging.
Patient, female, 65 years old. Due to bloating and abdominal pain for more than 2 months, aggravated with black stool for 3 days, he was admitted to the hospital with "cardia gastric base cancer", and because he needed further diagnosis, he underwent an elevated scan of the upper abdomen on the afternoon of the 2nd day of admission. The patient returns to the ward. When the head nurse of the ward inspected the ward after 30min, the patient complained of pain in the left upper limb, local hot compresses, extreme swelling and fullness between the left elbow and the shoulder joint, about 35 cm on the left side of the arm circumference, about 20 cm on the right side, swelling affecting the soft tissues of the entire upper limb, about 8 cm × 10 cm in the left ulnar eagle beak, painful to the touch, and pale skin. Immediately elevate the affected limb with a cushion pillow, cold compresses in ice packs, alternately wet compresses the swollen area with 50% magnesium sulfate and potato chips, organize special care, give psychological care, give hydrocolloid dressing cover, after the next day the hard lump at the ulnar eagle's mouth disappears, the pain is significantly reduced, after 48h, the upper arm circumference is reduced to 22cm, the needle eye is slightly painful to the touch, after 72h, the left upper arm circumference is similar to the right upper arm arm circumference, about 20cm, the pain disappears, the joint activity is normal, and the hospital is discharged after 4 days.
1. Cold therapy The swelling of the left upper arm is localized with cold compresses in ice packs to reduce swelling and relieve pain. Break the ice cubes into the ice pack, put the ice pack into the cloth bag and tie the mouth of the bag, apply it to the most swollen part 5 cm above the eye of the needle, replace the ice pack when it returns to room temperature, and remove the ice pack after 18 hours. The temperature should be suitable for the patient to feel comfortable and not cold. 50% magnesium sulfate and potato chips alternately wet compress The needle eye is protected by an infusion patch after iodine sterilization, and the wet compress is applied along the vein direction 2 cm from the needle eye. Soak 50% magnesium sulfate with 4 layers of 10cm × 10cm gauze, remove the wet gauze to put the drip horizontally without dripping water and lift the drip, fix the gauze with plastic wrap after applying, and pad the limb pad a one-time single. Magnesium sulfate is easy to precipitate crystals, and the gauze is dried and hardened, and it should be replaced in time after drying. Potato chips are cut into very thin slices with a special micromitting machine, with a thickness of about 0.2 to 0.3 mm, and all soft tissue swelling areas should be applied. Replace potato chips when oxidized to pink, thus ensuring freshness and absorption of active ingredients. Repeat this until the swollen soft tissues are visibly swollen, and it is best to choose a high-quality potato that is large, juicy, and yellowish.
2. Care of swelling Measure the upper arm circumference of the affected limb with a soft skin ruler, measure the arm circumference should be fixed, positioned, and fixed, observe the degree of swelling and peripheral nerve sensation at any time, touch the radial artery pulse regularly, and make a record. To help patients adjust the position of limb placement, the affected limb is raised with a cushion pillow, and the height exceeds the level of the heart by about 10cm to be comfortable, which is conducive to venous and lymphatic reflux, reduces swelling, reduces swelling of the affected limb as soon as possible, prevents limited joint mobility, and encourages patients to carry out the activity of the affected limb as much as possible.
3. Follow the doctor's instructions to calm and relieve pain, and the nursing staff communicates with the patient in a cordial manner in a timely manner, so that the patient feels warm, explains the cause of the pain, provides a quiet and comfortable environment for the patient, and the ventilation of the ward keeps the air fresh and the temperature and humidity appropriate. The nurse sent boiling water to the ward to assist in taking the medicine and assisted the patient with two stools. Take the initiative to contact the patient's friends to visit, chat, listen to music, watch TV, etc., divert the patient's attention, help him prepare for bedtime, improve the quality of sleep, facilitate the repair of limb tissue, and reduce pain.
4, diet care In the early stage of swelling, patients should eat light, fiber-containing, easy to digest and absorb food, avoid spicy, greasy fried products, later can enter some mixed nutrition food, eat more fresh vegetables and fruits, guide the family to provide delicious food according to the patient's preferences, pay attention to the reasonable blending of food color, aroma and taste.
5, psychological care Patients themselves are full of fear of their own diseases, showing nervousness, for patients and their families, the diagnosis of the disease before admission to the hospital has not produced results, so that they are very anxious, the unexpected situation at this time is more serious about their psychological burden, lack of trust in nursing, that complications are caused by improper operation of nursing staff. While actively taking therapeutic and nursing measures, we strengthen communication with patients and their families, make frequent observations, regardless of their excessive language, and tell them that iodoforol extravasation will not cause particularly serious consequences like extravasation of chemotherapy drugs.
(1) The patient uses a high-pressure syringe for brain enhancement CT with high pressure and fast flow rate;
(2) Patients with malignant tumors have low immunity and are not sensitive to pain;
(3) The puncture nurse evaluates the blood vessels insufficiently, fails to reasonably select the puncture site, and performs punctures in the dorsal veins of the hands with a high risk of extravasation;
(4) Cytotoxic effect of the use of drugs: the extravasation of contrast agents produces a local acute inflammatory reaction to the skin and peripheral tissues, and reaches a peak within 27 to 48 hours.
Mainly the needle is not firmly fixed, the steel needle slides out of the blood vessel after the limb is moved, and the flow rate and flow rate of the machine injection are high, and about 100ml of the liquid quickly enters the skin and causes swelling and pain in the upper arm.
1. A No. 20 indwelling needle can be used to puncture to ensure that the catheter has more parts in the intravenous lumen. The needle site should be pasted with a 3m transparent needle to the puncture point as the central point, and then fix the needle handle, and finally fix the extension tube on the patient's arm, so that it can move with the movement of the machine tool during the scan, to avoid the needle moving or puncturing the blood vessel during the scan, if a needle fails to puncture, another blood vessel should be selected to re-puncture, the nurse should carefully look for a sure blood vessel when puncturing, do not blindly puncture. It is advisable to choose thick, straight, elastic, and well-fixed blood vessels, to avoid veins such as sinuses and vascular bifurcation, commonly use the shallow vein of the forearm and the middle vein of the elbow. Avoid punctures in the veins of long-term infusions to avoid leakage of the walls of blood vessels near the end of the heart above the site of the puncture.
2. Observe the high-pressure injection process Before the operation, the nurse conscientiously does a good job of psychological care for the patient, during the bolus process, patiently ask and answer the questions raised by the patient (any problems that may occur during the contrast operation), instruct the patient to reflect to the operation nurse in time (raise his hand to show signs), once the patient raises his hand to signal, immediately stop the high-pressure injection, the nurse should go to the patient's side to check the puncture site, to avoid large doses of liquid rapidly entering the skin. If extravasation occurs, mild can be left untreated or only 50% magnesium sulfate local wet compress, replace the injection site to repuncture, severe leakage of the person to stop the enhanced scan, immediately give 50% magnesium sulfate local wet compress, 30min after return to the ward for observation. Local cold compresses, hot compresses are strictly prohibited, and the affected limb is instructed to be elevated to promote venous return and facilitate the absorption of contrast agents.
3. Because the swelling of this patient involves the soft tissue of the entire upper limb, in addition to the swelling of the soft tissue, due to the high concentration of contrast agent, it remains in the muscle space for a long time, and there is a possibility of muscle necrosis, so we must deal with it in time to prevent complications. Once the liquid exudation occurs, the contrast nurse must personally escort the patient back to the ward and make a detailed handover with the ward nurse to avoid serious consequences caused by the patient's own treatment.
4. 50% magnesium sulfate active ingredient and pharmacological effect 50% magnesium sulfate wet compress solution extravasation local, can cause neuromuscular conduction blockage and cause peripheral vascular smooth muscle relaxation and vasodilation. Promotes blood circulation in extravasive local tissues, thereby reducing inflammation such as edema and pain.
5, potato active ingredients and pharmacological effects Potatoes are sweet, with anti-infection, blood activation, swelling and other functions, its main medicinal ingredients are carotene, vitamin B1, vitamin C, solanine, solanine and tuber kudzu, etc., and contains a large number of polyphenol oxidase. The pharmacology of extravasation of potato treatment solution is that it contains starch, absorbs water in tissues, has good skin fit, strong water absorption, not only reduces swelling, anti-infection, but also has the effect of repairing skin tissue damage, polyphenol oxidase can protect cells and cell membranes, alleviate inflammation.
6. Active ingredients and pharmacological effects of Ruyi Golden Yellow Powder Main recipe: turmeric, rhubarb, yellow cedar, Cangshu, Magnolia, tangerine peel, licorice, shengtiannanxing, baizhi, smallpox pollen. Chinese medicine dialectical patient is due to damp heat, blood stasis and stagnant veins, and Ruyi Golden Yellow Powder has the effect of clearing heat, relieving pain, reducing swelling and dehumidification, dispersing stasis and sputum, it can activate phagocytes, so as to achieve sterilization, astringent and anti-inflammatory effects.
7. Intravenous injection of iodine with CNC syringes when enhancing CT has been widely used in the imaging department, such as the handover between nurses in the department of extravasation of the patient's liquid, and effective treatment and nursing should be actively taken, especially the close observation, comprehensive treatment and the effective implementation of various nursing measures within 24h, which is the key to promoting the recovery of limb tissue.