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How to take a scalp needle
May 28, 2018

1. Selection of needles For children born to 3 years of age, scalp needles of sizes 41 2 to 51 2 are generally used. Normal saline is drawn with a 2 to 5 ml syringe and connected with the scalp needle.


2 The strength of the light The brightness of the light and the angle of illumination directly affect the success rate of the puncture. The pupils are too bright and the pupils are too weak. The bright natural light is the ideal light. The veins are clear and the operator's eyes are not easily fatigued. When the light is not good, our department selects two 30W fluorescent lamps. The lamp is at the top of the operator, about 50cm from the puncture vein to ensure sufficient lighting conditions.


3 The choice of blood vessels in the median vein is fixed superficial, thick blood vessels, easy to puncture, but the infusion process is easy to leak, mainly for children with small drug stimulation, short time infusion; supraorbital vein superficial, clear, infusion It is not easy to seep and leak; the anterior tibial vein and the axillary vein are thick and deep, and are suitable for large infusions and injections of irritating drugs.


4 Before the scalp infusion, prepare according to the routine, select the puncture needle and the puncture site according to the disease condition, fix the child's head, make it unable to move, and then prepare the skin. When performing scalp venous puncture, strict asepsis should be observed, skin should be disinfected, air in the hose must be drained, and the punctured blood vessels should be tightened with the right thumb and forefinger so that they will not be slid. Due to the small and curved scalp veins in children, the blood vessel wall is thin and fragile. After the needle pierces the skin and enters the blood vessel immediately, there is a feeling of emptiness. At the same time, blood can sometimes be seen, indicating successful puncture. At this time, we must pay attention to the left hand must immediately use the tape to the right hand pinch needle handle fixed before letting go, or a slight movement of the child, that is, to give up before.


5 needle and needle fixed into the needle when the needle and the skin into an angle of 10 ° ~ 15 °, the needle obliquely facing up, holding the right hand needle, the left hand tighten the skin, directly through the skin into the vein, see the blood should not be re-advanced, direct fixed. If no blood is returned, the right hand draws a syringe needle plug. If the puncture is successful, the blood can be returned. After successful puncture, fix the needle handle with your left thumb and fix it with 3 to 4 tapes. After the scalp needle has been circled, fix it on the auricle with a short adhesive tape. The scalp needle should not be too large around the circle so as to avoid the infusion process. Being pulled or bumped, the hair around the puncture point should be shaved prior to puncturing to facilitate tape fixation. If the child is affected by crying or application of antipyretic drugs caused by head sweating and affect the fixed tape, the head circumference fixation method can be used. The elastic bands 35 to 45 cm long and 2 to 3 cm wide are connected at both ends and are inserted into the head and fixed on the adhesive tape at the puncture point. This can prevent the tape from falling off due to sweating, and does not stick to the hair when the needle is pulled out. Special attention should be paid to obese pediatric scalp venipuncture methods: obese pediatric scalp veins are not clear, scalp is thick, and the needle depth is not easy to grasp. The following two points can be used to operate: 1 Obesity pediatric scalp often vein exposed, but the lumen is fine Slow blood return. When puncturing, it is required to hold the needle steady, and to slowly enter the needle. The patient feels that the needle enters the blood vessel and then draws back the needle and punctures the needle to return the blood. This proves that the puncture is successful. 2 According to the venous anatomical position, in the corresponding parts of the median vein, anterior tibial vein, posterior ear vein and other blood vessels, when touching with the finger laterally, it can touch the sense of “trench marks”, and when touching “the groove marks”, the direction and depth of the vein can be felt. The puncture needle angle of 15 ° ~ 20 °, the needle speed should be slow, sometimes into the veins will have a sense of emptiness, see the success of puncture when returning blood. Children's skull along the frontal seam, coronal suture, sagittal suture, herringbone suture veins are running. When the puncture is made, clear the bone suture, and insert the needle at an angle of 45° to 60°. After the needle inclines into the skin, pierce it in parallel and see the blood to fix it.


6 When pressing the needle, separate the tape and place the sterilized cotton ball on the puncture site. The left thumb holds the cotton ball in the direction of the blood vessel and quickly pulls out the needle so that both the feeding needle and the vascular needle can be pressed at the same time. To prevent subcutaneous congestion. The “physiological hemostasis” due to platelets and other coagulation substances takes 1 to 3 minutes. In addition, when the child cries due to pain and fear during needle pull, the blood pressure in the scalp increases, so it is necessary to press 3 to 5 minutes. Avoid side pressure while kneading, rubbing can make blood clotting into the blood vessels re-bleeding, subcutaneous congestion. Do a good job in education, inform the parents of children before the intravenous puncture do not nurse, feed water, so as to avoid nausea and vomiting caused by crying in the puncture process, causing suffocation and accidents. Before the puncture operation, tell the parents how to restrain the head and legs of the child. One person can constrain the head and one person can constrain the knee. After the puncture is successful, you can hold the child in a nursing posture and restrain the children's hands properly to avoid suffering. Unplug the needle.


7 should pay attention to the following problems during operation should be based on the needs of the condition, select the puncture site and puncture needle, shock children, severe blood loss, severe dehydration in children, need to fast intravenous injection. For drugs with large vascular irritation, mannitol, and 50% glucose, choose a relatively large vein, choose 6-7 puncture needles, in order to ensure a large number of drugs and liquids in a short time. For children with heart, lung, and kidney insufficiency, and neonates, small capillaries were first selected and a puncture needle below No. 5 was selected. Children who take a long time to use drugs, such as myocarditis, tuberculous meningitis, sepsis, etc., should pay special attention to protect the blood vessels, from the distal end of the vein to the proximal end of the puncture in order to protect the passage of long-term intravenous medication; for children with edema, To gently press the perihematomal area of the vein, dissipate the edema of the edema to cause subcutaneous tissue next to the blood vessel, and then perform puncture when the vein is exposed.

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8 During the infusion process, pay attention to the “three pairs of seven pairs” and the drip speed of the infusion, and pay attention to check whether the needle is damaged or barb. After the barbed needle enters the blood vessel, it often causes local swelling. In the infusion before the parents should communicate with the sick children, to facilitate the child with a fixed head, as long as the above points can improve the infusion success rate. Children drop speed must be strictly controlled, because children with various physiological functions is not perfect, poor cardiopulmonary function, infusion of droplet speed can not be too fast to avoid pulmonary edema. Inspect the ward at any time after transfusion, pay attention to whether there is a change in condition and response after medication.


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