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Improve the scalp needle puncture success rate in children
May 28, 2018

Different puncture methods to improve the success rate of scalp venipuncture in children:

1 In order to increase the success rate of scalp acupuncture in children, it is necessary to know the location of pediatric scalp veins. The most commonly used scalp puncture needles for children are: the median right middle vein, superficial temporal vein, and posterior ear vein. The median right middle vein is splayed from the venous network to the median venous septum and the posterior edge of the frontal surface of the median venous line falls vertically along the frontal midline. It is accompanied by the opposite arterial artery and continues to the inner end of the eyebrow. [1] The characteristics of this vein are fine, long, straight, and relatively fixed. The success rate of puncture is high, and it is not easy to leak fluid. Occasionally, the input irritant fluid leaks. It can leak along the loose skin of the forehead. It should be promptly leaked. Apply wet with magnesium sulfate. The superficial temporal vein originates from the venous network at the top and lateral sides of the skull and merges into the superficial temporal vein, which is located subcutaneously on the ankle, on the surface of the temporal fascia, slightly above the sacrum, and in front of the external ear with the arteries of the same name. Can feel the fluctuations, veins often in front of the artery, this vein thick, straight, easy to slide obvious exposure, puncture easily pierced, causing hematoma, even if the puncture is successful, but also easy to leak, and the needle in the thick vein Involvement is not fixed, and venous indwelling needle puncture is appropriate. Because the indwelling needle is successfully punctured, only the hose is left floating in the thick blood vessel. Even if the blood vessel slides, it will not be punctured, and the success rate is higher than that of the steel needle. Leakage rate is low. If it is unsuitable for indwelling needle puncture, when using a scalp needle to inject needles with a side-into-side stoppage to observe blood return, because this blood vessel slides easily, this method can reduce the chance of puncturing blood vessels. As the blood vessel is thicker, the feeling of falling into the blood vessel is more obvious. After feeling the feeling of falling, it is necessary to stop the needle and gently squeeze the scalp needle tube to see if there is blood return, because some children have dehydration or poor circulation. Slower back to the blood, if you blindly advance to the needle easily pierce the blood vessels, see the return of blood and then go along the blood vessels into the 0.5-1cm, to ensure that the needle slant fully into the blood vessels, to avoid leakage due to half of the slope exposed to the outside. The posterior ear vein is located behind the auricle. It is anastomosed posterior to the posterior maxillary vein and connected to the papillary blood vessels. This vessel is slightly curved and is clearly visible. It is relatively fixed. Puncture is easier to puncture. The disadvantage is that it is located behind the ear and with more hair. The adhesive tape is not easy to fix, and when the family members hold the child's infusion, because of the position of the child, the head of the patient may accidentally touch the puncture needle to cause fluid leakage and increase the pain of the child, such as puncture in the back of the child. The family members grasped the side of the puncture needle on the side of the needle to prevent the children from scratching.

In addition to the above blood vessels, superficial veins on either side of the forehead or near the temple can also be selected. This vein is fine, but it is relatively fixed. The success rate of puncture is high and it is not easy to leak. The only drawback is that it is close to the eyelid and sometimes suffers. When the child raises his eyes or frowns, the infusion is sometimes unsmooth, so try to puncture the eyelid farther away, or let the child drip smoothly by letting the child fall asleep.

2 With the improvement of the economic level, there are more and more children with obesity. I introduce the experience gained from my work to everyone and hope to be helpful.

2.1 When it is difficult to find blood vessels when puncturing, try to remove some hairs as much as possible to increase the search range. The most important point is that while you are removing hair, the hair that goes along the veins is often difficult to remove. That's because the veins The ditch is lower than other skin locations, so it will leave a line of hair in place with blood vessels, which will help you find the location of the blood vessels.

2.2 When the puncture, the same two unclear blood vessels, to select the one that can touch the vein of the vascular puncture puncture, this blood vessel is more fixed, can not touch the veins of the blood vessels easily slide, the failure rate is high.

2.3 For the small veins of the head, it is generally superficial and clear. After the needle is inserted, the needle should be slowly inserted. Because the blood return is slow, the syringe suction method or the low-bottle high-profile method can be used to speed up the return of blood. Through clinical practice, I also invented a new method. After the air in the infusion set was drained, the infusion bottle was put on the patient's bed so that the pressure in the infusion bottle and the infusion set would be reduced. Large venous pressure, after the needle, because the blood pressure is greater than the pressure in the infusion device and the infusion bottle, the blood will flow out quickly, and then let the assistant hang the infusion bottle on the infusion stand, pay attention to whether there is air, The method is of great help to improve the success rate of puncture, especially when the emergency is severe, when the children's circulation is not good, this method is particularly effective.

2.4 The general requirements of the direction of the puncture in the direction of blood flow, through practice has proved that if the blood vessels in the lower segment has been damaged, retrograde puncture from the upper segment of the blood vessels, short-term infusion is feasible, for drugs with strong irritation can easily cause local necrosis is not easy to use This method, using this method to strengthen the inspection, observe the local skin and blood vessels.

2.5 For diarrhea, dehydration in children with obvious blood vessels can be used hot or local skin massage, stimulation of children crying and other methods to significantly increase blood vessel filling, increase the success rate of puncture.

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