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Scalp venipuncture techniques in children
May 28, 2018

1.1 The preparation before puncture is an important part of improving the success rate of puncture to make the child supine, while the parents hold the knee of the child. The other parent tightens the scalp with both hands, and the arms gently press and clamp the child's The shoulders make it relatively fixed, and another tape that is long enough to wrap around the child's head can be used to prevent the sticky children from leaving 10 cm at both ends of the hair and sticking most of the middle folds together.


1.2 Characteristics of Pediatric Scalp Veins Pediatric scalp veins are abundant and easy to see. Vessels are distributed in a reticular pattern. Blood can be circulated through the collaterals. Therefore, antegrade and retrograde needles do not affect reflux. The amount of median venous thick, straight, not sliding, easy to fix and easy to fix, does not affect the activities of children, easy to keep warm, generally preferred; superficial vein and superficial temporal vein superficial, straight, obvious exposure, do not slide, due to smaller blood vessels The puncture technique is difficult; the vein behind the ear is slightly thick, but the subcutaneous fat is thick, and it is not easy to grasp the depth and depth of the needle, and it is not good for care; the veins between the skulls are thick and straight but easy to slide.


1.3 Select the right scalp vein, try to avoid the forehead of the bone at the forehead vein, the amount of superficial vein, superficial temporal vein is generally 5 ° ~ 15 °, after entering the skin, parallel to the forward piercing, see the blood, you can fix . The posterior ear veins and the superior iliac veins are 15° to 30°. Children's skull along the frontal seam, coronal suture, sagittal suture, herringbone suture veins are running, puncture clear joints, the needle angle of 30 ° ~ 60 °. For less-clear or unclear blood vessels, use the fingertips to move toward the veins, feel the direction of the blood vessels, the depth, the thickness, and the degree of sliding, and then puncture them. The main point is that after the needle slanting surface enters the skin, the needle is inserted forward and downward from shallow to deep, and the blood can be fixed after seeing blood. Nurses should be light, steady, slow, and accurate. They should choose the blood vessels that they feel confident about. When a child is crying, the scalp venous blood vessels will undergo a brief filling process due to the increase of venous return pressure. At this time, the timing should be skillfully seized and the puncture should be completed successfully.


1.4 Do a Good Job for Parents Get the support of parents and fix the children so that they will not be twisted.


1.5 According to the depth of the vein to take appropriate intensity The blood vessels that are normally seen with the naked eye are shallow, and the blood vessels that are not seen or touched are deep. When the scalp vein was punctured, no tourniquet was used. There was no pressure difference between the two sides of the venous wall, and there was no resistance to blood flow back to the heart. Therefore, scalp vein puncture is slower and less frequent than veins in the extremities. Therefore, when you feel that the needle has entered the blood vessel and the puncture has a sense of emptiness and does not return to the blood, do not rush to pull out the needle. You should stop and wait, or pinch the rubber hose in the lower part of the infusion set or change the position of the needle. The angle is generally Visible blood.


1.6 Fixed Needle Tips Puncture success sees blood return. It is very important to fix the needle in time. After successful puncture, fix the needle handle with the index finger of the left hand and the middle finger and fix it with 3 to 4 tapes. Fix the scalp with a tape and scalp. Needle circle range should be appropriate, too large and easy to be pulled or touched in the infusion process, too small to fold, causing obstruction. Special mention should be made to shave off the hair around the puncture before puncture to facilitate tape fixation. If a child suffers from perspiration due to crying or application of antipyretic drugs and affects the fixation of the tape, it can be fixed on the adhesive tape of the puncture point by the head circumference fixation method to avoid the loss of the sweating tape. When the conventional fixed, must pay attention to the cooperation of the hands, the right hand to take the tape left hand fingers with paste, and try to stick the tape concentrated, fixed and then a long tape around the fixed, depending on the situation can be fixed directly or cross-fixed tape on the needle above on.


1.7 The puncture should also pay attention to several points to adjust the infusion tube regulator upside down drip pot, because the regulator closer to the drip pot, the smaller the pressure in the infusion tube, the higher the rate of blood return; vascular bifurcation at cautious wear, The needle was inserted slightly further away from the blood vessel. After the needle was inserted, the needle stopped at the bifurcation of the blood vessel; the blood vessel was touched with the finger slightly, and the blood vessel still looked blue and straight when the finger was removed. If you touch with your fingers, the blood vessels that are not visible are not available; transverse blood vessels can also be punctured. The traditional puncture direction is puncture in the centripetal direction. Because the scalp blood vessels of the pediatric scalp are distributed in a reticular pattern, they can circulate left and right. Therefore, in which direction the puncture direction can be worn, the medicine can be smoothly administered. If the blood vessels have already been punctured, the needle can be inserted in front of the puncture point. There are bifurcated vessels on the posterior or lateral sides of the blood vessels and the elasticity is good, and the direction of the adjustable needle can be punctured. The liquid does not pass through the punctured eye and is not prone to leakage.


1.8 The influence of psychological factors Puncture nurses must maintain a calm, stable psychological state medical education network, in order to reduce the failure rate. The success of pediatric scalp venipuncture depends not only on the level of technology, but also on the psychological, adverse emotions, interference and impact of the surrounding environment, if necessary, parents can be avoided.


1.9 The reason for the poor dripping is in the blood vessels, but when the number of drips is low, there are several reasons: the tip of the needle sticks against the wall of the blood vessel, and the needle pad can be fixed with a cotton swab; the pressure in the infusion bottle is low, and the infusion stand is raised; Keep the child quiet and keep it from crying; when there are no other reasons, the puncture needle can be fixed with the bevel facing down.


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