无菌技术基本操作方法(共160页).doc

精选优质文档-倾情为你奉上基础护理学实验指导目 录一、无菌技术基本操作方法····················································1(一)无菌持物钳的使用方法····················································1(二)无菌容器使用方法························································1(三)取用无菌溶液法··························································2(四)无菌包使用法····························································2(五)无菌盘的准备····························································3(六)戴脱无菌手套法··························································4(七)准备无菌换药盘··························································5二、隔离技术································································6(一)口罩的使用法····························································6(二)手的消毒································································6(三)穿脱隔离衣······························································7 (四)避污纸的使用····························································8三、口服给药法······························································9四、药液吸取法······························································12五、注射法··································································14(一)皮内注射法······························································14（二）皮下注射法·····························································15(三)肌内注射法······························································16(四)静脉注射与采血术························································18(五)动脉注射与采血术························································21六、静脉输液法······························································23(一)周围静脉输液法··························································23(二)头皮静脉输液法··························································26(三)静脉留置针输液法························································28七、静脉输血法······························································32八、滴药法··································································34九、吸入法··································································38(一)超声雾化吸入法··························································38(二)蒸气吸入法······························································39十、氧气吸入法······························································42十一、鼻饲法································································44十二、导尿术································································47(一)女病人导尿术····························································47(二)男病人导尿术····························································49（三）留置导尿管术···························································52(四)膀胱冲洗法······························································54十三、肛管排气法····························································57十四、灌肠法································································59(一)大量不保留灌肠法························································59(二)小量不保留灌肠法························································61(三)清洁灌肠法······························································62(四)保留灌肠法······························································63十五、简易通便法····························································66十六、人工取便法····························································68十七、洗胃法································································69(一)口服催吐洗胃法··························································69(二)胃管洗胃法······························································70十八、电动吸引器吸痰法······················································76十九、气管切开护理··························································78二十、心肺复苏术····························································80二十一、铺床法······························································84(一)备用床··································································84(二)暂空床··································································86(三)麻醉床··································································88二十二、卧床病人更换床单法··················································91二十三、常用卧位····························································93二十四、保护具的应用法······················································96二十五、搬运法······························································100(一)轮椅运送病人法··························································100(二)平车运送病人法··························································101二十六、冷、热疗法··························································105(一)热水袋热疗法····························································105(二) 热湿敷法·······························································106(三)冰袋的冷疗法····························································107(四)酒精擦浴法·····························································108二十七、口腔护理···························································111(一)口腔卫生指导···························································111(二)特殊口腔护理···························································112二十八、头发护理···························································114(一)床上梳头法·····························································114(二)床上洗发·······························································115二十九、病人的清洁卫生·····················································117(一)皮肤的护理·····························································117(二)压疮的预防及护理·······················································119三十、生命体征的测量·······················································123(一)体温的测量方法·························································123（二）脉搏的测量方法························································125(三)呼吸的测量方法·························································127(四)血压的测量方法·························································129三十一、晨间护理···························································132三十二、晚间护理···························································134三十三、一般急救法·························································136(一)绷扎法·································································136(二)固定法·································································141(三)止血法·································································144三十四、尸体的护理·························································148一、无菌技术基本操作方法无菌技术(asepsis)是指在医疗、护理操作过程中，防止一切微生物侵入人体和防止无菌物品、无菌区域被污染的技术。【计划】1护士准备：着装整洁、修剪指甲、洗手、戴口罩和帽子。2用物准备：治疗盘、无菌持物钳及浸泡溶器、无菌溶液、启瓶器、无菌手套包、无菌治疗巾包、2碘酊、70酒精、无菌平镊、棉签等。3环境准备：环境清洁、宽阔、人员流动少。【实施】(一)无菌持物钳的使用方法无菌持物钳是用来夹取和传递无菌物品的器械，常用的有三叉钳、卵圆钳和镊子三种。使用时先将无菌持物钳浸泡在盛有消毒液的大口有盖溶器内，液面浸没轴节以上2-3cm或镊子长度的1/2。每个容器只能放置一把无菌持物钳。操 作 步 骤要 点 与 说 明1将浸泡无菌持物钳的容器盖打开2手拿无菌持物钳上1/3处，将钳移至容器中央，使钳端闭合，垂直取出3使用时保持钳端向下，不可倒转向上 4用后闭合钳端，立即从容器中央垂直放回无菌容器内，浸泡时轴节松开5到远处取无菌物品时，连同容器一起搬移，就地使用6无菌持物钳及其浸泡溶器每周清洁、消毒二次，同时更换消毒液·在盖闭合时不可从盖孔中取、放无菌持物钳·取出时，不可触及容器口缘及液面以上的容器内壁，以免污染钳端·以防消毒液倒流而污染钳端。持物钳只能在持物者的胸部高度移动，不可甩动·避免触及容器口周围·松开轴节，使轴节与消毒液充分接触，达到消毒的效果·防止无菌持物钳在空气中暴露过久而污染·不用无菌持物钳夹取油纱布，防止油粘于钳端影响消毒效果·不用无菌持物钳换药或消毒皮肤,防止钳被污染·保持无菌持物钳的无菌状态(二)无菌容器使用方法盛放无菌物品的容器称无菌容器，如无菌盒、罐、贮槽等。操 作 步 骤要 点 与 说 明1取用无菌物品时，拿起容器盖平移离开容器，内面向上置于桌面上，或内面向下拿在手中2取物后，立即将容器盖反转，使内面向下，移至容器口上，小心盖严 3.手持无菌容器(如无菌碗或弯盘)时，应托住容器底部·防止盖上灰尘落人容器内·防止盖内面触及桌面或任何非无菌区域·拿盖时，手勿触及盖的内面及边缘·避免容器内无菌物品在空气中暴露过久·手指不可触及容器边缘及内面(三)取用无菌溶液法操 作 步 骤要 点 与 说 明1取盛有无菌溶液的密封瓶，应先擦去瓶外的灰尘2核对标签上的药名、灭菌日期、浓度，检查瓶子有无裂缝，瓶盖有无松动，以及药液有无变质、沉淀3用启瓶器启开铝盖，用拇指与食指或双手拇指将橡胶盖边缘向上翻起4一手食指和中指套住橡胶塞并将其拉出瓶口，置于手中5另一手拿起瓶子，标签面朝向掌心，倒出少量溶液冲洗瓶口6冲洗后，再由原处倒出所需溶液至无菌容器中7倒液体后立即塞上橡胶塞，用2的碘酊和70的酒精消毒瓶塞和瓶口，盖好瓶塞8记录开瓶日期、时间9如取烧瓶内无菌溶液，解开系带，手拿瓶口盖布外面，取出瓶塞，倾倒溶液的方法同上·避免使用过期或变质的药物，核对无误才能使用·手不可触及瓶口及瓶塞内面·防止瓶塞被污染·倒溶液时，勿将标签沾湿·冲净瓶口·倒溶液时，勿使瓶口与容器接触·防止污染·已开启的溶液瓶内的溶液，可保存24h·手不可触及盖布内面及瓶口·不可将物品伸人无菌溶液瓶内蘸取溶液，已倒出的溶液不可再倒回瓶内(四)无菌包使用法 一般敷料与器械应包于质厚、致密、未脱脂的双层包布内，高压灭菌后备用。操 作 步 骤要 点 与 说 明1包扎无菌包：将物品放在包布中央，用包布的一角盖住物品，然后遮盖左右两角，最后一角遮盖后，将带以“十”字形包扎，松紧合适2打开无菌包：(1)查看无菌包名称及灭菌日期，查看化学指示胶带颜色改变情况(2)将无菌包放在清洁、干燥、平坦处，解开系带，卷放在包布下，按顺序逐层打开无菌包：揭开包布外角、再揭开左右两角，最后揭开内角(3)用无菌持物钳取出所需物品，放在事先准备好的无菌区域内(4)如包内物品未用完，将包布按原折痕包起，将带以“一”字形包扎，注明开包日期及时间3需将无菌包内物品一次取完时，可在手上打开包布，使物品显露在无菌包布上，一手托住包布，另一手抓住包布四角，将物品全部投入无菌区域内·如包玻璃物品，应先用棉垫包裹再包布包扎·包布外标明物品名称及灭菌日期，有效期为1W·如超过有效期或未达到灭菌要求的物品，不可使用·如无菌包放在潮湿处，可能会因毛细现象而渗透入包布，污染物品·打开无菌包时仅能以手接触包布四角的外面，不可触及包布内面·操作时，手不可跨越无菌区·表示此包已打开过，所剩物品可在24h内使用·如不慎污染包内物品或包布被浸湿，应重行消毒·开包时，手不可触及包布内面及无菌物品 ·投放时，包布之无菌面朝向无菌区域(五)无菌盘的准备无菌盘是将无菌巾铺在清洁干净的治疗盘内，形成一无菌区，放置无菌物品，以供治疗之用。操 作 步 骤要 点 与 说 明1折叠治疗巾纵折法：将治疗巾纵折两次成4折，再横折两次，开口边向外横折法：将治疗巾横折后再纵折，成为4折，再重复一次2铺盘单层铺盘：(1)按无菌技术操作原则打开无菌包，用无菌持物钳取一块治疗巾放在治疗盘内(2)双手捏住无菌巾一边外面两角，轻轻抖开，双折铺于治疗盘上，上面一层向远端呈扇形折叠，开口边向外(3)放入无菌物品，拉平扇形折叠层盖于物品上，上下边缘对齐，将开口处向上翻折两次，两侧边缘向下翻折一次双层底铺盘：(1)取出无菌巾，双手捏住无菌巾一边的外面两角，轻轻抖开，从远到近，3折成双层底，上层呈扇形折叠，开口边向外(2)放入无菌物品，拉平扇形折叠层，盖于物品上，边缘对齐·折叠后便于铺盘及展开治疗巾时保持治疗巾的无菌·打开包后，注意保持包内无菌·治疗盘应清洁、干燥·手不可触及无菌巾内面·保持盘内无菌，4h内有效·手不可触及无菌巾内面·保持盘内无菌，4h内有效(六)戴脱无菌手套法由于寄居微生物的存在，用一般消毒方法很难使手达到绝对无菌。在手术、穿刺、导尿等医疗护理操作中，需要戴上无菌橡胶手套，以确保无菌效果。操 作 步 骤要 点 与 说 明1核对手套包上的手套号码及灭菌日期 2打开手套袋，取出滑石粉，用滑石粉擦双手 3一手掀起手套袋开口处外层，另一手捏住一只手套翻折部分取出手套，对准五指戴上4再以戴好手套的手指插入另一只手套翻折内(手套的外面)，取出手套，同法戴好5双手对合交叉调整手套位置，将手套的翻边扣套在工作衣袖外面6操作完毕，先将手套上的污渍、血迹洗净。再用戴手套的手捏住另一手套的套口外面翻转脱下7用已脱下手套的手指插入另一手套口内，将其翻转脱下8将手套浸泡在消毒液内，洗手·选择大小合适的号码·过期不可使用·防止滑石粉撒落在手套上，方便戴上手套 ·未戴手套的手不可触及手套的外面 ·注意已戴手套的手不可触及未戴手套的手或另一手套的内面·发现手套有破洞，立即更换·戴上无菌手套的双手应保持在腰部以上视线范围内·不可强拉手套边缘或手指部分，以免损坏·脱手套时，手勿接触手套脏污部分·整个过程小心勿使手套外面已污染处接触到皮肤(七)准备无菌换药盘操 作 步 骤要 点 与 说 明1洗手，用物齐备、放置合理2检查无菌治疗巾包的有效期和灭菌标记3按无菌技术操作原则打开无菌治疗巾包，用无菌持物钳取出无菌治疗巾放于治疗盘内，按原折痕包好无菌治疗包，系带以“一”字形包扎， 注明开包日期和时间4扇形打开无菌治疗巾，边缘向外形成一无菌区域 5用无菌操作法打开治疗碗包，放治疗碗于治疗巾无菌区内6用无菌持物钳夹取消毒棉球及生理盐水棉球分别放于两个治疗碗中7取无菌纱布放于治疗盘无菌区内8按无菌技术操作方法盖好治疗盘9放无菌手套包、弯盘、胶布于盘内10将用物携至病人床旁，向病人解释操作的目的，打开治疗巾11检查手套包，打开无菌手套包，取出滑石粉涂擦双手，按无菌技术操作的方法戴好手套 12操作完毕，将手套上的污渍、血迹洗净，脱去手套13收拾整理用物，按常规处理·防止无菌物品被污染，方便操作·如已过期或未达到灭菌要求，不可使用·开包24h后仍未用完，须重新灭菌·无菌区边缘3cm以内为无菌的安全范围·操作时，不可跨越无菌区域·治疗巾内为无菌区域，不可触及衣袖及其它有菌物品·滑润双手，便于戴手套·避免手和其它用物的污染·防止医院内交叉感染【评价】1.严格遵守无菌技术操作原则。2.操作程序熟练，方法正确。3.无菌观念强，无污染。二、隔离技术隔离是防止医院内感染的一项重要措施，控制感染发生的主要手段是阻断感染链(感染源、感染途径和易感人群)的形成。简单、直接而有效的阻断感染链的方法是应用各种屏障技术切断传播途径，这些技术措施之一便是隔离技术。【目的】保护病人及工作人员，避免交叉感染。【计划】1护理目标：病人、工作人员及探视者之间无交叉感染。2用物准备：口罩、洗手设备(手刷、肥皂、小毛巾)、隔离衣、挂衣架、污衣袋、避污纸。【实施】(一)口罩的使用法使用口罩是为了保护患者和工作人员避免互相传染，防止飞沫污染无菌物品、伤口或清洁食品等。操 作 步 骤要 点 与 说 明1洗手并擦干2取出清洁口罩3拿起口罩上方2根带子，罩住鼻和口，在头顶打活结；下方2根带子在颈后打活结4不用时，解开口罩带子，取下口罩 5将已污染的口罩，丢入污物桶内，然后洗手·除去手上的污垢·松紧要合适·不可用污染的手接触口罩；口罩潮湿时，立即更换 ·须先洗手，再取下口罩；口罩暂时不戴时不可挂胸前，应及时取下，污染面向内折叠放于清洁塑料袋中，再放入口袋·一般情况下，口罩4-8h后应更换；每次接触严密隔离的传染病患者后，应立即更换；所用一次性口罩不得超过4h(二)手的消毒护理人员在接触传染源后或为患者进行护理操作前，均应洗手或消毒双手，以除去手上污垢及沾染的致病菌，避免或减少感染和交叉感染的发生率。操 作 步 骤要 点 与 说 明1卫生洗手(1)取下手上的饰物及手表，卷袖，湿润双手(2)取皂液或肥皂涂抹双手，以环形动作，双手交互用力搓揉，使产生泡沫(3)用流水从上至下彻底冲洗双手，使污水从前臂流向指尖，冲洗干净后擦干2.刷手(1)将隔离衣袖塞至肘关节以上，双手浸泡于消毒液内(2)用刷子按前臂、腕关节、手背、手掌、手指指蹼、指缝及指甲处顺序刷手2min(3)用清水洗净双手后擦干(4)脱去隔离衣·用于各种操作前后清洁洗手·水勿开得太大，以免溅湿衣服·注意指尖、指缝、拇指、指关节等处，范围为双手、手腕及腕上10cm左右，时间至少15s·通过对手各部位的机械揉搓和流水冲洗可除去大部分的微生物 ·用于脱隔离衣前·按顺序刷洗，避免漏洗(三)穿脱隔离衣为保护患者和工作人员，避免互相传染，在护理隔离患者时，需按规定穿着隔离衣。操 作 步 骤要 点 与 说 明1穿隔离衣(1)备齐操作所需用物(2)戴好口罩、帽子，取下手表，卷袖过肘(冬季卷过前臂中段)(3)手持衣领取下隔离衣，清洁面面向自己；将衣领两端向外折齐，露出肩袖内口(4)右手持衣领，左手伸入袖内；右手将衣领向上拉，使左手露出(5)换左手持衣领，右手伸入袖内，依上方法使右手露出；举双手将袖抖上，露出手腕(6)两手持衣领，由领子中央顺着边缘向后将领扣扣好，再扣袖扣7)解开腰带活结，将隔离衣一边(约在腰下5cm处)渐向前拉，见到边缘则捏住；同法捏住另一侧边缘，双手在背后将边缘对齐，向一侧折叠；以手按住折叠处，另一手将腰带拉至背后，压住折叠处，将腰带在背后交叉，回到前面打一活结(8)扣上隔离衣后缘下部的扣子2.脱隔离衣 (1)解开隔离衣后缘下部的扣子，解开腰带，在前面打一活结(2)解开袖口扣子，在肘部将部分衣袖塞入袖内(污对污向内折)，露出双手(3)消毒双手(4)解开领口，右手伸入左手腕部衣袖内，拉下衣袖过手，用遮盖着的左手握住右手隔离衣袖的外面，将右侧袖子拉下，双手转换渐从袖管中退出，再以右手握住两肩缝撤左手，用左手握住衣领外面，退出右手(5)两手持领，将隔离衣两边对齐，挂在衣钩上；挂在半污染区，隔离衣的清洁面向外；挂在污染区，则清洁面向内；不再穿的隔离衣，脱下后清洁面向外，卷好投入污衣袋中·避免穿隔离衣后到清洁区取物，使清洁区污染·避免污染·衣领及隔离衣内面为清洁面·衣袖勿触及面部 ·此时手已被污染·手不触及衣里面·勿使折叠处松散·隔离衣长短要合适，须全部遮盖工作服，有破洞不可使用·穿隔离衣后不得进入清洁区·根据刷手法消毒双手·保持衣领清洁，系、解领扣时污染的袖口不可触及衣领、面部和帽子·隔离衣每天更换，如有潮湿或污染，应立即更换(四)避污纸的使用避污纸即清洁纸片。用避污纸垫着拿取物品或作简单操作，可保持双手或物品不被污染以省略消毒手续。操 作 步 骤要 点 与 说 明1.取避污纸时，应从页面抓取，不可掀页撕取2.避污纸用后丢入污物桶，定时焚烧·清洁的手拿取污染物品或污染的手拿取清洁物品，均可使用避污纸·病室门口备避污纸，病室内备污物桶【评价】1严格遵守隔离原则。2隔离、污染概念清楚。3操作程序、方法正确。 三、口服给药法口服给药是最常用、最方便、较安全的给药方法，药物经口服后被胃肠道吸收入血循环，可起到局部治疗或全身治疗的作用。但因吸收较慢,故不适于急救、意识不清、呕吐不止、禁食等患者。【目的】1正确提供药物的剂量、给药时间等。2. 达到预防、诊断和治疗疾病的作用。【评估】l病人口服药物的自理能力。2病人吞咽能力，有无口腔、食管和病理问题以及是否有恶心、呕吐，程度如何。3病人的合作程度，有无拒服药的情况。4病人是否具备对所用药物的有关知识。【计划】1护理目标(1)根据医嘱准时给药，无差错。(2)病人明确口服给药的目的并配合。(3)病人达到预期治疗效果。2准备：(1)用物准备：药物、药匙、乳钵、研锤、量杯、滴管、小毛巾(或纸巾)、药杯、小方纸片、小水壶、小药牌、服药卡、发药车。(2)环境准备：治疗室环境整洁、光线适宜。【实施】 操 作 步 骤要 点 与 说 明1.备药 (1)洗手、戴口罩、准备药车，取出小药牌，与服药本核对后，按床号顺序将小药牌插入发药盘内，放好药杯 (2)依据不同药物剂型采取不同的取药方法(先摆固体药，后摆水剂及油剂) 固体药(片剂、胶囊) 一手取药瓶，瓶签朝向自己，核对，另一手用药匙取出所需药量，放人药杯时再核对，将药瓶放回药柜时第三次核对 液体药 核对药液，检查药液质量 将药液摇匀，打开瓶盖，将瓶盖内面朝上放置 再核对一次标签，左手持量杯，拇指指在所需刻度上，与眼睛于同一水平；右手持药瓶，瓶签朝上，缓缓倒出所需药液至量杯中，再倒入小药杯里，倒毕，以湿纱布擦净瓶口，把药瓶放回药柜里，再次查对药液不足1ml时，于药杯内倒人少许冷开水，用滴管吸取所需药液量，滴管尖与药液水平面成45°角倾斜，将药液滴人药杯内取用油剂药物时，可先在杯中加少量冷开水一位病人同时服用几种水剂时，应分别倒入几个药杯内(3)摆药完毕，须将药物、小药牌与服药本核对一遍，用治疗巾盖好药盘，准备发药2发药(1)洗手，备齐用物后按服药本核对一遍(2)携带服药本、服药车至患者处，核对患者的姓名、床号，并称呼病人的全名，再查看药名、剂量、时间、给药途径是否正确(3)协助患者坐起，向患者及家属解释服药目的及注意事项(4)倒温开水或使用饮水管，帮助患者服药，视患者服下后方可离开(5)药杯收回时再次查对(6)协助患者取舒适卧位，整理床单位(7)清理用物用过的药杯进行消毒处理。盛油剂的药杯应先用纸巾擦净后再做初步处理一次性药杯，须经集中消毒处理后方可丢弃每日清洁发药盘、发药车，并整理药柜·根据医嘱给药是给药的重要原则之一。核对的内容包括病人的床号、姓名、药物的名称、浓度、剂量、给药方法和时间 ·按照查对制度，对照服药本取药，一个患者的药摆好后再摆第二个患者的药·严格三查七对 ·粉剂药物和口含片应用纸包好·对婴幼儿、鼻饲或上消化道出血不宜直接服药的病人，应将药片研碎 ·若有变质，应立即更换·避免药液内溶质沉淀而影响给药浓度·保持瓶盖内面清洁·使量杯之刻度与药液水平面同高，以保证给药量准确·防止倒药液时沾污瓶签·倒出来的药液不能再倒回药瓶内·量取不同的药液或计量完毕药液时，应先洗净量杯并擦干，以免更换药液时发生化学变化·以免药液粘附于杯壁影响用药的准确性·1ml以15滴计算；若药液不宜稀释时，可将药液滴于饼干或面包上，让患者及时服下·使病人服下的药量准确·以防药物互相拮抗，降低药效·以保证病人安全·以取得合作，并建立安全感·同一患者的药物应一次取离药车；不同患者的药物，不可同时取离药车，以免发生差错·若患者不在病室或因故暂不能服药，应将药物收回，适时再发或交班·若患者拒服药，应了解原因并及时向主管医生反映·增加或停用某药物，应及时告诉患者；当患者提出疑问时，应重新核对·危重患者应喂服，鼻饲患者应将药粉用水溶解后，从胃管灌人，再以少量温开水冲胃管 ·发药时，要根据药物不同的特性进行用药指导·为避免发生医院内交叉感染，保证病人安全，应正确进行用物处理【评价】1给药准确，无差错。2病人达到预期的疗效。3病人获得有关用药知识并配合。四、药液吸取法【目的】用无菌技术的方法，从安瓶或密封瓶内抽吸药液，准备给病人用药。【计划】1护士准备：着装整齐、修剪指甲、洗净双手、戴上口罩。2用物准备：注射盘、2碘酊、70乙醇、消毒平镊、无菌棉签、注射器、启瓶器、弯盘、注射卡及药液等。3环境准备：环境清洁，无尘埃飞扬，符合无菌操作的原则。【实施】 操 作 步 骤要 点 与 说 明1自安瓶内吸取药液法(1)查对药液的名称、浓度、失效期(2)消毒及折断安瓶：将安瓶尖端药液弹至体部，用砂轮在安瓶颈部划一锯痕后，用70%乙醇棉球消毒安瓶颈部至顶端，折断安瓶 (3)抽吸药液：将针头斜面向下放入安瓶的液面下，持活塞柄，抽动活塞，进行吸药(4)拉动活塞，再推动活塞，排尽空气(5)套上针头保护套备用2自密封瓶内吸药法(1)除去铝盖中心部分并常规消毒瓶塞，待干(2)注射器内先吸入与欲抽吸药量相等的空气，将针头穿过瓶盖中心刺入瓶内，并将空气注入(3)倒转药瓶及注射器，使针尖在液面下，稍抽动活塞，药液即会流入注射器内，待吸至所需量后，食指固定针栓，无名指或小指固定活塞柄，迅速拔出针头(4)拉动活塞，再推动活塞，排尽空气(5)套上针头保护套备用·保证安全用药，防止差错事故的发生·使药液集中到体部，抽吸药量准确 ·安瓶颈部若有蓝色标记，则不需划