骨髓腔内注射装置操作完整讲解程序-课件.ppt

《骨髓腔内注射装置操作完整讲解程序-课件.ppt》由会员分享，可在线阅读，更多相关《骨髓腔内注射装置操作完整讲解程序-课件.ppt（101页珍藏版）》请在淘文阁 - 分享文档赚钱的网站上搜索。

1、Intraosseous Vascular Access骨髓腔内血管通路 12The System系 统 介 绍3EZ-IO Training Materials EZ-IO培训材料PowerPoint Presentations PPT展示With comprehensive notes located behind each slide 每张幻灯片后附有注释EZ-IO StarCast Presentations EZ-IO 远程医疗展示Quick Reference Card 快速参考卡Insertion&Removal Poster插入和移除海报Training Mannequins用

2、于培训的人体模型Training Driver&Needle Sets 训练驱动器和套针Complete Web Site完整的网页Clinical Support Hotline临床支持热线4The EZ-IO Power Driver（骨髓腔内注射装置驱动器）Designed for 1000 human insertions 可使用1000人次 Sealed cap密封盖Lithium Batteries锂电池5Needle set packaging套针装置包装6EZ-IO PD 15 mm Needle Set 小儿型 15毫米针EZ-IO AD 25 mm Needle Set 成

3、人型25毫米针EZ-IO LD 45 mm Needle Set 加长45毫米套针Length and color are the only differences between these Needle Sets 不同型号的套针颜色不同5 mm mark5毫米毫米标志志7Catheter&Stylet The EZ-IO Needle Set EZ-IO套针 Needle Set Safety Cap套套针安全帽安全帽Catheter&Catheter Hub导管及管及导管外套管外套Stylet探探针Stylet Hub探探针外套外套Metal Disc金属金属垫EZ-IO Needle

4、Set(safety cap removed安全帽移除安全帽移除)EZ-IO Needle Set(“X-Ray View”with safety cap X片片视野下的安全帽野下的安全帽)Specialized tip特殊特殊针尖尖MRI禁止做磁共振禁止做磁共振检查8Sealed Sterile Cartridge密封无菌针筒Note:“lot code and expiration”moved to cartridge barrel 注意：代码和有效期Open Cartridge打开针筒Note:Needle Sets position Note:torn(and lifted)safet

5、y seal注意：撕开安全封条Open Cartridge打开针筒Note:torn(and lifted)safety seal注意：揭下安全封条Open Cartridge打开针筒Note:exposed“single use only”sticker注意：查看“一次性使用”标志Stylet in“Shuttle”保留探针在筒内Note:REMOVED safety seal撕下安全封条Stylet in“Shuttle”盖上针筒Note:REMOVED safety seal9Length and color are the only differences between EZ-IO

6、Needle Sets不同型号的套装颜色不同5 mm mark5毫米毫米标志志15 mm PD25 mm AD45 mm LDEZ-IO LD Needle Set Tray with Sharps Protectors锐器保护装置的针盒10Put them where they belong!废物处理Stylets belong in approved sharps containers探针放入特定的锐器盒 内EZ-IO LD Sharps protector锐器保护装置EZ-IO PD&AD Shuttles套针盒11Consider these points BEFORE EVERY E

7、Z-IO insertion:操作前注意事操作前注意事项：1.Did you“hear”a pop when the cartridge was opened?打开时是否有砰砰声？2 Did the Driver easily attach to the Needle Set (With the Needle Set remaining in the cartridge)是否有套针不能从针筒中取出的情况？3 Did you REMOVE the Needle Set Safety Cap from the Needle Set?能否打开套针安全帽？4Did you CONFIRM the 5

8、mm mark?能否有5毫米标志？Important EZ-IO usage considerations使用EZ-IO的主要注意事项Note that a“lone Stylet”sits deeper than a complete Needle Set探针要比整个套针在针筒内的位置更深Needle Set 12Precise cylindrical hole created by EZ-IO insertion由EZ-IO制作的精确的圆柱孔13 The EZ-IO Infusion Solution EZ-IO输液装置EZ-IO AD&PD Needle SetsTraining Nee

9、dle Sets练习套套针EZ-IO Storage Cases&Cradle EZ-IO箱和支架箱和支架 EZ-IO Driver驱动器器EZ-Connect连接接Training Driver训练驱动器器Wristband腕腕带14General IO Anatomy常规骨髓通路解剖15Anatomy of intraosseous access 骨髓通路解剖Thousands of small veins lead from the medullary space to the central circulation数以千计的小静脉将骨髓腔与中心静脉相连通1617Intraosseous

10、 usage and pain骨髓通路的使用和疼痛18Adult IO Anatomy成人骨髓通路解剖19Proximal Tibial Anatomy近端胫骨解剖20Note the distance from the proximal aspect of the tibia to the middle ofthe tuberosity注意：丛胫骨近端到结节中心的距离Note the average skin thickness atthe insertion site注意：插入点处平均皮肤厚度Adult female cadaver right proximal tibia22Distal

11、 Tibial Anatomy 远端胫骨解剖23 The ankle joint is comprised of the Tibia,Talus and Fibula踝关节由胫骨，距骨和腓骨组成24A closer look at the anatomy近距离观看解剖结构Posterior后面Anterior前面25PosteriorAnteriorDistal Tibia远端端胫骨骨Calcaneous跟骨Talus距骨距骨Adult female cadaver left distal tibia26PosteriorAnteriorDistal Tibia远端端胫骨骨Adult fema

12、le cadaver left distal tibia27PosteriorAnteriorDistal Tibia远端端胫骨骨Adult female cadaver left distal tibia28PosteriorAnteriorDistal Tibia远端胫骨Saphenous vein隐静脉Tendons肌腱Medial Malleolus内踝Adult female cadaver left distal tibia29Proximal Humeral Anatomy近端肱骨结构30Insertion site插入点Insertion site插入点31Land marki

13、ng the greater tubercle insertion site标记较大的结节插入点32Proximal Humerus Site 近端肱骨点Adult male cadaver right proximal humerus33Proximal Humerus Site 近端肱骨点Adult male cadaver right proximal humerus34Note that arm is adducted withthe elbow posteriorly placed!注意：上臂随肘部内收The Proximal Humerus insertion site is fo

14、und“slightly anterior to the arms lateral midline”发现肱骨近端插入点位于“上臂侧面的中线稍靠前一点”Right arm Adult male成年男性右上肢36The Proximal Humerus insertion siteNote that arm is adducted withthe elbow posteriorly placed!注意：上臂随肘部内收Note that the insertion site is found anterior to the arms lateral midline!注意：插入点位于上臂外侧中线之前L

15、eft arm Mannequin人体模型左上臂Anterior前面Posterior后面37Proximal Humerus肱骨近端Proximal Tibia胫骨近端Distal Tibia胫骨远端Fractures骨折B.Multiple options?Multiple options多处选择Distal Tibia胫骨远端Proximal Tibia胫骨近端Multiple concerns?多处关注？Proximal Humerus肱骨近端This slide illustratesimmediate real world solutionsto complex patient e

16、ncounters 38Pediatric Anatomy小儿解剖39Pediatric Anatomical Overview40Clearly visibletibial growth plateTibiaInsertion site The pediatric growth plateGrowth PlateLeft LegRight Leg41SkinSubcutaneous Fat Intraosseous CatheterTibiaFibulaPost.CompartmentAnt.CompartmentLat.Compartment AnatomyFemale neonate c

17、adaver Left proximal tibia42Eleven year old proximal tibia insertion site cross sectionInsertion siteTibiaFibulaLeft leg4311 mmMusclesSkinAdiposeCompact boneCancellous bone17.9 kg Male,Left ArmProximal HumerusSelect Needle Set based on size and weight443.1 kg female,Left Leg/1.5 cm proximal to the p

18、atella proximal viewVentralDorsal Site not FDA clearedDistal Femur45AnteriorPosteriorMedialLateralSkinAdiposeMuscleCompact boneCancellous bone3.1 kg female,Left Leg/1.5 cm proximal to the patella proximal viewPrimary muscle groups involvedwith distal femur intraosseousinsertion include the:Rectus Fe

19、morisVastus IntermediusVastus LateralisDistal Femur Site not FDA cleared46Distal FemurProximal TibiaDistal TibiaInfant IO site comparative 3.1 Kg female,left legSite not FDA clearedNote:Compact bone density,overall size of target bone,adjacent muscle structures and the catheter to bone relationship4

20、7Distal FemurProximal TibiaDistal TibiaToddler IO site comparative 17.9 kg MaleNote:Compact bone density,overall size of target bone,adjacent muscle structures and the catheter to bone relationshipSite not FDA clearedProximal Humerus48Proximal HumerusProximal HumerusProximal TibiaProximal TibiaDista

21、l TibiaDistal TibiaDistal FemurDistal FemurIntraosseous access sites for the pediatric patientNot FDA clearedNot FDA clearedExperience&anatomy suggest thatthis site is most suitable for patients5 years of age and older Experience&anatomy suggest thatthis site is suitable most for patients5 years of

22、age and older 49Indications for EZ-IO Access EZ-IO 使用适应症1.Altered level of consciousness意意识改改变2.Respiratory compromise呼吸窘迫呼吸窘迫3.Hemodynamic instability血流血流动力学不力学不稳定定To gain intraosseous access in emergencies502023/1/2451Preparing the EZ-IO for use使用EZ-IO准备52Contraindications for EZ-IO Access EZ-IO使用

23、的禁忌症Fracture(targeted bone)骨折（目标骨骨折）Previous orthopedic procedures near insertion site（Prosthetic Limb or joint）穿刺点附近做过整形术（假肢或人工关节）IO within past 24 hours(targeted bone)在过去24小时内做过骨髓通路术（目标骨）Infection at the insertion site 穿刺部位有感染Inability to locate landmarks or excessive tissue 操作者不能定位或由于组织过多无法定位53Ob

24、serve Body Substance Isolation Precautions54Retrieve EZ-IO driver and cartridge.Open cartridge&attach driver to needle set取出驱动器和针筒，打开针筒并将驱动器与套针相接55Adult Site Selection成人穿刺点的选择56Confirm and clean insertion site确定并清洁穿刺点57Identify the insertion site确定穿刺点58Confirm and clean insertion site确定并清洁穿刺点59Ident

25、ify the Proximal Humerus insertion site确定肱骨近端穿刺点Elbow should remain adductedand posteriorly located肘部内收并位于后方肘部内收并位于后方orient the arm to this position 保持上肢这种姿势 Place the hand over the umbilicusfor humeral positioning and safety手高于手高于脐利于定位肱骨和安全利于定位肱骨和安全60Preferred insertion site identification method首选

26、的穿刺点确定程序 Place the patient in a supine position with the arm correctly oriented置患者仰卧位，并调整上肢为正确姿势61Confirm and clean insertion site确定并清洁穿刺点62Pediatric Site Selection63If the patient“fits”on the Broselow Tape THINK PINK*and consider the EZ-IO PD=*Obese or large pediatric patients may require the EZ-IO

27、 AD needle Set Femur not FDA cleared64The Tibial Tuberosity can be difficult or impossible to palpate on younger patientsIf the Tibial TuberosityCANNOT be palpatedthe insertion site istwo finger widthsbelow the Patella(and then)medial along the flataspect of the TibiaIdentifying the pediatric EZ-IO

28、insertion site65As patients mature the Tibial Tuberosity becomes easier to identifyIf the Tibial TuberosityCAN be palpatedthe insertion site isone finger widthbelow the Tuberosity(and then)medial along the flataspect of the TibiaIdentifying the pediatric EZ-IO insertion site66Confirm and clean inser

29、tion site67Confirm and clean insertion site68Confirm and clean insertion site69Insertion&Infusion穿刺 及 输液70Remove needle set safety cap取下套针安全帽ROTATE SAFETY CAP CLOCKWISE TO REMOVE顺时针旋转取下安全冒71Stabilize Extremity 固定手足Guard against unexpected patient movement 防止患者活动72Insert AD needle set into appropriat

30、e siteDont force the needle set into position-“allow the driver to do the work”Position the EZ-IO Driver at a 90 degree angle to the bone Remember“EZ does it”40 kg and greater usageLightly holding the EZ-IO driver will improve usage73Insert PD needle set into appropriate siteSelect the correct needl

31、e set based on patient size,weight&5 mm mark Position the EZ-IO Driver at a 90 degree angle to the bone 3-39 kg usageLightly holding the EZ-IO driver will improve usageNot FDA cleared74Insert EZ-IO Needle Set-at a 90 degree angle to the bone THEN check the 5 mm mark垂直穿刺然后查看5毫米标记Check the 5 mm mark!检

32、查5毫米标记7525 mmNeedle Set25毫米长的套针5 mm mark5毫米标记处needle set pending FDA clearanceNote that the 5 mm mark is NOT visible above the skin5毫米标记线未在皮肤之上，不能看见Adipose or muscle tissue thickness should be considered prior to EZ-IO insertion穿刺之前，应该被考虑到脂肪或肌肉组织的厚度45 mmNeedle Set45毫米长套针5 mm mark5毫米标记处Needle Set has

33、 not been FDA cleared 不合格套针76Complete Insertion完成穿刺In the unlikely event of a driver failure consider manual insertion驱动器穿刺失败考虑手工完成是不太可能的事情77 Important needle set insertion tip重要的套针穿刺提示 User induced recoil may lead to needle set dislodgement or extravasation操作者不能控制反冲力可能导致套针移位或脱出 STOP WHEN YOU FEEL T

34、HE POP当有“砰砰”的感觉时停止穿刺反冲力反冲力!保持平衡保持平衡Allow driver to do the work!DO NOT EXCESSIVE FORCEGently GUIDE needle set into position让驱动器去工作勿给予过多的人工力量轻柔的引导套针进入位置Caution!Recoil!3-39 kg usage40 kg and greater usage78Remove Driver from needle set把驱动器丛套针上取下Stabilize Needle Set while disconnecting Driver分离驱动器时固定牢固套

35、针79Remove stylet from catheter 从套管内取下探针Never attempt to replace the stylet once removed from the catheter80Confirm catheter placement确定导管位置Confirm placement by noting通过以下提示确定位置Blood at the stylet tip探针针尖有血Firmly seated catheter导管固定牢固Blood in the catheter hub导管外套处有血Aspiration of blood有血溢出Fluids flow

36、without difficulty液体流入顺利Pharmacologic effects 药物发挥作用Monitor the insertion site and distal extremity for signs of extravasation观察穿刺点及察穿刺点及远端肢体，防止外渗端肢体，防止外渗81Put them where they belong!Stylets belong in approved sharps containers探针放于特定的锐气盒内 NEWEZ-IO LD Sharps protector新式锐器保护装置EZ-IO PD&AD Shuttles82Con

37、sider placing stabilizer on catheter安装导管固定装置Centrally locate Catheter to the eye of the Stabilizer固定导管于固定装置中心的孔内 212183Remove stabilizers adhesive backing撕掉固定装置的粘合底布Secured adhesive prevents lateral movement粘合剂可有效避免套针横向移动Grasp stabilizer and gently pull tabs固定好固定装置并轻拉底布84Lidocaine considerations and

38、 administration 利多卡因的应用及注意事项2%(preservative free)Lidocaine-given intraosseously(IO)-has been shown to offer effective local anesthesia in most alert patients 2%利多卡因局麻用于较敏感患者IO infiltration for alert patients:Consider priming the EZ-Connect with 2%Lidocaine Adult dosage 20 40 mg IO成人剂量20 40 mg Pediat

39、ric dosage 0.5 mg/kg IO小儿剂量0.5 mg/kg Infuse Lidocaine slowly(over 30 seconds)缓慢推注大于30秒Allow 1 minute for anesthetic effect一分钟后见效Repeat as needed to reach therapeutic level 有必要时可重复使用DO NOT exceed 3 mg/kg不能超过3 mg/kgSome patients may require repeated administration to achieve desired effect*See notes a

40、ttached to slide for bibliography and detailed explanation85No Flush=No FlowSyringe FLUSH catheterSyringe FLUSH catheter with 10 ml of a sterile solutionAlert patients may require2%preservative free LidocaineIntraosseously PRIOR to flushSome patients may require multiple syringe flushes86Avoid rocki

41、ng the EZ-IO catheter during usageUse the EZ-Connect supplied with the needle set87Begin infusion with pressureA pressure bag,infusion pump or syringe will improve the flow rates3-39 kg usageRegulate fluid deliveryfor ALL pediatric patients40 kg and greater usage88Removal89#1.Remove EZ-Connect#2.Lif

42、t Adhesive Dressing EZ-Stabilizer removal 90EZ-IO RemovalMaintain a 90 degree angleMaintain 90 degree angle91EZ-IO RemovalMaintain a 90 degree angleContinuously rotate syringe clockwiseContinuously rotatethe syringe clockwise92EZ-IO RemovalMaintain a 90 degree angleContinuously rotatethe syringe clo

43、ckwiseGently backcatheter outGentle back catheter out of patient93Once catheter has been removed dress site and monitor patient 94Possible ComplicationsIf breakage occurs Grasp the exposed catheter with a hemostat rotate and pullRocking,Bending or inadvertently Strikingthe catheter may cause it to b

44、reak24 hour emergency support 1.800.680.491195Possible ComplicationsIf breakage occurs Grasp the exposed catheter with hemostats rotate and pullRocking,Bending or inadvertently Strikingthe catheter may cause it to break24 hour emergency support 1.800.680.491196Quick Reference Card&Unit Poster快速参考卡片和装置视图9798Around the world-24 hours a day-7 days a week 无处不在，五十不在 99Questions?有提问吗？1002023/1/24101