【精品】9-腹膜腔穿刺术腹膜腔穿刺术及护理物品准备安置穿刺体位确定穿刺...59

腹膜腔穿刺术及护理 环境准备 环境清洁、消毒、无尘，室温不低 于200C。注意遮挡。 医务人员准备 洗手、带口罩、带帽子 。 病人准备 解释腹穿目的及注意事项，消除紧张心理 ；征得家属签字同意；术前做普鲁卡因皮 试；查血小板、出凝血时间等。术前排尿 。必要时术前用镇静剂。 物品准备 常规消毒物品、腹腔穿刺包（穿刺针、注射 器、橡皮管、血管钳、输液夹、洞巾、纱布 、弯盘）、无菌手套、局麻药、治疗用药、 胶布、腹带、血压计等。 安置穿刺体位 病人坐在靠背椅上，衰弱者可取半卧位或 侧卧位或在超引导下取特殊体位。 确定穿刺点 脐和髂前上棘间连线中、外1/3的交点为 穿刺点。放腹水时通常选用左侧穿刺点。 脐和耻骨联合连线的中点上方lcm稍偏左 或右11.5cm处 。 常规消毒穿刺点 戴手套、铺洞巾、局麻 护士将已消毒瓶塞的麻药瓶瓶塞面对术者， 术者用5ml注射器抽取麻药，进行麻醉。 穿 刺 将穿刺针从穿刺点 垂直刺入腹壁。 诊断性穿刺，可直接用2050ml注射器 抽吸。放液量大时，助手用消毒血管钳固 定针头，并夹持胶管。一般每次放腹水不 超过3000ml 。 抽 吸 拔 针 盖纱布、固定 碘酒消毒针眼后盖上无菌纱布，用力按压局 部，无渗血、渗液后贴胶布。大量放腹水后 缚紧腹带。 休 息 术后平卧休息至少812h 。 整理用物、记录 护护 理理 严密观察病情 观察有无腹胀、腹痛、肝脑的表现，穿刺 点有无渗液，尿量是否减少，生命体征是 否变化等。记录腹水量、色、性质等。 测腹围 放腹水前后均应测量腹围 、脉搏、血压，检查腹部 体征。对比放腹水前后情 况。 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