诊疗技术操作规程.doc

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诊疗技术操作规程皮内注射法（一） 目的1.作各种药物过敏试验，以观察局部反应。2.预防接种。3.用于局部麻醉的先驱步骤。（二）准备质量标准1.着装整洁。洗手带口罩。2.用物准备：治疗盘内盛：无菌注射器（1毫升）及针头（4-5号）、无菌持物钳、75%酒精、棉签、弯盘、纱布、药物、污物缸、急救药盒（注射器1副，肾上腺素1支，砂轮1个）。3.稀释好皮试药物。（三）操作流程质量标准1.携用物至床旁，对床号、姓名，向病员解释，询问过敏史，以取得合作。2.吸药：用酒精棉签消毒瓶塞，待干。往瓶内注入和所需药液等量的空气，倒转药瓶与注射器，使针头在液面以下，左手食、拇指握住瓶颈，中、无名指和小指与大鱼际肌握住针筒，右手拇指、食指和中指持注射器活塞柄，吸药液至所需量，再以右手食指固定针栓，拔出针头。3.消毒皮肤：左手食指夹住注射器，拇、中和无名指揭开棉签缸盖，右手持镊取一棉签蘸酒精消毒前臂掌侧皮肤（直径大于5厘米）。4.排气：将针头垂直向上，轻拉活塞使针头药液流入注射器内，并使气泡聚集在乳头口，左手拇指固定针栓，右手稍推活塞，驱出气体。5.左手在前臂背侧绷紧皮肤，右手持注射器，使针头斜面在上，和皮肤呈5度角刺入皮内，待针头斜面进入皮内后，放平注射器，左手拇指固定针栓，注入药液0。1毫升。6.注射完毕，迅速拔出针头，切勿按压。7.清理用物，归还原处。20分钟后观察结果。（四） 终末质量标准1.操作熟练，坚持三查七对，皮试液剂量准确。一次注射成功。2.口述结果判断及对照试验法。3.口述过敏反应的应急处理措施。（五） 注意事项1.皮试前详细询问有无过敏史，如对所需注射药物有过敏者不可做过敏试验。2.配制皮试药液必须用生理盐水，用于不同药物的注射器及针头禁止交叉使用。3.皮试后观察时间不能少于20分钟，阳性者禁用，并在医嘱单或门诊病历上注明过敏。4.青霉素皮试液要求现配现用。（六）皮试结果判断阴性：皮试20分钟后皮丘消失或无红肿，全身也无反应。阳性：局部皮肤出现红晕，硬块，皮丘直径大于1cm，也可出现寻麻疹。强阳性：试验处皮肤出现明显突起的风团或大丘疹，周围充血或不充血，部分病人伴有痒、麻、热等感觉或全身反应，个别青 霉素病人可出现过敏性休克。（七）操作流程图 衣帽、口罩整齐，洗净双手准备工作 准备注射盘、药物 询问用药及过敏史。配 药 消毒瓶盖 取注射器 稀释药液注 射 于前臂掌侧下端 消毒皮肤（由内向外直径大于5cm） 排 气。20分钟后观察结果 刺入皮内（针尖与皮肤呈5度角）左拇指轻压针栓推 药 液0.1ml拔针整理用物九肌肉注射法（一） 目的1.需达到药效和不能或不宜经口服给药时采用；注射刺激性较强或药量较大的药物。2.不能或不宜作静脉注射，要求比皮下注射更迅速发生疗效者。（二）准备质量标准1.着装整洁，洗手戴口罩。2.用物准备：治疗盘内：无菌注射器和针头，无菌持物钳，注射药物（根据需要还需备急救药品），砂轮、皮肤消毒剂（0.5%碘酊）棉签、弯盘污物缸、注射卡。3.口述目的。4.检查好药品质量，查对注射卡。（三）操作流程质量标准1.携用物至床旁，进行三查七对，向病员作好解释，解除顾虑，以取得合作。2.准备好注射器，抽吸药液（同皮内注射法）。从安瓿内吸药液法：将安瓿尖端药液弹至体部，用砂轮在安瓿颈部划一痕，用0.5%碘酊棉签消毒颈部，折断安瓿，用注射器将针头斜面向下放入安瓿内的液面下，左手食、中指增值住安瓿，拇、无名和小指握住针筒，右手拇、食和中指持活塞，吸净药液。3.消毒皮肤：同皮内注射法。从棉签缸或棉签纸袋内取出棉签两根，夹于左手小指，再从小指里取出一根蘸碘酊消毒皮肤（直径大于5厘米）后，夹于左手无名指。4.左手拇、食指分开皮肤，右手持针，以中指固定针栓，针头和注射部位呈直角，快速刺入肌肉内，进针约为2.5-3cm，消瘦者和病儿酌减。5.松开左手，抽动活塞，如无回血，缓慢注入药液。注射完毕，以左手小指中的干棉签按压针眼处的同时快速拔针。6.观察反应。清理用物，归还原处。（四） 终末质量标准1.无菌观念强，坚持三查七对。2.操作熟练、准确，能按无痛注射法进行操作。3.口述肌肉注射部位及定位方法。（五）注意事项1.切勿把针梗全部刺入，以防针梗从根部衔接处折断。万一针头折断，应保持局部与肢体不动，速用血管钳夹住断端拔出，如全部埋入肌肉，需请外科医生手术取出。2.长期作肌肉注射的病员，注射部位应交替更换，以减少硬结的发生。3.两种药液同量注射时，要注意配伍禁忌，在不同部位注射。4.根据药液的量、粘稠度和刺激性的强弱选择合适的注射器和针头。5.2岁以下的婴幼儿不宜选用后臀注射，因有损伤坐骨神经的危险，可选用臀中肌、臀小肌注射。6.避免在瘢痕、硬结、发炎、皮肤病及旧针眼处注射。淤血及血肿部位亦进行注射。（六）肌肉注射部位定位法及体位1.臀大肌注射法定位：（1）十字法：从臀裂顶点向左或右划一水平线，然后从髂