骨髓腔内注射装置操作完整讲解程序课件.ppt

IntraosseousVascularAccess骨髓腔内血管通路 TheSystem系统介绍 EZ IOTrainingMaterialsEZ IO培训材料 PowerPoint PresentationsPPT展示Withcomprehensivenoteslocatedbehindeachslide每张幻灯片后附有注释EZ IOStarCastPresentationsEZ IO远程医疗展示QuickReferenceCard快速参考卡Insertion RemovalPoster插入和移除海报TrainingMannequins用于培训的人体模型TrainingDriver NeedleSets训练驱动器和套针CompleteWebSite完整的网页ClinicalSupportHotline临床支持热线 TheEZ IOPowerDriver 骨髓腔内注射装置驱动器 Designedfor1000humaninsertions可使用1000人次 Sealedcap密封盖 LithiumBatteries锂电池 Needlesetpackaging套针装置包装 EZ IOPD15mmNeedleSet小儿型15毫米针 EZ IOAD25mmNeedleSet成人型25毫米针 EZ IOLD45mmNeedleSet加长45毫米套针 LengthandcoloraretheonlydifferencesbetweentheseNeedleSets不同型号的套针颜色不同 5mmmark5毫米标志 Catheter Stylet TheEZ IONeedleSetEZ IO套针 NeedleSetSafetyCap套针安全帽 Catheter CatheterHub导管及导管外套 Stylet探针 StyletHub探针外套 MetalDisc金属垫 EZ IONeedleSet safetycapremoved安全帽移除 EZ IONeedleSet X RayView withsafetycapX片视野下的安全帽 Specializedtip特殊针尖 MRI禁止做磁共振检查 SealedSterileCartridge密封无菌针筒Note lotcodeandexpiration movedtocartridgebarrel注意 代码和有效期 OpenCartridge打开针筒Note NeedleSet spositionNote torn andlifted safetyseal注意 撕开安全封条 OpenCartridge打开针筒Note torn andlifted safetyseal注意 揭下安全封条 OpenCartridge打开针筒Note exposed singleuseonly sticker注意 查看 一次性使用 标志 Styletin Shuttle 保留探针在筒内Note REMOVEDsafetyseal撕下安全封条 Styletin Shuttle 盖上针筒Note REMOVEDsafetyseal LengthandcoloraretheonlydifferencesbetweenEZ IONeedleSets不同型号的套装颜色不同 5mmmark5毫米标志 15mmPD 25mmAD 45mmLD EZ IOLDNeedleSetTraywithSharpsProtectors锐器保护装置的针盒 Putthemwheretheybelong 废物处理 Styletsbelonginapprovedsharpscontainers探针放入特定的锐器盒内 EZ IOLDSharpsprotector锐器保护装置 EZ IOPD ADShuttles套针盒 ConsiderthesepointsBEFOREEVERYEZ IOinsertion 操作前注意事项 Didyou hear apopwhenthecartridgewasopened 打开时是否有砰砰声 2DidtheDrivereasilyattachtotheNeedleSet WiththeNeedleSetremaininginthecartridge 是否有套针不能从针筒中取出的情况 3DidyouREMOVEtheNeedleSetSafetyCapfromtheNeedleSet 能否打开套针安全帽 DidyouCONFIRMthe5mmmark 能否有5毫米标志 ImportantEZ IOusageconsiderations使用EZ IO的主要注意事项 Notethata loneStylet sitsdeeperthanacompleteNeedleSet探针要比整个套针在针筒内的位置更深 NeedleSet PrecisecylindricalholecreatedbyEZ IOinsertion由EZ IO制作的精确的圆柱孔 TheEZ IOInfusionSolutionEZ IO输液装置 EZ IOAD PDNeedleSets TrainingNeedleSets练习套针 EZ IOStorageCases CradleEZ IO箱和支架 EZ IODriver驱动器 EZ Connect连接 TrainingDriver训练驱动器 Wristband腕带 GeneralIOAnatomy常规骨髓通路解剖 Anatomyofintraosseousaccess骨髓通路解剖 Thousandsofsmallveinsleadfromthemedullaryspacetothecentralcirculation数以千计的小静脉将骨髓腔与中心静脉相连通 Intraosseoususageandpain骨髓通路的使用和疼痛 AdultIOAnatomy成人骨髓通路解剖 ProximalTibialAnatomy近端胫骨解剖 Patella膝盖骨 AdultRightLeg成人右腿 Tuberosity结节 InsertionSite插入位点 EZ IOInsertedEZ IO插入 StyletRemoved导管管芯去除 Notecatheterlocationidentifyingstructuresandtissuethickness注意导管 位置 识别结构和组织厚度 Adultfemalecadaver rightproximaltibia成年女性尸体右胫骨近端 Notethedistancefromtheproximalaspectofthetibiatothemiddleofthetuberosity注意 丛胫骨近端到结节中心的距离 Notetheaverageskinthicknessattheinsertionsite注意 插入点处平均皮肤厚度 Adultfemalecadaver rightproximaltibia DistalTibialAnatomy远端胫骨解剖 TheanklejointiscomprisedoftheTibia TalusandFibula踝关节由胫骨 距骨和腓骨组成 Acloserlookattheanatomy近距离观看解剖结构 Posterior后面 Anterior前面 Posterior Anterior DistalTibia远端胫骨 Calcaneous跟骨 Talus距骨 Adultfemalecadaver leftdistaltibia Posterior Anterior DistalTibia远端胫骨 Adultfemalecadaver leftdistaltibia Posterior Anterior DistalTibia远端胫骨 Adultfemalecadaver leftdistaltibia Posterior Anterior DistalTibia远端胫骨 Saphenousvein隐静脉 Tendons肌腱 MedialMalleolus内踝 Adultfemalecadaver leftdistaltibia ProximalHumeralAnatomy近端肱骨结构 Insertionsite插入点 Insertionsite插入点 Landmarkingthegreatertubercleinsertionsite标记较大的结节插入点 ProximalHumerusSite近端肱骨点 Adultmalecadaver rightproximalhumerus ProximalHumerusSite近端肱骨点 Adultmalecadaver rightproximalhumerus Thegreatertubercleinsertionsite较大的插入点结节 Noteindexfingerintheintertuberculargroove注意 食指所指位置为结节间沟 Needlesetshouldneverenterorbemedialtotheintertuberculargroove 穿刺针不应该进入或接近结节间沟 ProximalHumerusSite近端肱骨点 Adultmalecadaver rightproximalhumerus Notethatarmisadductedwiththeelbowposteriorlyplaced 注意 上臂随肘部内收 TheProximalHumerusinsertionsiteisfound slightlyanteriortothearmslateralmidline 发现肱骨近端插入点位于 上臂侧面的中线稍靠前一点 RightarmAdultmale成年男性右上肢 TheProximalHumerusinsertionsite Notethatarmisadductedwiththeelbowposteriorlyplaced 注意 上臂随肘部内收 Notethattheinsertionsiteisfoundanteriortothearmslateralmidline 注意 插入点位于上臂外侧中线之前 LeftarmMannequin人体模型左上臂 Anterior前面 Posterior后面 ProximalHumerus肱骨近端 ProximalTibia胫骨近端 DistalTibia胫骨远端 Fractures骨折 B Multipleoptions Multipleoptions多处选择 DistalTibia胫骨远端 ProximalTibia胫骨近端 Multipleconcerns 多处关注 ProximalHumerus肱骨近端 Thisslideillustratesimmediaterealworldsolutionstocomplexpatientencounters PediatricAnatomy小儿解剖 PediatricAnatomicalOverview Clearlyvisibletibialgrowthplate Tibia Insertionsite Thepediatricgrowthplate GrowthPlate LeftLeg RightLeg Skin SubcutaneousFat IntraosseousCatheter Tibia Fibula Post Compartment Ant Compartment Lat Compartment Anatomy Femaleneonatecadaver Leftproximaltibia Elevenyearoldproximaltibiainsertionsitecrosssection Insertionsite Tibia Fibula Leftleg 11mm Muscles Skin Adipose Compactbone Cancellousbone 17 9kgMale LeftArm ProximalHumerus SelectNeedleSetbasedonsizeandweight 3 1kgfemale LeftLeg 1 5cmproximaltothepatella proximalview Ventral Dorsal SitenotFDAcleared DistalFemur Anterior Posterior Medial Lateral Skin Adipose Muscle Compactbone Cancellousbone 3 1kgfemale LeftLeg 1 5cmproximaltothepatella proximalview Primarymusclegroupsinvolvedwithdistalfemurintraosseousinsertionincludethe RectusFemorisVastusIntermediusVastusLateralis DistalFemur SitenotFDAcleared DistalFemur ProximalTibia DistalTibia InfantIOsitecomparative3 1Kgfemale leftleg SitenotFDAcleared Note Compactbonedensity overallsizeoftargetbone adjacentmusclestructuresandthecathetertobonerelationship DistalFemur ProximalTibia DistalTibia ToddlerIOsitecomparative17 9kgMale Note Compactbonedensity overallsizeoftargetbone adjacentmusclestructuresandthecathetertobonerelationship SitenotFDAcleared ProximalHumerus ProximalHumerus ProximalHumerus ProximalTibia ProximalTibia DistalTibia DistalTibia DistalFemur DistalFemur Intraosseousaccesssitesforthepediatricpatient NotFDAcleared NotFDAcleared Experience anatomysuggestthatthissiteismostsuitableforpatients5yearsofageandolder Experience anatomysuggestthatthissiteissuitablemostforpatients5yearsofageandolder IndicationsforEZ IOAccessEZ IO使用适应症 1 Alteredlevelofconsciousness意识改变2 Respiratorycompromise呼吸窘迫3 Hemodynamicinstability血流动力学不稳定 Togainintraosseousaccessinemergencies 2020 1 29 51 可编辑 PreparingtheEZ IOforuse使用EZ IO准备 ContraindicationsforEZ IOAccessEZ IO使用的禁忌症 Fracture targetedbone 骨折 目标骨骨折 Previousorthopedicproceduresnearinsertionsite ProstheticLimborjoint 穿刺点附近做过整形术 假肢或人工关节 IOwithinpast24hours targetedbone 在过去24小时内做过骨髓通路术 目标骨 Infectionattheinsertionsite穿刺部位有感染Inabilitytolocatelandmarksorexcessivetissue操作者不能定位或由于组织过多无法定位 ObserveBodySubstanceIsolationPrecautions RetrieveEZ IOdriverandcartridge Opencartridge attachdrivertoneedleset取出驱动器和针筒 打开针筒并将驱动器与套针相接 AdultSiteSelection成人穿刺点的选择 Confirmandcleaninsertionsite确定并清洁穿刺点 Identifytheinsertionsite确定穿刺点 Confirmandcleaninsertionsite确定并清洁穿刺点 IdentifytheProximalHumerusinsertionsite确定肱骨近端穿刺点 Elbowshouldremainadductedandposteriorlylocated肘部内收并位于后方 orientthearmtothisposition保持上肢这种姿势 Placethehandovertheumbilicusforhumeralpositioningandsafety手高于脐利于定位肱骨和安全 Preferredinsertionsiteidentificationmethod首选的穿刺点确定程序 Placethepatientinasupinepositionwiththearmcorrectlyoriented置患者仰卧位 并调整上肢为正确姿势 Confirmandcleaninsertionsite确定并清洁穿刺点 PediatricSiteSelection Ifthepatient fits ontheBroselow TapeTHINKPINK andconsidertheEZ IOPD ObeseorlargepediatricpatientsmayrequiretheEZ IOADneedleSet FemurnotFDAcleared TheTibialTuberositycanbedifficultorimpossibletopalpateonyoungerpatients IftheTibialTuberosityCANNOTbepalpatedtheinsertionsiteistwofingerwidthsbelowthePatella andthen medialalongtheflataspectoftheTibia IdentifyingthepediatricEZ IOinsertionsite AspatientsmaturetheTibialTuberositybecomeseasiertoidentify IftheTibialTuberosityCANbepalpatedtheinsertionsiteisonefingerwidthbelowtheTuberosity andthen medialalongtheflataspectoftheTibia IdentifyingthepediatricEZ IOinsertionsite Confirmandcleaninsertionsite Confirmandcleaninsertionsite Confirmandcleaninsertionsite Insertion Infusion穿刺及输液 Removeneedlesetsafetycap取下套针安全帽 ROTATESAFETYCAPCLOCKWISETOREMOVE顺时针旋转取下安全冒 StabilizeExtremity固定手足 Guardagainstunexpectedpatientmovement防止患者活动 InsertADneedlesetintoappropriatesite Don tforcetheneedlesetintoposition allowthedrivertodothework PositiontheEZ IODriverata90degreeangletothebone Remember EZdoesit 40kgandgreaterusage LightlyholdingtheEZ IOdriverwillimproveusage InsertPDneedlesetintoappropriatesite Selectthecorrectneedlesetbasedonpatientsize weight 5mmmark PositiontheEZ IODriverata90degreeangletothebone 3 39kgusage LightlyholdingtheEZ IOdriverwillimproveusage NotFDAcleared InsertEZ IONeedleSet ata90degreeangletotheboneTHENcheckthe5mmmark垂直穿刺然后查看5毫米标记 Checkthe5mmmark 检查5毫米标记 25mmNeedleSet25毫米长的套针 5mmmark5毫米标记处 needlesetpendingFDAclearance Notethatthe5mmmarkisNOTvisibleabovetheskin5毫米标记线未在皮肤之上 不能看见 AdiposeormuscletissuethicknessshouldbeconsideredpriortoEZ IOinsertion穿刺之前 应该被考虑到脂肪或肌肉组织的厚度 45mmNeedleSet45毫米长套针 5mmmark5毫米标记处 NeedleSethasnotbeenFDAcleared不合格套针 CompleteInsertion完成穿刺 Intheunlikelyeventofadriverfailureconsidermanualinsertion驱动器穿刺失败考虑手工完成是不太可能的事情 Importantneedlesetinsertiontip重要的套针穿刺提示 Userinducedrecoilmayleadtoneedlesetdislodgementorextravasation操作者不能控制反冲力可能导致套针移位或脱出 STOPWHENYOUFEELTHEPOP当有 砰砰 的感觉时停止穿刺 反冲力 保持平衡 Allowdrivertodothework DONOTEXCESSIVEFORCEGentlyGUIDEneedlesetintoposition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 39kgusage 40kgandgreaterusage RemoveDriverfromneedleset把驱动器丛套针上取下 StabilizeNeedleSetwhiledisconnectingDriver分离驱动器时固定牢固套针 Removestyletfromcatheter从套管内取下探针 Neverattempttoreplacethestyletonceremovedfromthecatheter Confirmcatheterplacement确定导管位置 Confirmplacementbynoting通过以下提示确定位置Bloodatthestylettip探针针尖有血Firmlyseatedcatheter导管固定牢固Bloodinthecatheterhub导管外套处有血Aspirationofblood有血溢出Fluidsflowwithoutdifficulty液体流入顺利Pharmacologiceffects药物发挥作用 Monitortheinsertionsiteanddistalextremityforsignsofextravasation观察穿刺点及远端肢体 防止外渗 Putthemwheretheybelong Styletsbelonginapprovedsharpscontainers探针放于特定的锐气盒内 NEWEZ IOLDSharpsprotector新式锐器保护装置 EZ IOPD ADShuttles Considerplacingstabilizeroncatheter安装导管固定装置 CentrallylocateCathetertotheeyeoftheStabilizer固定导管于固定装置中心的孔内 2 1 2 1 Removestabilizer sadhesivebacking撕掉固定装置的粘合底布 Securedadhesivepreventslateralmovement粘合剂可有效避免套针横向移动 Graspstabilizerandgentlypulltabs固定好固定装置并轻拉底布 Lidocaineconsiderationsandadministration利多卡因的应用及注意事项 2 preservativefree Lidocaine givenintraosseously IO hasbeenshowntooffereffectivelocalanesthesiainmostalertpatients2 利多卡因局麻用于较敏感患者IOinfiltrationforalertpatients ConsiderprimingtheEZ Connect with2 LidocaineAdultdosage20 40mgIO成人剂量20 40mgPediatricdosage0 5mg kgIO小儿剂量0 5mg kgInfuseLidocaineslowly over30seconds 缓慢推注大于30秒Allow1minuteforanestheticeffect一分钟后见效Repeatasneededtoreachtherapeuticlevel有必要时可重复使用DONOTexceed3mg kg不能超过3mg kg Somepatientsmayrequirerepeatedadministrationtoachievedesiredeffect Seenotesattachedtoslideforbibliographyanddetailedexplanation NoFlush NoFlow SyringeFLUSHcatheter SyringeFLUSHcatheterwith10mlofasterilesolution Alertpatientsmayrequire2 preservative