This nurse had an intravenous infusion stabbed backwards!

A patient with heart failure and chronic renal failure who was transferred from the Department of Cardiology suddenly complained to the head nurse one day: During the intravenous infusion, the responsible nurse performed retrograde puncture, which resulted in palpitations and chest tightness
.

A patient with heart failure and chronic renal failure who was transferred from the Department of Cardiology suddenly complained to the head nurse one day: During the intravenous infusion, the responsible nurse performed retrograde puncture, which resulted in palpitations and chest tightness
.

In the case of intravenous infusion for heart failure , the responsible nurse performed retrograde puncture, which resulted in palpitations and chest tightness

It turned out that because of the poor condition of the veins on the back of the patient's hand, there was a vein close to the metacarpophalangeal joints, but it was not easy to fix.

At that time, the patient did not raise any objections, but after the fluid infusion, the patient felt palpitation and chest tightness, which was considered to be caused by retrograde puncture

The patient said that she had a history of heart failure.

01 01

What is reverse puncture?

What is reverse puncture? What is reverse puncture?

The reverse vein puncture technique is basically the same as the conventional centripetal puncture technique, except that the puncture direction of the infusion needle is just the opposite
.

The reverse vein puncture technique is basically the same as the conventional centripetal puncture technique, except that the puncture direction of the infusion needle is just the opposite
.

When performing reverse venipuncture, stand facing the distal end of the patient's finger and ask the patient to half-fist the punctured hand, which is cup-shaped
.

When performing reverse venipuncture, stand facing the distal end of the patient's finger and ask the patient to half-fist the punctured hand, which is cup-shaped
.

Routine disinfection of the skin, the operator left hand holding the wrist of the patient, the patient will be forced to thumb skin pulled back to the proximal direction, stretch the skin, venous filling good, right hand holding the needle handle, the blood vessels into the needle above or beside the vessel, The angle of needle entry should be 35～40°
.

Routine disinfection of the skin, the operator left hand holding the wrist of the patient, the patient will be forced to thumb skin pulled back to the proximal direction, stretch the skin, venous filling good, right hand holding the needle handle, the blood vessels into the needle above or beside the vessel, The angle of needle entry should be 35～40°
.

Blood vessel

Advantages of reverse vein puncture infusion

Advantages of Reverse Venous Puncture Infusion Method Advantages of Reverse Venous Puncture Infusion Method

Intravenous infusion is a common clinical treatment method, and the vein on the back of the hand is the most commonly used puncture site
.

Intravenous infusion is a common clinical treatment method, and the vein on the back of the hand is the most commonly used puncture site
.

However, patients with long-term infusion, especially the elderly, have their blood vessels damaged due to long-term repeated puncture or drug stimulation, which reduces the number of available puncture blood vessels, and the success rate of puncture is low
.

However, patients with long-term infusion, especially the elderly, have their blood vessels damaged due to long-term repeated puncture or drug stimulation, which reduces the number of available puncture blood vessels, and the success rate of puncture is low
.

Improve the success rate of puncture:

Improve puncture success rate: Improve puncture success rate:

The blood flows in the venous lumen in a centripetal direction.
According to the principle of mechanics, the bevel of the needle tip is pierced in the reverse direction along the vein
.

The blood flows in the venous lumen in a centripetal direction.
According to the principle of mechanics, the bevel of the needle tip is pierced in the reverse direction along the vein
.

At this time, the direction of needle insertion is opposite to the direction of blood flow.
When the needle reaches the venous lumen, the blood under static pressure is more likely to rush into the needle faster, which is convenient for nurses to observe and judge, thereby increasing the success rate of venipuncture
.

At this time, the direction of needle insertion is opposite to the direction of blood flow.
When the needle reaches the venous lumen, the blood under static pressure is more likely to rush into the needle faster, which is convenient for nurses to observe and judge, thereby increasing the success rate of venipuncture
.

When using forward venipuncture, when the punctured person makes a fist, the distal veins of the back of the hand hinder the angle of needle insertion due to the protruding metacarpophalangeal joints higher than the back of the hand, which affects the success rate of puncture;

When using forward venipuncture, when the punctured person makes a fist, the distal veins of the back of the hand hinder the angle of needle insertion due to the protruding metacarpophalangeal joints higher than the back of the hand, which affects the success rate of puncture;

In reverse puncture, a half-fist shape is adopted, and the distal blood vessel is exposed on the skin surface, which can flexibly control the needle angle and is easy to puncture
.

In reverse puncture, a half-fist shape is adopted, and the distal blood vessel is exposed on the skin surface, which can flexibly control the needle angle and is easy to puncture
.

Although the veins near the palmar joints are curved and thin, they are superficial, soft, and not easy to slide, and venipuncture is rarely performed, so the puncture success rate is extremely high
.

Although the veins near the palmar joints are curved and thin, they are superficial, soft, and not easy to slide, and venipuncture is rarely performed, so the puncture success rate is extremely high
.

Reduce the leakage rate of infusion, easy to fix:

Reduce infusion leakage rate, easy to fix: Reduce infusion leakage rate, easy to fix:

The traditional antegrade puncture method is used to puncture the half of the finger (toe) under the back of the hand and foot, the peripheral superficial vein, and the place close to the joint.
Due to the short needle insertion site, the needle handle is located at the finger (toe) joint after the needle is inserted.
It is not easy to fix
.

The traditional antegrade puncture method is used to puncture the half of the finger (toe) under the back of the hand and foot, the peripheral superficial vein, and the place close to the joint.
Due to the short needle insertion site, the needle handle is located at the finger (toe) joint after the needle is inserted.
It is not easy to fix
.

Using the reverse puncture method, the needle handle is located on the back of the hand after the needle is inserted, and the supporting area is large.
Even if the puncture blood vessel is curved and short, as long as the needle tip enters the blood vessel, it is relatively stable, easy to fix, and has little effect on the movement of the fingers.
In a comfortable position
.

Using the reverse puncture method, the needle handle is located on the back of the hand after the needle is inserted, and the supporting area is large.
Even if the puncture blood vessel is curved and short, as long as the needle tip enters the blood vessel, it is relatively stable, easy to fix, and has little effect on the movement of the fingers.
In a comfortable position
.

In addition, the natural position is taken during the reverse puncture, and there is no need to loosen the fist after the needle is inserted, which effectively avoids the puncture leakage caused by the slight re-expansion of the blood vessel, and can ensure the smooth completion of the infusion process
.

In addition, the natural position is taken during the reverse puncture, and there is no need to loosen the fist after the needle is inserted, which effectively avoids the puncture leakage caused by the slight re-expansion of the blood vessel, and can ensure the smooth completion of the infusion process
.

The application of the reverse vein puncture infusion method not only improves the clinical work efficiency, but also reduces the pain caused by repeated puncture, and does not affect the joint activities of the patient's infusion side limbs, and improves the patient's comfort
.

The application of the reverse vein puncture infusion method not only improves the clinical work efficiency, but also reduces the pain caused by repeated puncture, and does not affect the joint activities of the patient's infusion side limbs, and improves the patient's comfort
.

Improve the rate of blood vessel usage and wide range of puncture:

Increase blood vessel usage rate and wide puncture range: Increase blood vessel usage rate and wide puncture range:

Tumor chemotherapy patients have long-term stimulation of blood vessels by chemotherapy drugs, and redness, pigmentation, pain, blood vessels hardening and obstructing blood flow can be seen in the concentric vein starting from the puncture point and along the vein direction, which may easily cause puncture failure
.

Tumor chemotherapy patients have long-term stimulation of blood vessels by chemotherapy drugs, and redness, pigmentation, pain, blood vessels hardening and obstructing blood flow can be seen in the concentric vein starting from the puncture point and along the vein direction, which may easily cause puncture failure
.

Use reverse venipuncture infusion to choose uncommon blood vessels, such as 1/3 of the vein under the back of the hand, and 1/3 of the vein in the lower segment after hardening of the forearm to the heart
.

Use reverse venipuncture infusion to choose uncommon blood vessels, such as 1/3 of the vein under the back of the hand, and 1/3 of the vein in the lower segment after hardening of the forearm to the heart
.

Because of its low puncture opportunity and unaffected elasticity, the blood vessel utilization rate is increased
.

Because of its low puncture opportunity and unaffected elasticity, the blood vessel utilization rate is increased
.

After applying the reverse venipuncture infusion method, it can significantly improve the success rate of venipuncture, the unblocked rate of infusion, and the rate of infusion speed up to standard
.

After applying the reverse venipuncture infusion method, it can significantly improve the success rate of venipuncture, the unblocked rate of infusion, and the rate of infusion speed up to standard
.

Combined with related literature research, reverse intravenous infusion is applied to patients with long-term intravenous infusion, elderly, children , wasting, and poor vascular conditions
.

Combined with related literature research, reverse intravenous infusion is applied to patients with long-term intravenous infusion, elderly, children , wasting, and poor vascular conditions
.
child

It can be used alternately with conventional anterior intravenous infusion, which can select and protect large blood vessels in a planned way, so that blood vessels damaged by long-term infusion can be restored, and follow the principle of "from small to large, from distal to proximal".
, Which makes the puncture range wider
.

It can be used alternately with conventional anterior intravenous infusion, which can select and protect large blood vessels in a planned way, so that blood vessels damaged by long-term infusion can be restored, and follow the principle of "from small to large, from distal to proximal".
, Which makes the puncture range wider
.

Reduce blood vessel damage and reduce the incidence of phlebitis:

Reduce blood vessel damage and reduce the incidence of phlebitis: reduce blood vessel damage and reduce the incidence of phlebitis:

Because the dorsal hand vein network is a part of the superficial veins of the upper limbs, it is located under the skin and has abundant anastomotic branches between the deep veins
.

Because the dorsal hand vein network is a part of the superficial veins of the upper limbs, it is located under the skin and has abundant anastomotic branches between the deep veins
.

Relevant studies have shown that the application of reverse venipuncture infusion of irritant drugs has less damage to blood vessels, less pain than normal, and the incidence of redness, swelling, heat, pain and other phlebitis is also reduced
.

Relevant studies have shown that the application of reverse venipuncture infusion of irritant drugs has less damage to blood vessels, less pain than normal, and the incidence of redness, swelling, heat, pain and other phlebitis is also reduced
.

02

02 02

Does reverse puncture really induce heart failure?

Does reverse puncture really induce heart failure? Does reverse puncture really induce heart failure?

Hand back vein network:

Back of the hand vein network: Back of the hand vein network:

From the perspective of local anatomy, the superficial veins originate from the fingers and form a mesh structure on the back of the hand.
There are abundant anastomotic branches between the subcutaneous and deep veins
.

From the perspective of local anatomy, the superficial veins originate from the fingers and form a mesh structure on the back of the hand.
There are abundant anastomotic branches between the subcutaneous and deep veins
.

Reverse puncture at the vein network on the back of the hand can flow back to the right heart through this network structure
.

Reverse puncture at the vein network on the back of the hand can flow back to the right heart through this network structure
.

Because the reverse puncture method usually chooses the blood vessel at 1/2 or 1/3 of the distal end of the back of the hand, the liquid can quickly reach the venous anastomotic branch after being injected into the human body under static pressure
.

Because the reverse puncture method usually chooses the blood vessel at 1/2 or 1/3 of the distal end of the back of the hand, the liquid can quickly reach the venous anastomotic branch after being injected into the human body under static pressure
.

After multiple anastomotic branches, the reflux is very fast, so the drip rate is not affected
.
Therefore, changing the direction of venipuncture does not affect the drip rate of the infusion, and does not affect the effect of the administration time.
The reverse puncture infusion method is theoretically feasible
.

After multiple anastomotic branches, the reflux is very fast, so the drip rate is not affected
.
Therefore, changing the direction of venipuncture does not affect the drip rate of the infusion, and does not affect the effect of the administration time.
The reverse puncture infusion method is theoretically feasible
.

2.
Venous return and blood flow resistance:

2.
Venous return and blood flow resistance: 2.
Venous return and blood flow resistance:

The venous return volume per unit time depends on the difference between peripheral venous pressure and central venous pressure, and the resistance of the vein to blood flow
.

The venous return volume per unit time depends on the difference between peripheral venous pressure and central venous pressure, and the resistance of the vein to blood flow
.

For the same part of the same patient, the difference between the peripheral venous pressure and central venous pressure under certain conditions (such as constant heart contractility, same posture, no skeletal muscle squeezing effect, calm breathing) at a certain time Little change
.

For the same part of the same patient, the difference between the peripheral venous pressure and central venous pressure under certain conditions (such as constant heart contractility, same posture, no skeletal muscle squeezing effect, calm breathing) at a certain time Little change
.

In the venous system, the pressure drop from the venules to the right atrium is only 15 mm Hg
.
(1 mm Hg=0.
133 kPa), indicating that the resistance of the vein to blood flow is very small
.

In the venous system, the pressure drop from the venules to the right atrium is only 15 mm Hg
.
(1 mm Hg=0.
133 kPa), indicating that the resistance of the vein to blood flow is very small
.

It can be explained that the venous return volume will not be affected by different puncture methods
.

It can be explained that the venous return volume will not be affected by different puncture methods
.

3.
Adverse reactions:

3.
Adverse reactions: 3.
Adverse reactions:

Compared with the forward puncture infusion method, the reverse puncture infusion method is easier to fix, improves the success rate of a puncture infusion, and has no adverse effects in clinical applications
.

Compared with the forward puncture infusion method, the reverse puncture infusion method is easier to fix, improves the success rate of a puncture infusion, and has no adverse effects in clinical applications
.

In addition, according to the anatomical characteristics of the dorsal veins of the hands and feet, reverse vein puncture infusion is not easy to cause abnormal reactions such as local swelling, exudation, pain, poor infusion, and intravenous needle prolapse.
It is also safe and reliable
.

In addition, according to the anatomical characteristics of the dorsal veins of the hands and feet, reverse vein puncture infusion is not easy to cause abnormal reactions such as local swelling, exudation, pain, poor infusion, and intravenous needle prolapse.
It is also safe and reliable
.

Let's take a look at the anatomical characteristics of dorsal hand veins:

Let's take a look at the anatomical characteristics of dorsal hand veins:

 

Figure/Clinical applied anatomy of dorsal hand vein puncture

Figure/Clinical applied anatomy of dorsal hand vein puncture

The veins of the dorsal hand are formed by the anastomosis of the dorsal finger veins, and are connected to each other in the middle of the back of the hand to form the dorsal hand vein network
.

The veins of the dorsal hand are formed by the anastomosis of the dorsal finger veins, and are connected to each other in the middle of the back of the hand to form the dorsal hand vein network
.

There are two sets of venous systems, deep and shallow, which are linked to each other by traffic branches
.

There are two sets of venous systems, deep and shallow, which are linked to each other by traffic branches
.

Because the dorsal hand vein extends upward from the third-level venous arch of the dorsal finger vein, its outer diameter is greater than 1.
5mm, and the outer diameter of a common infusion needle is 0.
6-0.
7mm
.
When retrograde puncture, it will not cause infusion;

Because the dorsal hand vein extends upward from the third-level venous arch of the dorsal finger vein, its outer diameter is greater than 1.
5mm, and the outer diameter of a common infusion needle is 0.
6-0.
7mm
.
When retrograde puncture, it will not cause infusion;

The hydraulic pressure difference is 80cmH2O
.
With the help of the pressure difference, the retrograde puncture liquid can flow back smoothly
.

The hydraulic pressure difference is 80cmH2O
.
With the help of the pressure difference, the retrograde puncture liquid can flow back smoothly
.

In other words, from anatomy and clinical practice, there is no contraindication to retrograde puncture!

In other words, from anatomy and clinical practice, there is no contraindication to retrograde puncture!

03

03 03

These 3 points should be paid attention to in retrograde puncture

Pay attention to these 3 points when retrograde puncture needs to pay attention to these 3 points

1 , adults should not choose venous infusion

1 , adults should not choose venous infusion 1 , adults should not choose venous infusion

Due to the effect of gravity and the influence of the lower limbs at the distal end, the venous circulation of the lower limbs is not as good as that of the upper limbs.
The lower limb infusion medicine can pump blood through the heart to reach all parts of the body.
The time to take effect is slower than that of the upper limb infusion
.

Due to the effect of gravity and the influence of the lower limbs at the distal end, the venous circulation of the lower limbs is not as good as that of the upper limbs.
The lower limb infusion medicine can pump blood through the heart to reach all parts of the body.
The time to take effect is slower than that of the upper limb infusion
.

Due to the weak constitution of the elderly, patients who need to stay in bed for a long time after major operations
.

Due to the weak constitution of the elderly, patients who need to stay in bed for a long time after major operations
.

The blood circulation in the veins of the lower extremities is poor.
In addition, the operation will cause water loss, blood loss, thickening of the blood and slow blood flow, so it is easy to form venous thrombosis of the lower extremities
.

The blood circulation in the veins of the lower extremities is poor.
In addition, the operation will cause water loss, blood loss, thickening of the blood and slow blood flow, so it is easy to form venous thrombosis of the lower extremities
.
thrombus

If the infusion needle is stuck in the lower limbs, the movement of the patient's lower limbs will be restricted
.

If the infusion needle is stuck in the lower limbs, the movement of the patient's lower limbs will be restricted
.

This will cause poorer blood circulation in the veins of the lower extremities, making it more prone to thrombosis in the veins of the lower extremities
.

This will cause poorer blood circulation in the veins of the lower extremities, making it more prone to thrombosis in the veins of the lower extremities
.

If the thrombus in the vein falls off, once the embolism embolizes in the lung, brain, kidney, etc.
, it will cause serious consequences
.

If the thrombus in the vein falls off, once the embolism embolizes in the lung, brain, kidney, etc.
, it will cause serious consequences
.

2.
Reverse puncture of small peripheral veins is not allowed

2.
Reverse puncture of small peripheral venules cannot be performed 2.
Reverse puncture of small peripheral venules cannot be performed

When choosing venous vessels for reverse puncture infusion, small veins that return upward from the fingers and toes should not be selected
.

When choosing venous vessels for reverse puncture infusion, small veins that return upward from the fingers and toes should not be selected
.

Therefore, there is no traffic branch, if reverse puncture will cause blood stasis, resulting in failure of puncture and transfusion
.

Therefore, there is no traffic branch, if reverse puncture will cause blood stasis, resulting in failure of puncture and transfusion
.

3.
Reverse infusion is not suitable for patients with edema

3.
Reverse infusion is not suitable for patients with edema.
3.
Reverse infusion is not suitable for patients with edema.

Edema patients such as cardiogenic edema, renal edema, dystrophic edema
.

Edema patients such as cardiogenic edema, renal edema, dystrophic edema
.

These patients with edema caused increased venous pressure due to blood volume expansion, and increased venous pressure caused by embolism
.

These patients with edema caused increased venous pressure due to blood volume expansion, and increased venous pressure caused by embolism
.

Increased venous pressure can increase the hydrostatic pressure at the venous end of the capillary, causing the interstitial fluid at the venous end of the capillary to reabsorb obstacles, making the filtration greater than the reabsorption, leading to the expansion of the interstitial fluid
.

Increased venous pressure can increase the hydrostatic pressure at the venous end of the capillary, causing the interstitial fluid at the venous end of the capillary to reabsorb obstacles, making the filtration greater than the reabsorption, leading to the expansion of the interstitial fluid
.

If the reverse venipuncture infusion is performed, the lighter case does not drip, and the more severe case aggravates the expansion of interstitial fluid, aggravates acral edema, and causes more pain to the patient
.

If the reverse venipuncture infusion is performed, the lighter case does not drip, and the more severe case aggravates the expansion of interstitial fluid, aggravates acral edema, and causes more pain to the patient
.

What are the clinical causes that can cause heart failure?

What are the clinical causes that can cause heart failure? What are the clinical causes that can cause heart failure?

 

There are no more than two reasons for heart failure, one is the heart is overloaded, and the other is the damage of the myocardium
.

There are no more than two reasons for heart failure, one is the heart is overloaded, and the other is the damage of the myocardium
.

Heart overload can be divided into pressure overload and volume overload
.

Heart overload can be divided into pressure overload and volume overload
.

What is related to the infusion is that the volume load is too heavy.
Too much and too fast infusion will cause the blood volume to increase rapidly, which can cause the heart volume to be overloaded
.

What is related to the infusion is that the volume load is too heavy.
Too much and too fast infusion will cause the blood volume to increase rapidly, which can cause the heart volume to be overloaded
.

When the heart volume just starts to increase, the ventricular cavity will expand compensatoryly, and the diastolic and contractile function of the myocardium can still maintain normal
.

When the heart volume just starts to increase, the ventricular cavity will expand compensatoryly, and the diastolic and contractile function of the myocardium can still maintain normal
.

But when it exceeds a certain limit and the heart can no longer hold too much blood, the structure and function of the myocardium will change, and heart failure will occur, just like a balloon that blows up to a certain extent
.

But when it exceeds a certain limit and the heart can no longer hold too much blood, the structure and function of the myocardium will change, and heart failure will occur, just like a balloon that blows up to a certain extent
.

Figure / manifestations of heart failure

Figure / manifestations of heart failure

 

04

04 04

Summarize

Summary summary

According to the above analysis, it can be seen that reverse puncture does not necessarily cause heart failure, but there are certain contraindications, and there are risks in application
.

According to the above analysis, it can be seen that reverse puncture does not necessarily cause heart failure, but there are certain contraindications, and there are risks in application
.

In the case of patients with failure and renal failure, it is likely to be accompanied by edema, so reverse puncture is not suitable
.

In the case of patients with failure and renal failure, it is likely to be accompanied by edema, so reverse puncture is not suitable
.

This also reminds us that when performing reverse puncture, we must be careful and make an assessment
.

This also reminds us that when performing reverse puncture, we must be careful and make an assessment
.

With the development of high-quality nursing services, nurses are playing an increasingly important role in clinical work.
The development of patient health education is an important work content for nurses!

With the development of high-quality nursing services, nurses are playing an increasingly important role in clinical work.
The development of patient health education is an important work content for nurses!

Therefore, in clinical work, we must not only know what is happening, but also know why, continue to strengthen our professional theoretical knowledge learning, and implement correct health education!

Therefore, in clinical work, we must not only know what is happening, but also know why, continue to strengthen our professional theoretical knowledge learning, and implement correct health education!

 

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