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A scalp vein puncture the current failure of 1.1 lack of good psychological quality and the lack of communication skills of nurses to communicate with the children and their parents, parents, distressed children, the requirement for nurses is also high, a lack of understanding of medical knowllimit, speak the language used and other emotions can affect the operation of nurses, nurses puncture failure caused by stress.

1.2 shall not be treated vascular puncture technique selection, needle holder approach is not correct, the lack of skilled nurses puncture techniques, can bring about puncture failure.

1.3 needle puncture fixed shall not be treated successfully, as a result of the fixed approach is not correct puncture failure.

1.4 special children such as obesity, dehydration, fever and other children of the scalp, puncture technique is difficult, easy to puncture failure.

1.5 children poor children do not match the fixed head, head swaying, hardly a fixed puncture the skin, coupled with the distressed parents of a child, a fixed head are not impactive, lead to puncture failure.

2 good scalp vein puncture shall meet the grades for successful

2.1 have good psychological quality pediatric nurse to have good patience and compassion, but also have excellent psychological quality, befactor now the children are home, baby, accompanied by a lot of people after disorder, which battle has offern us a kind of invisible pressure of nurses, coupled with the infusion needle before the success of the parents to ask for one. Puncture skills required of nurses is relatively high. At this time, we must not nervous confusion, it is easy to puncture and emotional impaction, leading to puncture failure. Parents of children experiencing a long time,[link widoczny dla zalogowanych], even when the parents experience extreme behavior, nurses have to stabilize mood, not to be the families of children with emotional contagion, this time to be calm tone of voice, explastate of the parents to be patient. Have a stable mood, strong self-confidence is the first step in a successful puncture.

2.2 to choose the appropriate first choice of vascular puncture the surest puncture, because the most important scalp puncture and was a success. Judge before the puncture, or arterial venous blood vessels. Veins are generally blue, touch and flexible, can be no rough idea depression; artery reddish color, touch of a stroke movement, feeling slightly harder vessels, do not contact the depression. Sometimes a baneful evil scalp arteriovenous judge, if the puncture is not reflux back into the blood, blood red, open the regulator switch the liquid does not flow, hand squeeze infusion tube, pale skin, around blood vessels, the arteries. In clinical work, we generally select the thick, straight, easy to center a fixed amount of veins, capillaries can also choose forehead, supraorbital vein, cranial sutural vein, ear vein. Different blood vessels, the author summarizes the toil of a deviateent puncture techniques, are presented below.

2.2.1 places the middle of the middle of the forehead vein, thickness appropriate. Individual differences, some children is obvious, while others do not know. Horizontal touch with your fingers, only where there is a feeling the grooves, obtain a clear idea of the feel of the direction and depth of blood vessels. Unable to figure out when the blood vessels in the direction, the index finger can be used with both hands on both sides of the skin blood vessels to the middle of pushing and shoving, then you can more clearly see the vessel go to increase the success rate. Pretty good idea of the blood vessels, the left thumb and middle finger blood pressure at both ends, tighten the skin, right hand needle, needle angle 5 ° ~ 15 ° aligned blood vessels into, Deep into the skin side of the needle slowly after observation of the needle back to the blood side, there was a sense of frustration. For such vessels, it is best to see a little blood back down after the needle into the needle handle and then some, into the point of attention at this time can not be peace, or they will burst blood vessels.

2.2.2 forehead capillaries often in our work of such vessels as \Press vascular filling good hands, touch the flexibility is good. Such as blood vessels is not clear, more rubbing alcohol swabs can be used several times to stimulate the expansion of vascular filling, because the character of alcohol there is expansion of blood vessels, puncture, should choose 四号 half or 五号 half of the scalp vein needle, relatively superficial location of these vessels , needle angle 5 ° ~ 10 ° or so. The direction parallel to the needle and blood vessels, needle holder to be stable, to avoid bruising the vessel wall, because the lumen of such small, slow return to the characteristics of the blood, so the needle must be slow and steady. In order to puncture easily back to the blood, can be placed Are dropper regulator bottom to 60 cm from the needle works best. After the puncture is not appropriate to see the blood back into the needle, such as the blood of no return, but a sense of frustration, not to rush back needle, try gently thin tube connected Withdrawing the needle, do not over Withdrawing coarse filter tube, otherwise it will result Withdrawing too much pressure leaving local swelling, blood vessel to see clearly, not to continue into the needle.

2.2.3 thick skull sutural veins and blood vessels on both sides of the skull on both sides and along their children the amount of joint, coronal suture, sagittal suture, lambdoid suture were intravenous procedures, look at this comparison of vascular thick, but in clinical practice in a certain degree of arduousy and skills. When a child crying more obviously see this vessel, do not cry when the vague horizontal touch with your fingers, you can hit \The needle point of the larger vessels. Both sides of the thick blood vessel is generally 20 ° ~ 30 °, cranial sutural vein 45 ° ~ 60 °. Vascular easy to slide into the left hand needle before the skin must be taut. If you do not tighten the skin, into the needle, the blood vessel with the needle to move forward to grasp the ambiguous rank of blood vessels. Right hand needle, piercing the skin blood vessels within the aligned 0.5 ~ 1 mm, it will stir up the needle, parallel to the forward stab. Because bone sutural veins, blood vessels larger space, if it is shallow to deep penetrate, then the vessel will be with the advance of the needle, into a suture, but not easy to grasp the depth and vessel location. Sometimes into the deep, the length will run into the artery with the needle up to stir up, the blood vessels were just to stir up, and then move in parallel it penetrates into the blood vessels can be. See back to the blood, and then a little forward in parallel, these blood vessels, can not see the return of blood after the needle stoppageped. In clinical situations we often encounter such a thick back to the blood vessel puncture good, but the liquid entered a period of time will be swelling around the needle, the liquid drops of good, but check back to the blood is also very good, the occurrence of such The factor for this is because the vessel diameter, as crying children exert oneself in the puncture, blood vessels expand, filling, tip back into the blood vessel after the visible, but when the children when the blood vessels and contraction in a quiet back to the birthal, then tip in the vessel or In addition, half of the vessel or outside, are prone to fluid leakage and swelling. Specific solution is: see back to the blood, the slightly lower angle, and then into the needle a little, you can avoid this from occuring, greatly improve the success rate of puncture.

2.2.4 auricular vein auricular vein easy to slide, subcutaneous fat thickness, skin soft and difficult to grasp the degree of the depth of the needle, and because the anatomical location of the reasons for poor care. In clinical work, drum pin high rate of blood vessels is generally not as preferred. But in the last resort to choose the puncture site should be able to: first to assert the basic stability of the head in children, do not shake, then to tighten the skin, needle holder to be stable, must be appropriate to grasp the needle speed, tried to be slow, stability.

2.2.5 Comparison of body fat and scalp edema e3ef55c3fe8b6deharmful567c251f5168e1d with black children or children with this sectionicular vessel is more difficult choice, to puncture succeed, we must have self-confidence, can not see the vein to depend on the feeling, mainly hand-feeling, with the right index finger at the head of several large veins at the touch, finger, and perpendicular to the direction of the vein on the scalp can touch the vein gently sliding groove, you felt vein with the thumb pressing the local ditch vein, do not force too much, can see the filling of the veins slightly higher than the surrounding skin. Hands of the index finger can also be used on both sides of the skin blood vessels to the middle of pushing and shoving, then you can more clearly see the vessel go, then immediately puncture, the highest success rate. Visible veins on the small little press but can also improve the success rate of puncture. Can not find a suitable vein in when the capillaries appear to be very small object as a choice, so that the success rate of vascular puncture puncture success rate than the seat of your pants higher.

2.2.6 of dehydration in children with severe dehydration due to volume depletion in children with poor vascular filling, and blood vessel elasticity and poor, this brought a lot of trouble to the puncture, and sometimes puncture into the blood vessel has been a, but not back to the blood and not mistaken for a successful exit, leading to puncture failure. See this in the first before infusion into the blood vessels, puncture obvious sense of frustration can be retraced to the small tube connecting the needle; infusion can also be placed on the head in children below 15 ~ 20 s observed to see whether back to the blood. If you but back to the blood, may try to slowly open the regulator switch, the phenomenon of the needle in front of the uplift of skin biopsy confirmed the success.

addition should also mention that the supraorbital vein of a blood vessel, due to closedown from the eyebrow, so when the kids frown or to the point of scene, the liquid is poor circulation. So try to encoufury children to look down or inform parents of this situation, to get with, or make children sleep better.

2.3 needle holder the right approach in clinical work, I observed the surrounding colleagues, their methods are different needle holder, and some before and after the thumb with the index finger puncture and hold the needle handle, and some two fingers up and down direct needle puncture and hold the handle, there's thumb, middle finger, index finger, pinch the needle handle into the skin before puncture needle handle puncture blood before and after the kneading. The disadvantage of these methods are: flexibility in the hands of the poor, poor grasp the depth and speed of the needle, causing the needle too fast or too deep too shallow, too fast puncture blood vessels, can not be too deep too shalmuch lessto the vascular smooth and after the transformation into the subcutaneous needle manner easy implementation of vision and the needle handle scattered searng, resulting in inaccusize tip led to puncture failure. According to the author's experience, or feel that with the thumb and middle finger around the handle and hold the needle, and then to the needle handle index cards above, the implementation of the advantages of needle technique: back of the hand facing up, and hand more flexible, do not deviate after the step into the skin at one go, easy to manner, and more stable needle holder, needle is not easy to shake,[link widoczny dla zalogowanych], easy to grasp the depth of the needle after the degree.

2.4 fixed needle puncture is successful if the fixed due to improper needle or fixed is not strong, the staff need to repeatedly interrupt infusion needle, not only increased the suffering of children, and time consuming work of the nurses, so the needle fixed is also very importante. Hands after successful puncture, the needle handle with the left index finger fixed on the scalp, the left thumb pad in the plastic tube near the needle shank below the needle can be adjusted into a proper angle with the skin, keeping the needle body and the blood vessels in parallel, to prevent the tip tilt. Right hand switch to open infusion was observed after infusion smooth, secure a good first piece of tape affixed to the crucial. The author's experience is: the first piece of tape pasted on the needle handle with the needle at the stem of the phase. This tape stuck a needle shank half, half stuck a needle stem, fixed to the skin is strong, not easy to change with the position of head shaking. Such as the needle handle vacant Xiadian in a dry cotton ball needle handle, with the second block with a sterilized cotton tape attached to the eye of a needle on. Tape with the third block of the scalp from the needle near the pin handle through the plastic tube to the following, the forward cross-fixation. The scalp needle bent into a thin tube up the natural use of the fourth after a small circular tape fixed block. Fifth block of tape to the end of the scalp needle thin tube fixed to the left or right ear, or fixed in no hair on the scalp. It's only the end of the puncture success. Sometimes the children crying irritability, fever, sweating and other children with fever of more Scotch tape is not tight, we generally use wide tape to contacte around the head circumference to suppress the original circle, so that is more firmly fixed. Also like to mention here that the tape is that the hair of the paste, so should be clear upd before the needle puncture site around the hair at about 3 cm in order to better fixed.

seen as a pediatric nurse, clinical care in peacetime, not only to have enhenceiasm, selfless love and a strong sense of responsibility, but also a good psychological quality, excellent care technology, skilled puncture techniques, and make families with children and good communication with children, the only way to greatly improve the scalp vein puncture success rate. In addition, in the work to continue to learn the lessons of failure, summing up successful experience, he learned excellent skills, improve their overall capacity and quality, greatly improve the quality of care, the establishment of jeopardizeonious relationships between doctors and patients make medical care for patients supply a good service system.