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输血器能不能用来输液?

2018-06-11 经典小药片 中国护理管理

输血器是为适应血液及其制品而设定的一款专用输注器材,不适合输液。

输血器是为适应血液及其制品而设定的一款专用输注器材,不适合输液。

案例一

患者高大爷,男性,79岁,诊断为慢性粒细胞性白血病合并冠心病心律失常。贫血貌,血红蛋白5.1g/L,入院后给予完善相关检查、输血治疗、硝酸甘油扩冠、丹红改善微循环及参芪扶正增加免疫力等治疗,详见医嘱单。入院第二天,责任护士小雪为患者输液时考虑患者要输血,为了省去更换输血器的麻烦,也为了给患者节省输液器的费用,于是,就用输血器为患者直接输上了液体。10点左右,护士长巡视病房时发现,用输血器静脉输注的丹红注射液。于是,告诉护士小雪中成药不能使用输血器输注。

案例二

网友提问(@优优):我在消化内科实习时,老师告诉我输血器不可以用来输液。但是我转到血液内科时,老师们在病人输完血之后就用输血器给病人换上液体,我问老师,老师说可以为患者节省住院费,这个理由我很不满意。不知道各位有没有知道为什么的,如果用输血器来输液的话,会不会有什么影响?比如说过滤掉大量的药液分子,影响药物的治疗作用?

网友回答:

@xinghailanghua520:没见过那儿有明文规定不可以输液啊,以

前我们医院都是直接接着输液的。

@最烦想名字:输血器都能输血细胞和血浆蛋白,这么大的分子都不会滤掉,输液应该不会出现滤掉大量的药液分子的吧?

@xiaojiaan:输血器没有那么精密的过滤膜,液体中的一些杂质,比如我们掰安瓶时产生的玻璃碎屑,输血器不能过滤掉,这些杂质输入人体很危险。

解  析

1、输液器的种类及过滤孔径

现在临床使用的输液器基本有三种:一种是普通PVC输液器,过滤孔径为15um;一种是含PVC的精密输液器,过滤孔径为3um、5um,甚至孔径更小;另一种为不含PVC塑化剂的TPE输液器,过滤孔径为15um,可以防止对乳剂类、油剂类如硝酸甘油、丁苯肽注射液及某些化疗药的吸附作用。

2、输血器的材质及过滤孔径

目前国产输液器管路及输血漏斗材质90%为聚氯乙烯PVC,过滤孔径为170 um~260um,孔径太小时,容易被血细胞中的血小板白细胞的微聚物阻塞,影响有效过滤面积。

3、浓缩红细胞特点

单个红细胞的直径6~9微米。但浓缩红细胞由于去除了大部分血浆及血小板、白细胞,红细胞浓度增大,往往好多红细胞粘合到一起,所以浓缩红细胞的粘度比全血大,流畅性仅是全血的60%。

4、各种药物输注时对输液器的要求

(1)中成药输注:由于中成药制剂在制备过程中,提纯工艺欠缺而存在杂质,或粉针剂溶解不充分,导致微粒数增加,故输注时应选用具有药物过滤装置的精密输液器,以过滤孔径为2.2~5μm,药物吸附性<28.6%为好。

(2)营养剂:美国2016INS过滤器条款中提到,使用0.2微米的过滤器过滤不含脂肪的肠外营养液,使用1.2微米过滤器过滤含脂肪的乳剂,且每隔24小时更换一次过滤器。

5、输液微粒污染与过滤器

2016美国INS过滤器条款中提到,不断更新的研究证据提示颗粒物(如橡胶、玻璃、乳胶)对毛细血管内皮细胞存在影响,液体中的微小气泡可能引起脑和肺缺血;而具有颗粒截留和消除空气功能的过滤器的使用可以预防来自空气/颗粒物的潜在损害(如右向左分流的心脏畸形)。

输液微粒是液体中存在的非代谢性颗粒杂,其直径多在1~15微米,少数可在50~300微米,较大的微粒能造成局部血管堵塞或供血不足、组织缺氧、促发静脉炎和水肿、肉芽肿,甚至促发肿瘤的形成。不溶性微粒还可以引起过敏反应和热原样反应。

6、PVC材质对药物的吸附作用

PVC 材质对一些醇溶性、脂溶性药物有较强的吸附性,使处方用药不准,影响治疗效果。这些药物主要有紫杉醇、硝酸甘油注射液、单硝酸异山梨酯注射液、尼莫地平、氯硝西泮、地西泮、氯丙嗪、尿激酶、胰岛素、脂肪乳、鸦胆子油、川芎嗪、乙胺碘呋酮、芬太尼、替硝唑、莪术油等。

总结

综上所述,鉴于输血器的PVC材质及较大的过滤网孔径,说明输血器是为适应血液及其制品而设定的一款专用输注器材,它不适合输液。

原始出处:

1、刘景兰.红细胞的输注及护理.河南医药信息.2001第9卷8期.

2、余强 李佳宁 郭亮. 输液器材质对输注药物吸附作用的研究进展. 中国护理管理 2016第16卷第6期.

3、乔爱珍.《安全输液百问百答》.科学普及出版社.

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    2018-06-13 windight
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    2018-06-12 changjiu

    学习一下谢谢

    0

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    2018-06-12 张新亮1853311252142e2fm

    好文献学习了

    0

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    2018-06-11 王秀

    学习了.涨知识了!

    0

  5. [GetPortalCommentsPageByObjectIdResponse(id=1259687, encodeId=9f43125968e09, content=<a href='/topic/show?id=569c9382389' target=_blank style='color:#2F92EE;'>#输血#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=68, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=93823, encryptionId=569c9382389, topicName=输血)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ec9955, createdName=windight, createdTime=Wed Jun 13 12:06:00 CST 2018, time=2018-06-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=323437, encodeId=9c2032343e68, content=学习一下谢谢, beContent=null, objectType=article, channel=null, level=null, likeNumber=107, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3zSn0GqHrsfLGSUSR8zwnWWLT4FMl5XH8S58HuZslVkLsAPbXDXaliagK7TOxQfmngKibG1yrDonepCLDkcxGk8hS/0, createdBy=b8282062892, createdName=changjiu, createdTime=Tue Jun 12 06:00:37 CST 2018, time=2018-06-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=323432, encodeId=e1e6323432ef, content=好文献学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=86, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b5a62240667, createdName=张新亮1853311252142e2fm, createdTime=Tue Jun 12 05:51:47 CST 2018, time=2018-06-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=323378, encodeId=ba323233e801, content=学习了.涨知识了!, beContent=null, objectType=article, channel=null, level=null, likeNumber=97, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/ajNVdqHZLLDM9swhbgTo7nzqRKzMmzckmEoeTyLQVDCgjqsicjyhxPs0vPoYU6GsSYbCjSkNHicJkz3NL0a0EbUMVdNjkctXI6FocpGKaVr9E/0, createdBy=29392048316, createdName=王秀, createdTime=Mon Jun 11 22:47:32 CST 2018, time=2018-06-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=323364, encodeId=1e46323364e6, content=^_^^_^^_^, beContent=null, objectType=article, channel=null, level=null, likeNumber=97, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/vi_32/Swp2ehfHpiciczeTntUyQOlIGMzQ705ic67sdMTVMbwTv7KbmlUvxrGvRSvQZjPkz7ib5tEDfIaORgczPtmHDpwojg/0, createdBy=c54b2163125, createdName=wqkm, createdTime=Mon Jun 11 21:36:24 CST 2018, time=2018-06-11, status=1, ipAttribution=)]
    2018-06-11 wqkm

    ^_^^_^^_^

    0

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