骨髓腔内注射装置操作完整讲解程序-PPT课件.ppt

1、Intraosseous Vascular Access骨髓腔内血管通路 12The System系 统 介 绍3EZ-IO Training Materials EZ-IO培训材料 PowerPoint Presentations PPT展示 With comprehensive notes located behind each slide 每张幻灯片后附有注释 EZ-IO StarCast Presentations EZ-IO 远程医疗展示 Quick Reference Card 快速参考卡 Insertion & Removal Poster插入和移除海报 Training Man

2、nequins用于培训的人体模型 Training Driver & Needle Sets 训练驱动器和套针 Complete Web Site完整的网页 Clinical Support Hotline临床支持热线4The EZ-IO Power Driver（ 骨髓腔内注射装置驱动器）Designed for 1000 human insertions 可使用1000人次 Sealed cap密封盖Lithium Batteries锂电池5Needle set packaging套针装置包装6EZ-IO PD 15 mm Needle Set 小儿型 15毫米针EZ-IO AD 25 m

3、m Needle Set 成人型25毫米针EZ-IO LD 45 mm Needle Set 加长45毫米套针Length and color are the only differences between these Needle Sets 不同型号的套针颜色不同5 mm mark5毫米毫米标标志志7Catheter & StyletThe EZ-IO Needle Set EZ-IO套针 Needle Set Safety Cap套套针针安全帽安全帽Catheter &Catheter Hub导导管及管及导导管外套管外套Stylet探探针针Stylet Hub探探针针外套外套Metal

4、Disc金属金属垫垫EZ-IO Needle Set (safety cap removed安全帽移除安全帽移除)EZ-IO Needle Set (“X-Ray View” with safety cap X片片视视野下的安全帽野下的安全帽)Specialized tip特殊特殊针针尖尖MRI禁止做磁共振禁止做磁共振检查检查8Sealed Sterile Cartridge密封无菌针筒Note: “lot code and expiration”moved to cartridge barrel 注意：代码和有效期Open Cartridge打开针筒Note: Needle Sets pos

5、ition Note: torn (and lifted) safety seal注意：撕开安全封条Open Cartridge打开针筒Note: torn (and lifted) safety seal注意：揭下安全封条Open Cartridge打开针筒Note: exposed “single use only” sticker注意：查看“一次性使用”标志Stylet in “Shuttle”保留探针在筒内Note: REMOVED safety seal撕下安全封条Stylet in “Shuttle”盖上针筒Note: REMOVED safety seal9Length and

6、color are the only differences between EZ-IO Needle Sets不同型号的套装颜色不同5 mm mark5毫米毫米标标志志15 mm PD25 mm AD45 mm LDEZ-IO LD Needle Set Tray with Sharps Protectors锐器保护装置的针盒10Put them where they belong!废物处理Stylets belong in approved sharps containers探针放入特定的锐器盒 内EZ-IO LD Sharps protector锐器保护装置EZ-IO PD & AD S

7、huttles套针盒11Consider these points BEFORE EVERY EZ-IO insertion:操作前注意事操作前注意事项项： ：1.Did you “hear” a pop when the cartridge was opened? 打开时是否有砰砰声？2 Did the Driver easily attach to the Needle Set (With the Needle Set remaining in the cartridge) 是否有套针不能从针筒中取出的情况？3 Did you REMOVE the Needle Set Safety Ca

8、p from the Needle Set? 能否打开套针安全帽？4Did you CONFIRM the 5 mm mark? 能否有5毫米标志？Important EZ-IO usage considerations使用EZ-IO的主要注意事项Note that a “lone Stylet” sits deeper than a complete Needle Set探针要比整个套针在针筒内的位置更深Needle Set 12Precise cylindrical hole created by EZ-IO insertion由EZ-IO制作的精确的圆柱孔13 The EZ-IO Inf

9、usion Solution EZ-IO输液装置EZ-IO AD & PD Needle SetsTraining Needle Sets练习练习套套针针EZ-IO Storage Cases & Cradle EZ-IO箱和支架箱和支架 EZ-IO Driver驱动驱动器器EZ-Connect连连接接Training Driver训练驱动训练驱动器器Wristband腕腕带带14General IO Anatomy常规骨髓通路解剖15Anatomy of intraosseous access 骨髓通路解剖Thousands of small veins lead from the medu

10、llary space to the central circulation数以千计的小静脉将骨髓腔与中心静脉相连通1617Intraosseous usage and pain骨髓通路的使用和疼痛18Adult IO Anatomy成人骨髓通路解剖19Proximal Tibial Anatomy近端胫骨解剖20Patella膝盖骨 Adult Right Leg成人右腿 Tuberosity结节Insertion Site插入位点EZ-IO Inserted EZ-IO插入Stylet Removed导管管芯去除Note catheter locationidentifying struc

11、turesand tissue thickness注意导管 ：位置、 识别结构和组织厚度Adult female cadaver right proximal tibia成年女性尸体右胫骨近端21Note the distance from the proximal aspect of the tibia to the middle ofthe tuberosity注意：丛胫骨近端到结节中心的距离Note the average skin thickness atthe insertion site注意：插入点处平均皮肤厚度Adult female cadaver right proximal

12、 tibia22Distal Tibial Anatomy 远端胫骨解剖23 The ankle joint is comprised of the Tibia, Talus and Fibula踝关节由胫骨，距骨和腓骨组成24A closer look at the anatomy近距离观看解剖结构Posterior后面Anterior前面25PosteriorAnteriorDistal Tibia远远端端胫胫骨骨Calcaneous跟骨Talus距骨距骨Adult female cadaver left distal tibia26PosteriorAnteriorDistal Tibi

13、a远远端端胫胫骨骨Adult female cadaver left distal tibia27PosteriorAnteriorDistal Tibia远远端端胫胫骨骨Adult female cadaver left distal tibia28PosteriorAnteriorDistal Tibia远端胫骨Saphenous vein隐静脉Tendons肌腱Medial Malleolus内踝Adult female cadaver left distal tibia29Proximal Humeral Anatomy近端肱骨结构30Insertion site插入点Insertio

14、n site插入点3132Proximal Humerus Site 近端肱骨点Adult male cadaver right proximal humerus33Proximal Humerus Site 近端肱骨点Adult male cadaver right proximal humerus34The greater tubercle insertion site较大的插入点结节较大的插入点结节Note index finger in the intertubercular groove注意：食指所指位置注意：食指所指位置为结节间为结节间沟沟 穿刺针不应该进入或接近结节间沟Proxi

15、mal Humerus Site近端肱骨点Adult male cadaver right proximal humerus35Note that arm is adducted withthe elbow posteriorly placed! 注意：上臂随肘部内收The Proximal Humerus insertion site is found “slightly anterior to the arms lateral midline”发现肱骨近端插入点位于“上臂侧面的中线稍靠前一点”Right arm Adult male成年男性右上肢36The Proximal Humerus

16、 insertion siteNote that arm is adducted withthe elbow posteriorly placed! 注意：上臂随肘部内收Note that the insertion site is found anterior to the arms lateral midline! 注意：插入点位于上臂外侧中线之前Left arm Mannequin人体模型左上臂Anterior前面Posterior后面37Proximal Humerus肱骨近端Proximal Tibia胫骨近端Distal Tibia胫骨远端Fractures骨折B. Multipl

17、e options?Multiple options多处选择Distal Tibia胫骨远端Proximal Tibia胫骨近端Multiple concerns?多处关注？Proximal Humerus肱骨近端This slide illustratesimmediate real world solutionsto complex patient encounters 38Pediatric Anatomy小儿解剖39Pediatric Anatomical Overview40Clearly visibletibial growth plateTibiaInsertion siteTh

18、e pediatric growth plateGrowth PlateLeft LegRight Leg41SkinSubcutaneous Fat Intraosseous CatheterTibiaFibulaPost. CompartmentAnt. CompartmentLat. CompartmentAnatomyFemale neonate cadaver Left proximal tibia42Eleven year old proximal tibia insertion site cross sectionInsertion siteTibiaFibulaLeft leg

19、4311 mmMusclesSkinAdiposeCompact boneCancellous bone17.9 kg Male, Left ArmProximal HumerusSelect Needle Set based on size and weight443.1 kg female, Left Leg / 1.5 cm proximal to the patella proximal viewVentralDorsal Site not FDA clearedDistal Femur45AnteriorPosteriorMedialLateralSkinAdiposeMuscleC

20、ompact boneCancellous bone3.1 kg female, Left Leg / 1.5 cm proximal to the patella proximal viewPrimary muscle groups involvedwith distal femur intraosseousinsertion include the: Rectus FemorisVastus IntermediusVastus LateralisDistal Femur Site not FDA cleared46Distal FemurProximal TibiaDistal Tibia

21、Infant IO site comparative 3.1 Kg female, left legSite not FDA clearedNote: Compact bone density, overall size of target bone, adjacent muscle structures and the catheter to bone relationship47Distal FemurProximal TibiaDistal TibiaToddler IO site comparative 17.9 kg MaleNote: Compact bone density, o

22、verall size of target bone, adjacent muscle structures and the catheter to bone relationshipSite not FDA clearedProximal Humerus48Proximal HumerusProximal HumerusProximal TibiaProximal TibiaDistal TibiaDistal TibiaDistal FemurDistal FemurIntraosseous access sites for the pediatric patientNot FDA cle

23、aredNot FDA clearedExperience & anatomy suggest thatthis site is most suitable for patients5 years of age and older Experience & anatomy suggest thatthis site is suitable most for patients5 years of age and older 49Indications for EZ-IO Access EZ-IO 使用适应症1. Altered level of consciousness意意识识改改变变2. R

24、espiratory compromise呼吸窘迫呼吸窘迫3. Hemodynamic instability血流血流动动力学不力学不稳稳定定To gain intraosseous access in emergencies502022-4-451Preparing the EZ-IO for use使用EZ-IO准备52Contraindications for EZ-IO Access EZ-IO使用的禁忌症 Fracture (targeted bone) 骨折（目标骨骨折） Previous orthopedic procedures near insertion site（Pros

25、thetic Limb or joint） 穿刺点附近做过整形术（假肢或人工关节） IO within past 24 hours (targeted bone) 在过去24小时内做过骨髓通路术（目标骨） Infection at the insertion site 穿刺部位有感染 Inability to locate landmarks or excessive tissue 操作者不能定位或由于组织过多无法定位53Observe Body Substance Isolation Precautions54Retrieve EZ-IO driver and cartridge. Open

26、 cartridge & attach driver to needle set取出驱动器和针筒，打开针筒并将驱动器与套针相接55Adult Site Selection成人穿刺点的选择56Confirm and clean insertion site确定并清洁穿刺点57Identify the insertion site确定穿刺点58Confirm and clean insertion site确定并清洁穿刺点59Identify the Proximal Humerus insertion site确定肱骨近端穿刺点Elbow should remain adductedand po

27、steriorly located肘部内收并位于后方肘部内收并位于后方orient the arm to this position 保持上肢这种姿势 Place the hand over the umbilicusfor humeral positioning and safety手高于手高于脐脐利于定位肱骨和安全利于定位肱骨和安全60Preferred insertion site identification method首选的穿刺点确定程序 Place the patient in a supine position with the arm correctly oriented置患

28、者仰卧位， 并调整上肢为正确姿势61Confirm and clean insertion site确定并清洁穿刺点62Pediatric Site Selection63If the patient “fits” on the Broselow Tape THINK PINK* and consider the EZ-IO PD=*Obese or large pediatric patients may require the EZ-IO AD needle Set Femur not FDA cleared64The Tibial Tuberosity can be difficult

29、or impossible to palpate on younger patientsIf the Tibial TuberosityCANNOT be palpatedthe insertion site istwo finger widthsbelow the Patella(and then) medial along the flataspect of the TibiaIdentifying the pediatric EZ-IO insertion site65As patients mature the Tibial Tuberosity becomes easier to i

30、dentifyIf the Tibial TuberosityCAN be palpatedthe insertion site isone finger widthbelow the Tuberosity(and then) medial along the flataspect of the TibiaIdentifying the pediatric EZ-IO insertion site66Confirm and clean insertion site67Confirm and clean insertion site68Confirm and clean insertion si

31、te69Insertion & Infusion穿刺 及 输液70Remove needle set safety cap取下套针安全帽ROTATE SAFETY CAP CLOCKWISE TO REMOVE顺时针旋转取下安全冒71Stabilize Extremity 固定手足Guard against unexpected patient movement 防止患者活动72Insert AD needle set into appropriate siteDont force the needle set into position - “allow the driver to do t

32、he work”Position the EZ-IO Driver at a 90 degree angle to the bone Remember“EZ does it”40 kg and greater usageLightly holding the EZ-IO driver will improve usage73Insert PD needle set into appropriate siteSelect the correct needle set based on patient size, weight & 5 mm mark Position the EZ-IO Driv

33、er at a 90 degree angle to the bone 3 - 39 kg usageLightly holding the EZ-IO driver will improve usageNot FDA cleared74Insert EZ-IO Needle Set - at a 90 degree angle to the bone THEN check the 5 mm mark垂直穿刺然后查看5毫米标记Check the 5 mm mark !检查5毫米标记7525 mmNeedle Set25毫米长的套针5 mm mark5毫米标记处needle set pendin

34、g FDA clearanceNote that the 5 mm mark is NOT visible above the skin5毫米标记线未在皮肤之上，不能看见Adipose or muscle tissue thickness should be considered prior to EZ-IO insertion穿刺之前，应该被考虑到脂肪或肌肉组织的厚度45 mmNeedle Set45毫米长套针5 mm mark5毫米标记处Needle Set has not been FDA cleared 不合格套针76Complete Insertion完成穿刺In the unlik

35、ely event of a driver failure consider manual insertion驱动器穿刺失败考虑手工完成是不太可能的事情77 Important needle set insertion tip重要的套针穿刺提示 User induced recoil may lead to needle set dislodgement or extravasation操作者不能控制反冲力可能导致套针移位或脱出 STOP WHEN YOU FEEL THE POP当有“砰砰”的感觉时停止穿刺反冲力反冲力!保持平衡保持平衡Allow driver to do the work!

36、DO NOT EXCESSIVE FORCEGently GUIDE needle set into position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 - 39 kg usage40 kg and greater usage78Remove Driver from needle set把驱动器丛套针上取下Stabilize Needle Set while disconnecting Driver分离驱动器时固定牢固套针79Remove stylet from catheter 从套管内取下探针Never attempt to repla

37、ce the stylet once removed from the catheter80Confirm catheter placement确定导管位置Confirm placement by noting通过以下提示确定位置Blood at the stylet tip探针针尖有血Firmly seated catheter导管固定牢固Blood in the catheter hub导管外套处有血Aspiration of blood有血溢出Fluids flow without difficulty液体流入顺利Pharmacologic effects 药物发挥作用Monitor t

38、he insertion site and distal extremity for signs of extravasation观观察穿刺点及察穿刺点及远远端肢体，防止外渗端肢体，防止外渗81Put them where they belong!Stylets belong in approved sharps containers探针放于特定的锐气盒内 NEWEZ-IO LD Sharps protector新式锐器保护装置EZ-IO PD & AD Shuttles82Consider placing stabilizer on catheter安装导管固定装置Centrally loc

39、ate Catheter to the eye of the Stabilizer固定导管于固定装置中心的孔内 212183Remove stabilizers adhesive backing撕掉固定装置的粘合底布Secured adhesive prevents lateral movement粘合剂可有效避免套针横向移动Grasp stabilizer and gently pull tabs固定好固定装置并轻拉底布84Lidocaine considerations and administration 利多卡因的应用及注意事项2 % (preservative free) Lidoc

40、aine - given intraosseously (IO) - has been shown to offer effective local anesthesia in most alert patients 2 %利多卡因局麻用于较敏感患者 IO infiltration for alert patients: Consider priming the EZ-Connect with 2% Lidocaine Adult dosage 20 40 mg IO成人剂量20 40 mg Pediatric dosage 0.5 mg/kg IO小儿剂量0.5 mg/kg Infuse L

41、idocaine slowly (over 30 seconds)缓慢推注大于30秒Allow 1 minute for anesthetic effect一分钟后见效Repeat as needed to reach therapeutic level 有必要时可重复使用 DO NOT exceed 3 mg/kg不能超过3 mg/kgSome patients may require repeated administration to achieve desired effect*See notes attached to slide for bibliography and detai

42、led explanation85No Flush = No FlowSyringe FLUSH catheterSyringe FLUSH catheter with 10 ml of a sterile solutionAlert patients may require2% preservative free LidocaineIntraosseously PRIOR to flushSome patients may require multiple syringe flushes86Avoid rocking the EZ-IO catheter during usageUse th

43、e EZ-Connect supplied with the needle set87Begin infusion with pressureA pressure bag, infusion pump or syringe will improve the flow rates3 - 39 kg usageRegulate fluid deliveryfor ALL pediatric patients40 kg and greater usage88Removal89# 1. Remove EZ-Connect# 2. Lift Adhesive Dressing EZ-Stabilizer

44、 removal 90EZ-IO RemovalMaintain a 90 degree angleMaintain 90 degree angle91EZ-IO RemovalMaintain a 90 degree angleContinuously rotate syringe clockwiseContinuously rotatethe syringe clockwise92EZ-IO RemovalMaintain a 90 degree angleContinuously rotatethe syringe clockwiseGently backcatheter outGent

45、le back catheter out of patient93Once catheter has been removed dress site and monitor patient 94Possible ComplicationsIf breakage occurs Grasp the exposed catheter with a hemostat rotate and pullRocking, Bending or inadvertently Strikingthe catheter may cause it to break24 hour emergency support 1.

46、800.680.491195Possible ComplicationsIf breakage occurs Grasp the exposed catheter with hemostats rotate and pullRocking, Bending or inadvertently Strikingthe catheter may cause it to break24 hour emergency support 1.800.680.491196Quick Reference Card & Unit Poster快速参考卡片和装置视图9798Around the world - 24 hours a day - 7 days a week 无处不在，五十不在 99Questions?有提问吗？ 1002022-4-4101