化疗药物使用流程

化疗药物使用流程 1、化疗前了解患者的基础资料,如体温、脉搏、呼吸、血压、心电图、白细胞、血红蛋白、血小板、骨髓像,肝功能、肾功能等。有心脏疾患或老年患者要进行心电监护。 2、指导患者保持安静,精神愉快。 3、选择合适的血管进行静脉穿刺,一般从肢体远端开始,两臂静脉轮换注射,不宜选择最细的血管,避开肘窝、手腕,以免患者活动后引起药液外渗。 4、静脉穿刺成功后先滴注生理盐水50~100ml,确保滴注安全无渗漏再使用化疗药。胃肠道反应明显的要用减轻胃肠反应的药。 5、加强巡视,注意穿刺部位和血管的反应情况及观察药物的不良反应,发现问题及时处理。 6、化疗药注射完毕,继续用生理盐水100~250ml,以冲洗停留在静脉血管壁上的药物,并嘱患者抬高被注射的肢体有简于药物随静脉回流,从而防止静脉炎。 化疗药物使用流程 了解患者的基础资料 做好心理护理 根据药物和患者情况准备化疗用物 选合适血管进行穿刺，并滴注生理盐水确保穿刺成功 先推注或滴注抗呕吐药，再滴注化疗药 beam and reinforced concrete floor. , Hanger location should be correct, install neat and firm, tubes and scaffolds should be in very close touch. Pipe and bracket weld shall not eat, burn-through and other phenomena. (2) No heat displacement of the pipe, the suspenders should be installed vertically, boom length can be adjusted; thermal displacement pipe, hangers should be ? of thermal displacement offset value in the opposite direction tilt installation. Two hot pipe of varying displacement or displacement in the opposite direction, unless specified design shall use the same hanger. (3), davit specifications should comply with the design requirements. (4) large diameter pipe valve, there should be support shall not be piping weight. (5) fixed to the structure of pipe support, crane and carrier shall not affect safety. (6) steel pipe support spacing for horizontal installation according to the design requirements and the national construction code. (7) the riser pipe, when the height is less than or equal to 5M, installed on each floor, 1 for height is greater than 5M, each floor shall be not less than 2, it tube cards apart from the ground level to more than 1.5~1.8M,2 pipe clamp can be installed symmetry. 7. installation of indoor drainage pipe (1) pipe and pipe fittings should comply with the design requirements and the provisions of the code. (2) pipe through the basement wall 严密观察注射部位，血管情况及药物的不良反应 细胞毒性药物使用安全流程 两人核对 了解病情、化疗方案 确诊有效医嘱 知情同意书 确认患者 评估患者静脉状况 评估解释 解释、指导 做好个人防护 准备药物、用物 三查七对 配伍禁忌 正确配药 注意药物特性(避光、现配现用等 ) 三查七对 合理选择静脉 正确穿刺 0.9%生理盐水引导穿刺 调节输液速度 加强巡视、倾听主诉 安全输入 局部无渗出及外惨 合理、正确排序 局部观察 相应措施 异常 观察 全身观察 beam and reinforced concrete floor. , Hanger location should be correct, install neat and firm, tubes and scaffolds should be in very close touch. Pipe and bracket weld shall not eat, burn-through and other phenomena. (2) No heat displacement of the pipe, the suspenders should be installed vertically, boom length can be adjusted; thermal displacement pipe, hangers should be ? of thermal displacement offset value in the opposite direction tilt installation. Two hot pipe of varying displacement or displacement in the opposite direction, unless specified design shall use the same hanger. (3), davit specifications should comply with the design requirements. (4) large diameter pipe valve, there should be support shall not be piping weight. (5) fixed to the structure of pipe support, crane and carrier shall not affect safety. (6) steel pipe support spacing for horizontal installation according to the design requirements and the national construction code. (7) the riser pipe, when the height is less than or equal to 5M, installed on each floor, 1 for height is greater than 5M, each floor shall be not less than 2, it tube cards apart from the ground level to more than 1.5~1.8M,2 pipe clamp can be installed symmetry. 7. installation of indoor drainage pipe (1) pipe and pipe fittings should comply with the design requirements and the provisions of the code. (2) pipe through the basement wall 0.9%生理盐水冲洗后拔针 按压进针处5分钟 输液完毕 输错液、液体浑浊的应急程序 1、立即停止药液输入,然后更换液体及输液管。 2、及时通知主管医生和护士长。 3、严密监测患者血压、脉搏、呼吸、体温及神志的变化,有无变态反应,准备好抢救 车、抢救用品,积极配合抢救。 4、加药前及时了解药物的配伍禁忌。 5、向主管医生了解新药的作用和副作用。 6、保留浑浊药液、空针,停加其他药液,以备送检。 7、严格交接班,每班留有标记。 发生输错液、液体浑浊 立即停止药液输入，然后更换液体及输液管 及时通知主管医生和护士长 严密监测患者血压、脉搏、呼吸、体温及神志的变化，有无过敏反应，准 备好抢救车、抢救用品，积极配合抢救 beam and reinforced concrete floor. , Hanger location should be correct, install neat and firm, tubes and scaffolds should be i加药前及时了解药物的配伍禁忌n very close touch. Pipe and bracket weld shall not eat, burn-through and other phenomena. (2) No heat displacement of the pipe , the suspenders should be installed vertically, boom length can be adjusted; thermal displacement pipe, hangers should be ? of thermal displacement offset value in the opposite direction tilt installation. Two hot pipe of varying displacement or displacement in the opposite direction, unless specified design shall use the same hanger. (3), davit specifications should comply with the design requirements. (4) large diameter pipe valve, there should be support shall not be piping weight. (5) fixed to the structure of pipe support, crane and carrier shall not affect safety. (6) steel pipe support spacing for horizontal installation according to the design requirements and the national construction code. (7) the riser pipe, when the height is less than or equal to 5M, installed on each floor, 1 for height is greater than 5M, each floor shall be not less than 2, it tube cards apart from the ground level to more than 1.5~1.8M,2 pipe clamp can be installed symmetry. 7. installation of indoor drainage pipe (1) pipe and pipe fittings should comply with the design requirements and the provisions of the code. (2) pipe through the basement wall 向主管医生了解新药的作用和副作用 青霉素使用安全流程 确认有效医嘱 询问用药史、过敏史、家族史 正确使用皮试液 注射部位、方法、剂量准确 青霉素过敏试验 皮试后20分钟看结果，超时重做 皮试液保存正确 标明PG(-) 阴性:皮丘无改变，周 围不红肿，无自觉症状 报告医生开医嘱 建立整套PG(+) 阳性:局部隆起，周围 红晕直径>1cm可有伪告知医生、患者及家属 判断处理 足或痒感 电脑输入PG(+) 可疑阳性:皮丘不大，生理盐水对照试验明 红晕直径<1cm 确结果 三查七对(每次注射PG前要告知患者) 现配现用(静脉用药应悬挂红色PG标识) 执行医嘱 无菌操作 用药过程中有无局部或全身不适 密切观察 用药后观察30分钟 beam and reinforced concrete floor. , Hanger location should be correct, install neat and firm, tubes and scaffolds should be in very close touch. Pipe and bracket weld shall not eat, burn-through and other phenomena. (2) No heat displacement of the pipe, the suspenders should be installed vertically, boom length can be adjusted; thermal displacement pipe, hangers should be ? of thermal displacement offset value in the opposite direction tilt installation. Two hot pipe of varying displacement or displacement in the opposite direction, unless specified design shall use the same hanger. (3), davit specifications should comply with the design requirements. (4) large diameter pipe valve, there should be support shall not be piping weight. (5) fixed to the structure of pipe support, crane and carrier shall not affect safety. (6) steel pipe support spacing for horizontal installation according to the design requirements and the national construction code. (7) the riser pipe, when the height is less than or equal to 5M, installed on each floor, 1 for height is greater than 5M, each floor shall be not less than 2, it tube cards apart from the ground level to more than 1.5~1.8M,2 pipe clamp can be installed symmetry. 7. installation of indoor drainage pipe (1) pipe and pipe fittings should comply with the design requirements and the provisions of the code. (2) pipe through the basement wall 立即停药，通知医师 一般过 按医嘱用药，观察病情 敏反应 对症处理，做好安慰、解释 预防青霉素差错管理流程 管理层 执行层 制定预防青霉素差错 明确方法与流程 具体措施和使用规范 严格查对和执行规范 出现过敏反应 定期检查 立即停药，就地抢救 逐级报告，做好解释 了解情况指导处理 迅速报告医生 做好解释工作 平卧，应用肾上腺素 有无纠纷苗头 遵医嘱用药 有 无 启动医疗纠纷处理预案 密切观察病情变化 跟踪病情 详细记录 beam and reinforced concrete floor. , Hanger location should be correct, install neat and firm, tubes and scaffolds should be in very close touch. Pipe and bracket weld shall not eat, burn-through and other phenomena. (2) No heat displacement of the pipe, the suspenders should be installed vertically, boom length can be adjusted; thermal displacement pipe, hangers should be ? of thermal displacement offset value in the opposite direction tilt installation. Two hot pipe of varying displacement or displacement in the opposite direction, unless specified design shall use the same hanger. (3), davit specifications should comply with the design requirements. (4) large diameter pipe valve, there should be support shall not be piping weight. (5) fixed to the structure of pipe support, crane and carrier shall not affect safety. (6) steel pipe support spacing for horizontal installation according to the design requirements and the national construction code. (7) the riser pipe, when the height is less than or equal to 5M, installed on each floor, 1 for height is greater than 5M, each floor shall be not less than 2, it tube cards apart from the ground level to more than 1.5~1.8M,2 pipe clamp can be installed symmetry. 7. installation of indoor drainage pipe (1) pipe and pipe fittings should comply with the design requirements and the provisions of the code. (2) pipe through the basement wall 分析原因 科室填写差错上报表 制定改进措施 执行 预防静脉输液差错管理流程 管理层 执行层 制定预防输液差错的具体措施明确方法与流程 和使用规范 严格查对和执行规范 下发科室并组织学习，征求意见 出现差错:如有异物、杂质、错定期检查 用患者 了解情况指导处理 立即更换药物和输液器 做好解释工作 做好患者解释 逐级报告，通知医生 关注事件动态 密切观察，执行医嘱 有无纠纷苗头 做好护理记录 有 启动医疗纠纷处理预案 无 跟踪病情 分析原因 beam and reinforced concrete floor. , Hanger location should be correct, install neat and firm, tubes and scaffolds should be in very close touch. Pipe and bracket weld shall not eat, burn-through and other phenomena. (2) No heat displacement of the pipe, the suspenders should be installed vertically, boom length can be adjusted; thermal displacement pipe, hangers should be ? of thermal displacement offset value in the opposite direction tilt installation. Two hot pipe of varying displacement or displacement in the opposite direction, unless specified design shall use the same hanger. (3), davit specifications should comply with the design requirements. (4) large diameter pipe valve, there should be support shall not be piping weight. (5) fixed to the structure of pipe support, crane and carrier shall not affect safety. (6) steel pipe support spacing for horizontal installation according to the design requirements and the national construction code. (7) the riser pipe, when the height is less than or equal to 5M, installed on each floor, 1 for height is greater than 5M, each floor shall be not less than 2, it tube cards apart from the ground level to more than 1.5~1.8M,2 pipe clamp can be installed symmetry. 7. installation of indoor drainage pipe (1) pipe and pipe fittings should comply with the design requirements and the provisions of the code. (2) pipe through the basement wall 科室填写差错上报表 制定改进措施 执行 预防服药差错管理流程 管理层 执行层 制定预防服药差错具体措施和明确方法与流程 使用规范 下发科室并组织学习，征求意见 出现差错:错用患者、剂量或用 法错误 定期检查 立即停药 报告并向患者解释 了解情况指导处理 通知医生 做好患者解释 执行医嘱 有无纠纷苗头 密切观察做好护理记录 有 启动医疗纠纷处理预案 无 跟踪病情 beam and reinforced concrete floor. , Hanger location should be correct, install neat and firm, tubes and scaffolds should be in very close touch. Pipe and bracket weld shall not eat, burn-through and other phenomena. (2) No heat displacement of the pipe, the suspenders should be installed vertically, boom length can be adjusted; thermal displacement pipe, hangers should be ? of thermal displacement offset value in the opposite direction tilt installation. Two hot pipe of varying displacement or displacement in the opposite direction, unless specified design shall use the same hanger. (3), davit specifications should comply with the design requirements. (4) large diameter pipe valve, there should be support shall not be piping weight. (5) fixed to the structure of pipe support, crane and carrier shall not affect safety. (6) steel pipe support spacing for horizontal installation according to the design requirements and the national construction code. (7) the riser pipe, when the height is less than or equal to 5M, installed on each floor, 1 for height is greater than 5M, each floor shall be not less than 2, it tube cards apart from the ground level to more than 1.5~1.8M,2 pipe clamp can be installed symmetry. 7. installation of indoor drainage pipe (1) pipe and pipe fittings should comply with the design requirements and the provisions of the code. (2) pipe through the basement wall 分析原因 科室填写给药差错登记表 加强输液管理，减少输液反应的措施 管理层 执行层 制定预防及处理输液反应规范 明确方法与流程 发生输液反应 监控检查 停止输液，解释 观察病情逐级上报 纠纷苗头 有 无 启动纠纷处理预案 残液送检做细菌培养 跟踪病情及化验结果 严密观察 分析原因反馈信息 执行 制定改进措施 beam and reinforced concrete floor. , Hanger location should be correct, install neat and firm, tubes and scaffolds should be in very close touch. Pipe and bracket weld shall not eat, burn-through and other phenomena. (2) No heat displacement of the pipe, the suspenders should be installed vertically, boom length can be adjusted; thermal displacement pipe, hangers should be ? of thermal displacement offset value in the opposite direction tilt installation. Two hot pipe of varying displacement or displacement in the opposite direction, unless specified design shall use the same hanger. (3), davit specifications should comply with the design requirements. (4) large diameter pipe valve, there should be support shall not be piping weight. (5) fixed to the structure of pipe support, crane and carrier shall not affect safety. (6) steel pipe support spacing for horizontal installation according to the design requirements and the national construction code. (7) the riser pipe, when the height is less than or equal to 5M, installed on each floor, 1 for height is greater than 5M, each floor shall be not less than 2, it tube cards apart from the ground level to more than 1.5~1.8M,2 pipe clamp can be installed symmetry. 7. installation of indoor drainage pipe (1) pipe and pipe fittings should comply with the design requirements and the provisions of the code. (2) pipe through the basement wall 持续改进 未达目标 已达目标 输血过程流程 1、2人核对患者病历、输血申请单并核对患者,无误后进行抽血并在输血申请单和临时医嘱单上签名。 2、由专人送输血申请单和血样到输血科,然后凭取血单在输血科领取需输注的成分血。 3、成分血领回病房后经2人核对输血单和血袋上血型、血号、剂量一致,血袋完整无破损,成分血无过期,确保安全后准备输注。 4、选择较粗、较直的血管用生理盐水开辟静脉通路,选用较大针头的输血器,穿刺成功后先根据医嘱静脉注射地塞米松预防输血反应的发生。 5、2人核对患者、输血单、成分血,确保准确、安全后缓慢给患者输入,密切观察不良反应。 6、20分钟后患者无寒战、皮肤瘙痒等不良反应发生,可根据患者实际情况适当加快输注速度。血小板则要快速输入,一般在30分钟内输完。 7、一袋成分血输注结束后继续滴注生理盐水冲管,直至输血管内成分血全部输入再输beam and reinforced concrete floor. , Hanger location should be correct, install neat and firm, tubes and scaffolds should be in very close touch. Pipe and bracket weld shall not eat, burn-through and other phenomena. (2) No heat displacement of the pipe, the suspenders should be installed vertically, boom length can be adjusted; thermal displacement pipe, hangers should be ? of thermal displacement offset value in the opposite direction tilt installation. Two hot pipe of varying displacement or displacement in the opposite direction, unless specified design shall use the same hanger. (3), davit specifications should comply with the design requirements. (4) large diameter pipe valve, there should be support shall not be piping weight. (5) fixed to the structure of pipe support, crane and carrier shall not affect safety. (6) steel pipe support spacing for horizontal installation according to the design requirements and the national construction code. (7) the riser pipe, when the height is less than or equal to 5M, installed on each floor, 1 for height is greater than 5M, each floor shall be not less than 2, it tube cards apart from the ground level to more than 1.5~1.8M,2 pipe clamp can be installed symmetry. 7. installation of indoor drainage pipe (1) pipe and pipe fittings should comply with the design requirements and the provisions of the code. (2) pipe through the basement wall 注另外一袋。 8、输血结束后输血袋在低温下保存24小时,观察患者输血后反应。 输血过程流程 2人核对病历、输血单、患者后合血并签名 专人送血样和输血申请单 2人核对输血单和成分血，确保准确无误 选合适血管用生理盐水建立静脉通路 注射地塞米松预防输血反应 2人核对患者、输血单和成分血血型等，确保一致后缓慢输入 无不良反应后可适当加快输入速度，严密观察输血反应 输入结束后用生理盐水冲管，输血袋低温保留24小时 beam and reinforced concrete floor. , Hanger location should be correct, install neat and firm, tubes and scaffolds should be in very close touch. Pipe and bracket weld shall not eat, burn-through and other phenomena. (2) No heat displacement of the pipe, the suspenders should be installed vertically, boom length can be adjusted; thermal displacement pipe, hangers should be ? of thermal displacement offset value in the opposite direction tilt installation. Two hot pipe of varying displacement or displacement in the opposite direction, unless specified design shall use the same hanger. (3), davit specifications should comply with the design requirements. (4) large diameter pipe valve, there should be support shall not be piping weight. (5) fixed to the structure of pipe support, crane and carrier shall not affect safety. (6) steel pipe support spacing for horizontal installation according to the design requirements and the national construction code. (7) the riser pipe, when the height is less than or equal to 5M, installed on each floor, 1 for height is greater than 5M, each floor shall be not less than 2, it tube cards apart from the ground level to more than 1.5~1.8M,2 pipe clamp can be installed symmetry. 7. installation of indoor drainage pipe (1) pipe and pipe fittings should comply with the design requirements and the provisions of the code. (2) pipe through the basement wall