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TROUVAILLES ET ASTUCES
I. INJECTIONS / PONCTIONS
1.1 Comment reboucher une aiguille de seringue sans s'inoculer l'hépatite? Cela semble évident, mais quant on voit certaines personnes replacer un capuchon, cela fait frémir. Deux possibilités: - jeter immédiatement l'aiguille sans la reboucher dans un récipient prévu à cet effet - à défaut, reboucher l'aiguille en l'approchant du capuchon à 45 degrés, plutôt que parallèlement, jusqu'à ce que l'extrémité de l'aiguille soit à l'intérieur du capuchon. Il est ainsi virtuellement impossible de se piquer, puisque l'aiguille n'est pas dirigée vers l'autre main mais devant soi. 1.2 Prise de sang indolore - Painless Blood-taking Rest the needle on the skin for about twenty seconds before inserting the needle through the skin. Separating the touch sensation from the pain sensation results in far less pain. People have told me they cannot feel their blood being taken using this technique. Also, do not press the cotton wool on until the needle is out of the skin. Colin Read, United Kingdom 1.3 Comment faire mieux apparaître les veines? - Difficult Vein Access Simplified 1.3.1 To gain access to difficult veins, place a BP cuff on the arm and pump the cuff up until you just lose the radial pulse. Slowly deflate the cuff until you just obtain the pulse again. Wait approximately 2 to 3 minutes and you will see any accessible vein pop up before your eyes. You are allowing blood flow into the vascular system (pulse), but obstructing venous outflow with the cuff pumped up. Medscape 1.3.2 If you are experiencing difficulty locating a vein during an intravenous procedure, apply a blood pressure cuff instead of a tourniquet to the patient's arm. Inflate the cuff 100 to 110 mm Hg and drop the arm below the level of the stretcher to induce greater vein dilation. Bill Weiss, PA-C, Las Vegas, Nev 1.4 Technique d'injection indolore - Painless Injection Technique 1.4.1 Warm the syringe contents to body temperature by holding the syringe in your hand until warm, while preparing to inject. Use the minimum gauge needle size necessary. Ensure any alcohol skin swab solution has dried prior to injecting. Gently stretch the skin to be injected, and flick the needle quickly through the stretched skin using a dart-throwing motion, to minimise the time cutaneous nerves are contacted by your needle. Inject slowly to allow the injected solution to disperse into the tissues with little stretching. Withdraw the needle quickly and briefly rub the skin surface briskly without pressing. Malcolm Dobbin, PhD, MB, BS, MPH, Dip RACOG, FAFPHM Melbourne, Australia
1.4.2 When preparing for a biopsy or excision, warm the lidocaine syringe in your hand or under warm water. This will reduce the burning sensation that the patient experiences as you inject. Anne M. Elliot, MPAS, PA-C, Oro Valley, Ariz 1.5 Comment repérer des veines difficiles? - Starting Difficult IVs Locating a vein for intravenous access can prove difficult in the edematous or obese patient. Use your otic thermometer! Change the setting from "tympanic" to "surface," gently roll over the skin surface and listen for the "beeps." The beeps become higher in frequency when over a "hotter" area--indicating the location of a vein. Jeanne Gates, RN, PA-C, Maite, Guam 1.6 Anesthésie de surface de la main - Topical Anesthetic for the Hand Applying an ice cube to the hand prior to lidocaine injection may alleviate the ensuing discomfort of digital nerve blocks. Specifically, place the ice cube directly on the dorsal side of the web between the fingers for at least 20 seconds before injecting. Application of the ice will distract the patient, as well as provide instant topical anesthesia. Lisa A. Ashton, PA-C, Ashton, Md 1.7 Atténuer la douleur d'une injection glutéale - Buttock Injection Pain Relief To reduce the pain of buttock injections, ask the patient to stand in front of the examining table with toes pointed inward (use precautions to prevent the patient from falling down). The gluteal muscle cannot be tightened when the leg is turned inward, so the muscle stays relaxed, allowing for a less painful injection. Douglas Di Ruggiero, PA-C, Rome, Ga 1.8 Préparation d'une plaie avant suture - Suture Preparation When preparing to suture an open laceration, try 'drizzling' or squirting a small amount of lidocaine with epinephrine into the wound. This provides better hemostasis and makes the insertion of a needle for local anesthesia less painful. Louanne K. Weber, RN-CS, MSN, Greer, SC 1.9 Comment marquer une lésion à ponctionner Lorsqu'on pratique un repérage sous échographie, sous radioscopie ou sous scanner, le marquage effectué au stylo feutre ou stylo à bille a tendance à s'effacer lors de la désinfection. En effectuant une pression prolongée à l'endroit au moyen d'une pointe mousse (capuchon de stylo, d'aiguille hypodermique ou même avec l'ongle), on obtient une marque cutanée qui reste suffisamment longtemps et ne sera pas effacée. Pierre Bénédict
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