无菌技术基本操作方法.docx

无菌技术基本操作方法.docx

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无菌技术基本操作方法

基础护理学

实验指导

一、无菌技术基本操作方法····················································1

（一）无菌持物钳的使用方法····················································1

（二）无菌容器使用方法························································1

（三）取用无菌溶液法··························································2

（四）无菌包使用法····························································2

（五）无菌盘的准备····························································3

（六）戴脱无菌手套法··························································4

（七）准备无菌换药盘··························································5

二、隔离技术································································6

（一）口罩的使用法····························································6

（二）手的消毒································································6

（三）穿脱隔离衣······························································7

（四）避污纸的使用····························································8

三、口服给药法······························································9

四、药液吸取法······························································12

五、注射法··································································14

（一）皮内注射法······························································14

（二）皮下注射法·····························································15

（三）肌内注射法······························································16

（四）静脉注射与采血术························································18

（五）动脉注射与采血术························································21

六、静脉输液法······························································23

（一）周围静脉输液法··························································23

（二）头皮静脉输液法··························································26

（三）静脉留置针输液法························································28

七、静脉输血法······························································32

八、滴药法··································································34

九、吸入法··································································38

（一）超声雾化吸入法··························································38

（二）蒸气吸入法······························································39

十、氧气吸入法······························································42

十一、鼻饲法································································44

十二、导尿术································································47

（一）女病人导尿术····························································47

（二）男病人导尿术····························································49

（三）留置导尿管术···························································52

（四）膀胱冲洗法······························································54

十三、肛管排气法····························································57

十四、灌肠法································································59

（一）大量不保留灌肠法························································59

（二）小量不保留灌肠法························································61

（三）清洁灌肠法······························································62

（四）保留灌肠法······························································63

十五、简易通便法····························································66

十六、人工取便法····························································68

十七、洗胃法································································69

（一）口服催吐洗胃法··························································69

（二）胃管洗胃法······························································70

十八、电动吸引器吸痰法······················································76

十九、气管切开护理··························································78

二十、心肺复苏术····························································80

二十一、铺床法······························································84

（一）备用床··································································84

（二）暂空床··································································86

（三）麻醉床··································································88

二十二、卧床病人更换床单法··················································91

二十三、常用卧位····························································93

二十四、保护具的应用法······················································96

二十五、搬运法······························································100

（一）轮椅运送病人法··························································100

（二）平车运送病人法··························································101

二十六、冷、热疗法··························································105

（一）热水袋热疗法····························································105

（二）热湿敷法·······························································106

（三）冰袋的冷疗法····························································107

（四）酒精擦浴法·····························································108

二十七、口腔护理···························································111

（一）口腔卫生指导···························································111

（二）特殊口腔护理···························································112

二十八、头发护理···························································114

（一）床上梳头法·····························································114

（二）床上洗发·······························································115

二十九、病人的清洁卫生·····················································117

（一）皮肤的护理·····························································117

（二）压疮的预防及护理·······················································119

三十、生命体征的测量·······················································123

（一）体温的测量方法·························································123

（二）脉搏的测量方法························································125

（三）呼吸的测量方法·························································127

（四）血压的测量方法·························································129

三十一、晨间护理···························································132

三十二、晚间护理···························································134

三十三、一般急救法·························································136

（一）绷扎法·································································136

（二）固定法·································································141

（三）止血法·································································144

三十四、尸体的护理·························································148

一、无菌技术基本操作方法

无菌技术（asepsis）是指在医疗、护理操作过程中，防止一切微生物侵入人体和防止无菌物品、无菌区域被污染的技术。

【计划】

1．护士准备：

着装整洁、修剪指甲、洗手、戴口罩和帽子。

2．用物准备：

治疗盘、无菌持物钳及浸泡溶器、无菌溶液、启瓶器、无菌手套包、无菌治疗巾包、2％碘酊、70％酒精、无菌平镊、棉签等。

3．环境准备：

环境清洁、宽阔、人员流动少。

【实施】

（一）无菌持物钳的使用方法

无菌持物钳是用来夹取和传递无菌物品的器械，常用的有三叉钳、卵圆钳和镊子三种。

使用时先将无菌持物钳浸泡在盛有消毒液的大口有盖溶器内，液面浸没轴节以上2-3cm或镊子长度的1/2。

每个容器只能放置一把无菌持物钳。

操作步骤

要点与说明

1．将浸泡无菌持物钳的容器盖打开

2．手拿无菌持物钳上1/3处，将钳移至容器中央，使钳端闭合，垂直取出

3．使用时保持钳端向下，不可倒转向上

4．用后闭合钳端，立即从容器中央垂直放回无菌容器内，浸泡时轴节松开

5．到远处取无菌物品时，连同容器一起搬移，就地使用

6．无菌持物钳及其浸泡溶器每周清洁、消毒二次，同时更换消毒液

·在盖闭合时不可从盖孔中取、放无菌持物钳

·取出时，不可触及容器口缘及液面以上的容器内壁，以免污染钳端

·以防消毒液倒流而污染钳端。

持物钳只能在持物者的胸部高度移动，不可甩动

·避免触及容器口周围

·松开轴节，使轴节与消毒液充分接触，达到消毒的效果

·防止无菌持物钳在空气中暴露过久而污染

·不用无菌持物钳夹取油纱布，防止油粘于钳端影响消毒效果

·不用无菌持物钳换药或消毒皮肤,防止钳被污染

·保持无菌持物钳的无菌状态

（二）无菌容器使用方法

盛放无菌物品的容器称无菌容器，如无菌盒、罐、贮槽等。

操作步骤

要点与说明

1．取用无菌物品时，拿起容器盖平移离开容器，内面向上置于桌面上，或内面向下拿在手中

2．取物后，立即将容器盖反转，使内面向下，移至容器口上，小心盖严

3.手持无菌容器（如无菌碗或弯盘）时，应托住容器底部

·防止盖上灰尘落人容器内

·防止盖内面触及桌面或任何非无菌区域

·拿盖时，手勿触及盖的内面及边缘

·避免容器内无菌物品在空气中暴露过久

·手指不可触及容器边缘及内面

（三）取用无菌溶液法

操作步骤

要点与说明

1．取盛有无菌溶液的密封瓶，应先擦去瓶外的灰尘

2．核对标签上的药名、灭菌日期、浓度，检查瓶子有无裂缝，瓶盖有无松动，以及药液有无变质、沉淀

3．用启瓶器启开铝盖，用拇指与食指或双手拇指将橡胶盖边缘向上翻起

4．一手食指和中指套住橡胶塞并将其拉出瓶口，置于手中

5．另一手拿起瓶子，标签面朝向掌心，倒出少量溶液冲洗瓶口

6．冲洗后，再由原处倒出所需溶液至无菌容器中

7．倒液体后立即塞上橡胶塞，用2％的碘酊和70％的酒精消毒瓶塞和瓶口，盖好瓶塞

8．记录开瓶日期、时间

9．如取烧瓶内无菌溶液，解开系带，手拿瓶口盖布外面，取出瓶塞，倾倒溶液的方法同上

·避免使用过期或变质的药物，核对无误才能使用

·手不可触及瓶口及瓶塞内面

·防止瓶塞被污染

·倒溶液时，勿将标签沾湿

·冲净瓶口

·倒溶液时，勿使瓶口与容器接触

·防止污染

·已开启的溶液瓶内的溶液，可保存24h

·手不可触及盖布内面及瓶口

·不可将物品伸人无菌溶液瓶内蘸取溶液，已倒出的溶液不可再倒回瓶内

（四）无菌包使用法

一般敷料与器械应包于质厚、致密、未脱脂的双层包布内，高压灭菌后备用。

操作步骤

要点与说明

1．包扎无菌包：

将物品放在包布中央，用包布的一角盖住物品，然后遮盖左右两角，最后一角遮盖后，将带以“十”字形包扎，松紧合适

2．打开无菌包：

（1）查看无菌包名称及灭菌日期，查看化学指示胶带颜色改变情况

（2）将无菌包放在清洁、干燥、平坦处，解开系带，卷放在包布下，按顺序逐层打开无菌包：

揭开包布外角、再揭开左右两角，最后揭开内角

（3）用无菌持物钳取出所需物品，放在事先准备好的无菌区域内

（4）如包内物品未用完，将包布按原折痕包起，将带以“一”字形包扎，注明开包日期及时间

3．需将无菌包内物品一次取完时，可在手上打开包布，使物品显露在无菌包布上，一手托住包布，另一手抓住包布四角，将物品全部投入无菌区域内

·如包玻璃物品，应先用棉垫包裹再包布包扎

·包布外标明物品名称及灭菌日期，有效期为1W

·如超过有效期或未达到灭菌要求的物品，不可使用

·如无菌包放在潮湿处，可能会因毛细现象而渗透入包布，污染物品

·打开无菌包时仅能以手接触包布四角的外面，不可触及包布内面

·操作时，手不可跨越无菌区

·表示此包已打开过，所剩物品可在24h内使用

·如不慎污染包内物品或包布被浸湿，应重行消毒

·开包时，手不可触及包布内面及无菌物品

·投放时，包布之无菌面朝向无菌区域

（五）无菌盘的准备

无菌盘是将无菌巾铺在清洁干净的治疗盘内，形成一无菌区，放置无菌物品，以供治疗之用。

操作步骤

要点与说明

1．折叠治疗巾

纵折法：

将治疗巾纵折两次成4折，再横折两次，开口边向外

横折法：

将治疗巾横折后再纵折，成为4折，

再重复一次

2．铺盘

◆单层铺盘：

（1）按无菌技术操作原则打开无菌包，用无菌持物钳取一块治疗巾放在治疗盘内

（2）双手捏住无菌巾一边外面两角，轻轻抖开，双折铺于治疗盘上，上面一层向远端呈扇形折叠，开口边向外

（3）放入无菌物品，拉平扇形折叠层盖于物品上，上下边缘对齐，将开口处向上翻折两次，两侧边缘向下翻折一次

◆双层底铺盘：

（1）取出无菌巾，双手捏住无菌巾一边的外面两角，轻轻抖开，从远到近，3折成双层底，上层呈扇形折叠，开口边向外

（2）放入无菌物品，拉平扇形折叠层，盖于物品上，边缘对齐

·折叠后便于铺盘及展开治疗巾时保持治疗巾的无菌

·打开包后，注意保持包内无菌

·治疗盘应清洁、干燥

·手不可触及无菌巾内面

·保持盘内无菌，4h内有效

·手不可触及无菌巾内面

·保持盘内无菌，4h内有效

（六）戴脱无菌手套法

由于寄居微生物的存在，用一般消毒方法很难使手达到绝对无菌。

在手术、穿刺、导尿等医疗护理操作中，需要戴上无菌橡胶手套，以确保无菌效果。

操作步骤

要点与说明

1．核对手套包上的手套号码及灭菌日期

2．打开手套袋，取出滑石粉，用滑石粉擦双手

3．一手掀起手套袋开口处外层，另一手捏住一只手套翻折部分取出手套，对准五指戴上

4．再以戴好手套的手指插入另一只手套翻折内（手套的外面），取出手套，同法戴好

5．双手对合交叉调整手套位置，将手套的翻边扣套在工作衣袖外面

6．操作完毕，先将手套上的污渍、血迹洗净。

再用戴手套的手捏住另一手套的套口外面翻转脱下

7．用已脱下手套的手指插入另一手套口内，将其翻转脱下

8．将手套浸泡在消毒液内，洗手

·选择大小合适的号码

·过期不可使用

·防止滑石粉撒落在手套上，方便戴上手套

·未戴手套的手不可触及手套的外面

·注意已戴手套的手不可触及未戴手套的手或另一手套的内面

·发现手套有破洞，立即更换

·戴上无菌手套的双手应保持在腰部以上视线范围内

·不可强拉手套边缘或手指部分，以免损坏

·脱手套时，手勿接触手套脏污部分

·整个过程小心勿使手套外面已污染处接触到皮肤

（七）准备无菌换药盘

操作步骤

要点与说明

1．洗手，用物齐备、放置合理

2．检查无菌治疗巾包的有效期和灭菌标记

3．按无菌技术操作原则打开无菌治疗巾包，用无菌持物钳取出无菌治疗巾放于治疗盘内，按原折痕包好无菌治疗包，系带以“一”字形包扎，

注明开包日期和时间

4．扇形打开无菌治疗巾，边缘向外形成一无菌区域

5．用无菌操作法打开治疗碗包，放治疗碗于治疗巾无菌区内

6．用无菌持物钳夹取消毒棉球及生理盐水棉球分别放于两个治疗碗中

7．取无菌纱布放于治疗盘无菌区内

8．按无菌技术操作方法盖好治疗盘

9．放无菌手套包、弯盘、胶布于盘内

10．将用物携至病人床旁，向病人解释操作的目的，打开治疗巾

11．检查手套包，打开无菌手套包，取出滑石粉涂擦双手，按无菌技术操作的方法戴好手套

12．操作完毕，将手套上的污渍、血迹洗净，脱去手套

13．收拾整理用物，按常规处理

·防止无菌物品被污染，方便操作

·如已过期或未达到灭菌要求，不可使用

·开包24h后仍未用完，须重新灭菌

·无