User:Zhaozyf/sandbox

Wiki ID : Zhaozyf

Tutor’s name : Jordan Church

Daytime and place of tutorial:

Friday 3pm-5pm

Bren Learning Studio 120

A link to the manual of style:

https://en.wikipedia.org/wiki/Wikipedia:Manual_of_Syle

Topic: Arterial transfusion

This means that the new blood is passed through the body's arteries and then a needle is used for transfusion

About the invention of blood transfusion technology

The world's first successful blood transfusion took place around 1665. John Wilkins used a feather tube and a bladder to take blood from one dog and put it into another dog's vein. It wasn't until the 19th century that doctor John leacock rediscovered his interest in using blood transfusions to treat massive blood loss. He believed that it was safe to transfuse blood between two animals of the same species He used a syringe to draw blood from his assistants and inject it into patients he knew were dying. In 1829, he successfully transferred the blood of his assistant to a woman suffering from severe postpartum bleeding. The woman was saved. However, problems arose when more transfusions were carried out. Sometimes the blood mixed successfully, but sometimes it coagulated. This problem was solved by jansky and Carl landsteiner, who studied blood types.

 The operation name 

Arterial blood transfusion is a medical term for a small amount of arterial blood transfusions that can raise blood pressure in severe cases of hypotension

 The role of arterial blood 

The function of arterial blood is to transport the blood of the thigh artery away from the blood vessels of the heart. After it is sent from the ventricle, it branches repeatedly, becoming thinner and thinner, and finally moves to the capillaries. The walls of the arteries are thicker and can withstand greater pressure. Arterial wall elastic fiber is more, there is greater elasticity, ventricular ejection when the wall expansion, ventricular diastole when the wall back, make blood continue to flow forward. In, arteriole, especially the smooth muscle of arteriole tube wall is more developed, can be in nerve humoral regulation next systole or diastole, in order to change lumen and size, affect local blood flow resistance. The flow of blood is fast.

structural characteristics of artery intima coronary artery is composed of endothelium, subendothelium and inner elastic membrane. The lower layer of endothelium is a thin loose connective tissue outside the endothelium, which contains a few smooth muscle fibers. The inner elastic membrane is composed of elastin, which has many holes in it. The contraction of smooth muscle fibers controls the size of the tube and regulates the blood flow to the organ. (2) structural characteristics of arterioles and arterioles the diameter of the tube is between 0.3 and 1mm, which is called arterioles. The wall structure of the tube is similar to the middle artery, but each layer is thinner.

structural features of the great arteries, also known as elastic arteries, such as the aorta, pulmonary artery, innominate artery, common carotid artery, subclavian artery and common iliac artery, etc. The great and middle arteries are tapered, with no distinct boundaries between them. Between the elastic membrane there are smooth muscle and a small amount of collagen fiber and elastic fiber; Outer membrane is thinner, form by connective tissue, have nutrient blood vessel, lymphatic vessel, nerve to wait among them. The outer elastic membrane is connected with the middle elastic membrane, so the boundary is not clear. The vessels that carry blood back to the heart

 Don't do it 

In this case, an arterial transfusion is not possible

1.Patients with severe kidney disease or hypertension should not receive blood transfusions. If a transfusion is urgently needed, it should be done only slowly.

2.People with severe allergic reactions should not receive arterial transfusions

 To prepare 

1.When performing arterial blood transfusion on patients, the prime minister shall explain the purpose and method of blood transfusion treatment to patients, let patients cooperate, and make sure to explain matters needing attention to patients. So that patients can rest assured to cooperate

2.When putting blood into a bottle, the patient's name, blood type and bottle number should be repeatedly confirmed. To ensure that there is no mistake, this mistake is a fatal mistake, once the wrong operation, to the patient and the doctor is an indelible pain and responsibility

Important methods of operation

1.The radial artery should be sterilized at the site of the patient's transfusion, followed by a longitudinal incision of about 1-2 cm in size through the skin and subcutaneous tissue. When separating the radial artery, care must be taken not to injure the two meridians that accompany the radial artery. At a distance of 2 cm from the radial artery, tighten the artery with two middle silk threads, and then puncture the artery with the arterial needle to remove the needle core. If there is blood flow, it proves successful. When connecting the installed arterial transfusion device, 300ml of blood should be injected quickly and finished within 5 minutes. Then the middle silk thread should be removed and sutured. The needle remains in the artery for later use.

2. For femoral artery blood transfusion, a pillow is placed on the hip to make the hip joint tense, and then local disinfection is performed. Under the silver alloy of the femoral artery pulse point under the inguinal ligament, 18 needles are used to obliquely upward, and then the artery is punctured. If there is no local swelling, connect directly to the arterial transfusion device. Then get a blood transfusion as soon as possible. After pulling out the needle, apply local pressure for 5-10 minutes to stop the bleeding

 Matters needing attention 


 * 1) Two bottles of blood cannot be mixed directly, and the blood collection cannot be injected with glucose water
 * 2) During a pressurized blood transfusion, care should be taken not to allow bubbles to enter the blood vessels
 * 3) When the puncture needle is blocked by a clot, another needle should be prepared for puncture, and the clot should not be washed away to prevent embolism
 * 4) Attention to maintain the infusion bottle mouth, joint, needle is sterile. Long-term intravenous devices should be replaced daily

5. Complications

(1)Fever reaction: During or after a transfusion, if severe tremors occur, the transfusion should be discontinued immediately. Subcutaneous or intramuscular injection of morphine at 10mg or ruminax at 0.1g should eliminate the reaction in a short time

(2) An allergic reaction: After transfusion, the patient should immediately stop transfusion if he/she has symptoms such as measles and fever. The patient should take diphenhydramine hydrochloride orally for 50mg and take it 4 times a day, or subcutaneously inject 1mg epinephrine, or intramusculally inject 50mg promethazine.

(3) hemolytic reaction: The patient may have difficulty breathing, irritability, a desire for sleep, lightheadedness of the head, weakness of the body, and severe shock. If this is the case, blood transfusions should be stopped immediately, urine should be alkalized, and various measures should be actively taken to prevent treatable renal failureal closure, alkalization of urine, and active prevention and treatment of acute renal failure.

What's more, strict checks should be made during the implementation, and no mistakes should be made. The principles of aseptic operation and disinfection isolation should be kept in mind, and the area of disinfection should be larger than that of arterial puncture.

When we do this procedure, if the patient is prone to bleeding, we have to be careful about using arterial puncture, and for newborns, we tend to use circumarterial puncture. In the process of infusion, we must listen to the patient's chief complaint, observe local conditions and changes in the condition, and pay more attention to the patient's feelings. Always use sterile gauze to stop the bleeding when pulling out the needle to avoid infection or hematoma formation.

 Advantages of arterial blood transfusion 

Arterial infusion can replenish blood volume and maintain blood volume. In order to achieve the purpose of preventing shock, arterial blood transfusion can also reduce the occurrence of acute hypoxia and supplement various coagulation factors under certain conditions. Blood transfusions are performed differently depending on the patient. Blood transfusion is an important measure to treat anemia, but it is not all good

 Risk of arterial transfusion 

Arterial transfusion is an effective treatment in severe shock, acute blood loss, frequent death and clinical death. At the same time, arterial blood transfusion may also have certain risks, such as the corresponding limb in the case of very ischemic blood pressure transfusion, severe cases can lead to gangrene. Paleness and rash of the entire limb may also result in sensory and motor dysfunction. If an artery blood transfusion is not successful, then for the second time, this is undoubtedly increased the risk probability, the doctor when there is no guarantee that the second injection of various medical product is sterile, also may increase the risk of doctors to the effect, such as ignoring the needle in the bubble, which can lead to bubbles into the cause of death in the human body. Arterial blood transfusion is suitable for patients who have no other method to treat, but the doctor who USES arterial blood transfusion must be highly skilled, and this method has the risk of sacrificing an artery. Therefore, arterial blood transfusion should not be used when it is not necessary, You can't change doctors during the procedure. A doctor should be in charge of the operation until the end.So try to do it in one shot.

 Clinical significance of arterial blood transfusion 

The blood is first pressurized through an artery, from the bottom up to the arch of the aorta, and then into the coronary and common carotid arteries, allowing the brain to first adapt by improving the blood supply. This treatment is conducive to the recovery of shock.

Blood transfusions from the lower to the upper arteries stimulate receptors in the blood vessel walls, increase the flow of blood to the coronary arteries, improve the body's ability to drain blood, and promote blood circulation.

This technique is particularly suitable for patients with severe shock or first aid resuscitation, and arterial transfusions should not be performed too late.

 Related technologies 

Arteriotomy of upper limb;Incision of artery of upper limb

Arteriotomy is mainly aimed at the arterial blood transfusion that must be carried out in severe shock patients, and some special physical examinations should be carried out in advance, such as cardiovascular examination, imaging, extracorporeal circulation and so on.

Arteriotomy should not be performed if the patient has inflammation of the skin around the artery or if they have embolism.

 Reference 

IVEAL,R.,RUSSELL, A. s.andASHBURN, F. s.(1952).Ann.Surg., 136,485.

IARA AS, X I C L U N A and L E C A. (1949). Afr. Franc. Chir. P.,237.

http://www.bloodjournal.org/content/132/Suppl_1/415?sso-checked=true#xref-fn-1-1

'''Braz. J. Cardiovasc. Surg. vol.32 no.5 São José do Rio Preto Sept./Oct. 2017'''

Monash Health (2016) Peripheral arterial line insertion and management (neonates) procedure (Intranet only document)

Royal Women’s Hospital, Policy Guideline and Procedure Manual (2014) Arterial catheterisation-peripheral infant (Intranet only document)

. Shaw RE, Johnson CK, Ferrari G, Zapolanski A, Brizzio M, Rioux N, et al. Balancing the benefits risks of blood transfusions in patients undergoing cardiac surgery: a propensity-matched analysis. Interact CardioVasc Thorac Surg 2013;17:96–103 [PMC free article] [PubMed] [Google Scholar]

Surgenor SD, Kramer RS, Olmstead EM, Ross CS, Sellke FW, Likosky DS, et al. The association of perioperative red blood cell transfusions and decreased long-term survival after cardiac surgery. Anesth Analg. 2009;108:1741–6. [PubMed] [Google Scholar]

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