Puncture procedure of the subcutaneous reservoir
Introduction of a curved needle with special bevel and extension cord through the silicone membrane of the subcutaneous reservoir.
Objectives:
– To access the patient’s subcutaneous reservoir for therapeutic and diagnostic purposes. – Prevent infections.
Equipment:
– Trolley or trolley for cures. – Sterile drapes. – Sharps container.
Material:
– 1 pair of sterile gloves. – 1 sterile dressing. – Sterile gauze. – Antiseptic solution. – Physiological saline solution. – 2 syringes of 10-20 ml. – 22G (routine use) and 20G (nutrition or blood products) needles with special bevel and extension. – 1 obturator. – 1 intravenous needle. – Diluted sodium heparin (commercial preparation). – Hypoallergenic plaster. – Nursing records.
Procedure:
– Perform hand washing. – Prepare the necessary material. – Preserve the patient’s privacy. – Inform the patient of the procedure to be performed. – Ask for the patient’s cooperation. – Place the patient in supine decubitus position, with the head turned to the opposite side where the opposite side where the reservoir is implanted. – Assess the appearance of the skin covering the subcutaneous chamber (make sure there is no redness, edema, subcutaneous infiltration, ulceration or suppuration). – Put on sterile gloves. – Create the sterile field and place all the necessary material for the puncture in it. – Load a 10 cc syringe with 5 ml of diluted heparin sodium and another with saline. – Purge the needle system with special bevel and extension pole with physiological saline. – Clamp the system. – Clean the area with iodine solution and let it dry. – Locate the device by palpation. – Immobilize the chamber with the fingers of the non-dominant hand. – Insert the needle perpendicularly to the membrane of the reservoir, looking for the center of the chamber and avoiding previous injection points, advancing it firmly until it meets the metal stop. – Declamp the system. – Inject 2-3 c.c. of physiological saline solution and aspirate to check that blood refluxes. – Clamp the system. – Change the saline syringe for the heparin syringe (5 ml). – Unclamp and introduce the 5 ml of diluted sodium heparin. – Screw the obturator on the distal end of the system. – Place a sterile gauze under the needle to avoid skin erosion. – Place a sterile transparent dressing. – Discard the sharp material in the container provided for this purpose. – Collect the material. – Leave the patient in a comfortable position. – Remove gloves. – Wash hands. – Record in the nursing documentation: procedure, reason, date and time, incidences and patient’s response.
Observations:
Never inject liquids through the reservoir with syringes of less than 10 ml, since the silicone of the chamber may crack and extravasate the medication.
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