Practical Operation

Mao wenjia Chenliping 23ed,May,2023

Today Mission
Subcutaneous Injection
Intradermal Injection
Intramuscular Injection
Venous Infusion
Venous Puncture
Oxygen Delivery
Nasogastric Insertion
Subcutaneous Injection
 国际一流的卓越护理

Prepare
• Dress neatly and properly ， wash your hands and wear a
mask

• Check the bed number, name and ID; ask three histories;
assess the patient and injection site

• Communicate and explain with patients and family

members

• Prepare and evaluate supplies

• Clean environment, suitable temperature, conform to

aseptic operation requirements
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国际一流的卓越护理

Operating process
• Introduce yourself,check and confess,explain purpose
and get cooperation

• Check the injection card and medicine

• Properly configured medicine according to aseptic

principles

• Select injection site

• Disinfect skin twice and aside to dry

• Check again, adjust the needle, and vent air

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国际一流的卓越护理

Operating process
• Hold tightly the skin with one hand; hold the syringe in the other hand, the needle is 30~40° angle
quickly pierce the skin with the depth of 1/2~2/3 of the needle stem

• Pull back the syringe ,without blood, slowly inject the medicine

• Quickly pull out needles and press

• Wash your hands and take off your mask

• Ask the patient for reaction and explain the matters needing attention

• Chenk the injection card and medication again

• Record, sign the execution time and name

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 国际一流的卓越护理

Post-operation processing
• Proper placement of patients and cleaning the bed units

• Health Education

• Proper disposal supplies and proper garbage sorting

• Humanistic Care

• Aseptic Concepts:Cross the aseptic zone twice or more full buckle

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 国际一流的卓越护理

• In case of serious violation of aseptic principle and treatment safety principle (any
one or more of the following), 50 points will be deducted from the total score

• No mask is worn during aseptic procedures

• Not sterilized before injection

• Three histories were not asked before injection

• Use expired sterile items during operation

• Any error in the name, dosage, or route of use of the injection

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Intradermal Injection
 国际一流的卓越护理

Prepare
• Dress neatly and properly ， wash your hands and wear a mask

• Check the bed number, name and ID; ask three histories; knowing about

eating,etc; assess the injection site

• Communicate and explain with patients and family members

• Prepare and evaluate supplies

• Clean environment, suitable temperature, conform to aseptic operation

requirements

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国际一流的卓越护理

Operating process
• Introduce yourself,check and confess,explain purpose
and get cooperation

• Check the injection card and medicine

• Properly configured drugs according to aseptic

principles

• Select injection site

• Disinfect skin twice and aside to dry

• Check again, adjust the needle, and vent air

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 国际一流的卓越护理

Operating process
• Left hand tightens the front arm side of the skin, right hand with syringe, needle slope
upward, with the skin at 5° angle to push into the skin
• keep the syringe flat
• 0.1ml of liquid medicine was injected to form a raised pitus
• Pull out the needle quickly and do not press
• Wash your hands and take off your mask
• Ask the patient for reaction and explain the matters needing attention
• Check again, record and sign
• Two people observed the results and recorded them

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 国际一流的卓越护理

Post-operation processing
• Proper placement of patients and cleaning the bed units

• Health Education

• Proper disposal supplies and proper garbage sorting

• Humanistic Care

• Aseptic Concepts:Cross the aseptic zone twice or more full buckle

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国际一流的卓越护理

• In case of serious violation of sterility principle and treatment safety principle (any one
or more of the following), 50 points will be deducted from the total score

• No mask is worn during aseptic procedures

• Not sterilized before injection

• Three histories were not asked before injection

• Use expired sterile items during operation

• Any error in the name, dosage, or route of use of the injection

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Intramuscular Injection
 国际一流的卓越护理

Prepare
• Dress neatly and properly ， wash your hands and wear a mask

• Check the bed number, name and ID; ask three histories; assess the
patient and injection site

• Communicate and explain with patients and family members

• Prepare and evaluate supplies

• Clean environment, suitable temperature, conform to aseptic

operation requirements

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国际一流的卓越护理

Operating process
• Introduce yourself,check and confess,explain purpose and get cooperation

• Check the injection card and medicine

• Properly configured drugs according to aseptic principles

• Choose the right injection site

• Assist client to take proper position

• Disinfect skin twice and aside to dry

• Check again, adjust the needle, and vent air

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国际一流的卓越护理

Operating process
• Tighten or pinch the skin of the injection area with one hand, hold the syringe in

pen style with the other hand, fix the needle plug with the middle finger, and

vertically insert the needle stem 2/3 ~ 3/4, or according to the patient's fat and thin

reasonable grasp of depth

• Pull back the syringe ,without blood, slowly inject the medicine

• Quickly pull out needles and press

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国际一流的卓越护理

Operating process

• Wash your hands and take off your mask

• Ask the patient for reaction and explain the matters

needing attention

• Chenk the injection card and medication again

• Record, sign the execution time and name

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 国际一流的卓越护理

Post-operation processing
• Proper placement of patients and cleaning the bed units

• Health Education

• Proper disposal supplies and proper garbage sorting

• Humanistic Care

• Aseptic Concepts:Cross the aseptic zone twice or more full

buckle

关爱感恩 热忱专注 合作分享 务实创新

国际一流的卓越护理

• In case of serious violation of sterility principle and treatment safety principle (any
one or more of the following), 50 points will be deducted from the total score

• No mask is worn during aseptic procedures

• Not sterilized before injection

• Three histories were not asked before injection

• Use expired sterile items during operation

• Any error in the name, dosage, or route of use of the injection

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Venous Infusion
 国际一流的卓越护理

Prepare
• Clean and dress ， standardized, wash hands and wear masks

• Check the bed number, name and ID number to assess the

patient's condition and degree of cooperation; Skin and blood
vessel conditions at the puncture point

• Communicate and explain with patients and family members

• Prepare and evaluate supplies

• Clean environment, suitable temperature, enough light

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 国际一流的卓越护理

Operating process
• Check name, bed number, ID number,explain and get cooperation

• Double check doctor's orders and treatment materials

• Wear gloves; Apply a tourniquet and a pillow

• Select the vein and tie the tourniquet; Sterilize skin twice and set aside to dry

• Ask to clench a fist, tighten the skin and blood vessels with one hand, hold a syringe,
stab the vein at an Angle of 20° ~ 30° between the needle and the skin, and inject a little
more blood after seeing the return

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国际一流的卓越护理

Operating process
• Ask to loosen the fist and tourniquet during IV injection

• Hold the needle handle and slowly inject the drug

• Correct needle extraction and press

• Take the pillow and the tourniquet

• Take off gloves, wash your hands, and remove your mask

• Check again, send the blood sample for examination in time or observe after
medication

• Check again, record

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 国际一流的卓越护理

Post-operation processing
• Proper placement of patients and cleaning the bed units

• Health Education

• Proper disposal supplies and proper garbage sorting

• Humanistic Care

• Aseptic Concepts:Cross the aseptic zone twice or more full

buckle

关爱感恩 热忱专注 合作分享 务实创新

国际一流的卓越护理

• In case of serious violation of sterility principle and treatment safety principle (any one
or more of the following), 50 points will be deducted from the total score

• No mask is worn during aseptic procedures

• Not sterilized before injection

• Three histories were not asked before injection

• Use expired sterile items during operation

• Any error in the name, dosage, or route of use of the injection

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Venous Puncture
 国际一流的卓越护理

Prepare
• Clean and dress ， standardized, wash hands and wear masks

• Check the bed number, name and ID number to assess the

patient's condition and degree of cooperation; Skin and blood
vessel conditions at the puncture point

• Communicate and explain with patients and family members

• Prepare and evaluate supplies

• Clean environment, suitable temperature, enough light

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 国际一流的卓越护理

Operating process
• Check name, bed number, ID number,explain and get cooperation

• Double check doctor's orders and treatment materials

• Wear gloves; Apply a tourniquet and a pillow

• Select the vein and tie the tourniquet; Sterilize skin twice and set aside to dry

• Ask to clench a fist, tighten the skin and blood vessels with one hand, hold a syringe,
stab the vein at an Angle of 20° ~ 30° between the needle and the skin, and inject a little
more blood after seeing the return

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国际一流的卓越护理

Operating process
• The needle handle is fixed during venous blood collection to extract the required
blood

• Ask to loosen the fist, loosen the tourniquet

• Correct needle extraction and press

• Take the pillow and the tourniquet

• Take off gloves, wash your hands, and remove your mask

• Check again, send the blood sample for examination in time or observe after
medication

• Check again, record

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 国际一流的卓越护理

Post-operation processing
• Proper placement of patients and cleaning the bed units

• Health Education

• Proper disposal supplies and proper garbage sorting

• Humanistic Care

• Aseptic Concepts:Cross the aseptic zone twice or more full

buckle

关爱感恩 热忱专注 合作分享 务实创新

国际一流的卓越护理

• In case of serious violation of sterility principle and treatment safety principle (any
one or more of the following), 50 points will be deducted from the total score

• No mask is worn during aseptic procedures

• Not sterilized before injection

• Three histories were not asked before injection

• Use expired sterile items during operation

• Any error in the name, dosage, or route of use of the injection

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Oxygen Delivery(oxygen center)
 国际一流的卓越护理

Prepare
• Dress properly and neatly, wash hands and wear a mask

• Check bed number, name, ID number, assess patient,

respiratory, nasal condition, etc

• Communicate and explain with patients and family

members

• Item preparation and evaluation

• The environment is clean, quiet and safe with oxygen

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国际一流的卓越护理

Install oxygen meter for central oxygen supply

• Remove dust cover and install oxygen meter

• Install humidifying tubes and bottles in sequence

• Open the flow switch to check whether there is air leakage in the
oxygen device and whether the oxygen pipe is smooth

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国际一流的卓越护理

Oxygen Delivery
• Assess hypoxia, interpret, and obtain cooperation

• Check nasal passages and moisten them

• Oxygen connection tube and nasal catheter

• Wet and check nasal catheters for patency

• Adjust the appropriate oxygen flow

• Insert the nasal tube into the nasal cavity at an appropriate length

• Fixed catheter

• Record oxygen time and oxygen flow

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国际一流的卓越护理

Stop Oxygen Delivery

• Check the doctor's advice, evaluate the patient, and inform him to stop oxygen

• Remove the nasal catheter, turn off the flow meter switch (tube oxygen intake:
turn off the flow switch, turn off the switch, turn on the flow switch to release the
remaining oxygen, turn off

• Flow switch)

• Remove the humidification device and flowmeter

• Clean facial tape marks

• Record the duration of oxygen withdrawal

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国际一流的卓越护理

Post-operation processing
• Proper placement of patients and cleaning the
bed units
• Proper disposal supplies and proper waste
classification
• Humanistic Care
• Education: oxygen inhalation and disease related
knowledge; Matters needing attention

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国际一流的卓越护理

• For serious violations of oxygen safety (any one or more of the

following), 50 points will be deducted from the total score

• The environment for safe use of oxygen has not been assessed

• Patients can adjust oxygen flow freely during oxygen

inhalation

• Oxygen switch sequence is incorrect

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Oxygen Delivery(oxygen cylinder)
 国际一流的卓越护理

Prepare
• Dress properly and neatly, wash hands and wear a mask

• Check bed number, name, ID number, assess patient,

respiratory, nasal condition, etc

• Communicate and explain with patients and family

members

• Item preparation and evaluation

• The environment is clean, quiet and safe with oxygen

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国际一流的卓越护理

Install an oxygen meter on the oxygen tank

• Open the main switch of oxygen cylinder, deflate the dust of the bottle mouth, and close
the main switch

• Install oxygen meter, wrench tight, oxygen meter perpendicular to the floor

• Turn on the main switch to check for air leakage

• Install humidifying tubes and bottles in sequence

• Open the flow switch to check whether the oxygen device has air leakage and whether the
oxygen outflow is smooth

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国际一流的卓越护理

Oxygen Delivery
• Assess hypoxia, interpret, and obtain cooperation

• Check nasal passages and moisten them

• Oxygen connection tube and nasal catheter

• Wet and check nasal catheters for patency

• Adjust the appropriate oxygen flow

• Insert the nasal tube into the nasal cavity at an appropriate length

• Fixed catheter

• Record oxygen time and oxygen flow

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国际一流的卓越护理

Stop Oxygen Delivery

• Check the doctor's advice, evaluate the patient, and inform him to stop oxygen
• Remove the nasal catheter, turn off the flow meter switch (tube oxygen intake:
turn off the flow switch, turn off the switch, turn on the flow switch to release the
remaining oxygen, turn off
• Flow switch)
• Remove the humidification device and flowmeter
• Clean facial tape marks
• Record the duration of oxygen withdrawal

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 国际一流的卓越护理

Post-operation processing
• Proper placement of patients and cleaning the bed units

• Proper disposal supplies and proper waste classification

• Humanistic Care

• Education: oxygen inhalation and disease related

knowledge; Matters needing attention

关爱感恩 热忱专注 合作分享 务实创新

国际一流的卓越护理

• For serious violations of oxygen safety (any one or more of the

following), 50 points will be deducted from the total score

• The environment for safe use of oxygen has not been assessed

• Patients can adjust oxygen flow freely during oxygen

inhalation

• Oxygen switch sequence is incorrect

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Nasogastric Insertion
国际一流的卓越护理

Prepare
• Check name, sex, age

• Explain the necessity of gastric tube insertion to the patient and family members, and

ask family members to avoid

• Explain the coordination method to the client (emphasizing breathing adjustment

and coordination of swallowing)

• Wash hands before operation

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国际一流的卓越护理

Prepare
• Items: Treatment tray (14 pieces, standardize the placement of all items, facilitate the
examination), carried to the bedside of the patient (patient

• Right)

• Check nasal cavity and mouth with flashlight (for dentures and deviation of nasal
septum), and remove dentures

• Choose nostril with patient's advice and clean nostril with wet cotton swab

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国际一流的卓越护理

Position
• Assist client in semi-seated position (raise bed or back pillow)

• Put a therapeutic towel under the jaw

• Place the bend in the corner

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国际一流的卓越护理

Gastric tube insertion

• Wear a mask and gloves (check the packaging and use aseptic method)

• The gastric tube was removed and the length of insertion was measured, about 55
~ 60 cm for adults

• After measuring, keep your left hand fixed near the reservation point

• Pay attention to aseptic operation, try not to touch the front end of the gastric tube
with your hand, and do not touch the patient's body when measuring

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国际一流的卓越护理

Gastric tube insertion

• Paraffin oil Smooth Stomach Tube End (front end 10cm)

• Hold the end with a right hand hemostatic clamp. Insert the end into
the nasal vestibule, first slightly upward and then parallel and then
slowly and gently back down

• Insert 14 ~ 16 cm and ask client to swallow and push forward until

desired length

• Preliminary fixation

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国际一流的卓越护理

Gastric tube insertion

• Determine the position of the gastric tube (all three methods can be used:

• wipe the corners of the patient's mouth with gauze, remove the bending disc, remove gloves,

• fix the cheek with adhesive tape (firm, and pay attention to the natural curvature to prevent

dissolving),

• fold the end of the gastric tube back, wrap the gauze, or connect the drainage bag

• Remove the treatment towel

• fix the drainage bag

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国际一流的卓越护理

Postoperative management

• Assist client in comfortable position and ask client how

they feel

• Organize patient (quilt) and articles

• Tell the patient and family members to pay attention

• Humanitarian Care

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国际一流的卓越护理