CACH LAY BENH PHAM XET NGHIEM
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MUC TIEU
1. Trinh bay ditdc tam quan trong cua viec lay benh pham de xet nghiem.
2. Trinh bay ditdc vai tro cua ngitcfi dieu ditdng trong viec chuan bi xet nghiem
cho ngitcfi benh. »
3. Trinh bay ditdc ky thuat lay mot so benh pham de xet nghiem.
1. TAM QUAN TRONG
Lay benh pham de xet nghiem la mot cong viec rat quan trong giup cho
qua trinh chan doan va dieu tri benh nhanh chong, chinh xac co hieu qua.
2. VAI TRO CUA NGUOl DIEU DUCfNG TRONG QUA TRiN H LAY
BENH PHAM XET NGHIEM
- Chuan bi tot cong tac ttf ttfdng de ngtfdi benh yen tam.
- Dan ngtfdi benh nhtfng dieu can thiet trtfdc khi lay benh pham (nhin
an ...).
- Chuan bi dung cu dung theo yeu cau cua ttfng loai xet nghiem.
- Lay benh pham dung thdi gian, dung so' ltfdng, dung ky thuat.
- Bao quan tot benh pham khi chtfa gtfi den phong xet nghiem.
- Ghi ro ho ten, tuoi, so gitfdng, khoa, dan vao lo dtfng benh pham va gtfi
den phong xet nghiem.
3. KY THUAT LAY MAU XET NGHIEM
3.1. Nhtfng quy dinh chung
- Trtfdc khi lay mau ngtfdi benh nhin an, khong uong thuoc.
- Lay mau vao buoi sang sau khi ngu day (trtf khi co chi dinh c£p ctfu).
- Ong nghiem hoac tube dtfng mau phai ghi ro ho ten ngtfdi benh, tucJi, so
gitfdng, khoa.
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Khi lay mau phai tuan thu dung quy trinh ky thuat de tranh vd hong cau
(bdm tiem kho, kim tiem to, hut nhe, thao kim tiem bdm nhe nhang vao
thanh ong).
- Lay mau xong de vao gia 5-10 phut sau do gUi len phong xet nghiem.
- Trong trUdng hdp lay mau xet nghiem yeu cau co chat chong dong: sau
khi cho mau vao ong nghiem phai lac nhe ong nghiem trong 3 - 5 phut.
3.2. Ky thua t lay m au tinh m ach.
Ap dung cho cac xet nghiem can lay so' ludng mau > 0,5 ml.
• Xem ho scf benh an - chuan bi ngtfdi benh
Thong bao, giai thich va dong vien ngUdi benh ve viec lav mau xet
nghiem de ngUdi benh yen tam.
• Chuan bi ngtfdi dieu dtfdng
- Dieu dUdng co du ao, mu, khau trang.
- Riia tay thUdng quy.
• Chuan bi dung cu
- Khay chut nhat, tru d m mot kim Kocher.
- Bdm tiem (tuy theo yeu cau xet nghiem), gang tay.
- Con iod, con 70° de sat khuan vi tri lay mau, hai coc dung bong cau.
- Gia dUng, ong nghiem, phieu xet nghiem.
- Huyet ap ong nghe, hop chong soc, goi ke tay, day garo.
- Hop dUng vat s£c nhon, tui dung do ban.
• Tien hanh
- Dieu dUdng mang gang, giup ngUdi benh nSm ngUa thoai mai tren
giudng.
- Boc lo, xac dinh vi tri lay mau, ke goi dudi vi tri lay mau (neu lay mau d
tay), dat day garo phia tren cach vi tri lay mau tU 3 - 5 cm va that day garo.
- Sat khuan vi tri lay mau: con iod trUdc, con 70° sau.
- Cam bdm tiem dam kim vao tinh mach, lay du lUdng mau theo yeu cau
xet nghiem, thao day garo.
- Rut kim nhanh ket hdp k6o chech da, sat khuan lai vi tri lay mau.
- Thao kim tiem, bdm mau vao ong nghiem (khi bdm mau de ong nghiem
nghieng mot g6c 45° va bdm ttf ttf vao thanh o'ng nghiem).
- Lac nhe ong nghiem (n£u c6 chat chong dong) va gtfi benh pham, giay xet
nghiem len phdng x6t nghiem.
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• Thu don dung cu
- S ip xep dung cu gon gang de dung ndi quy dinh, thao g&ng.
- Ghi ho sd:
+ Ngay gid thuc hien thu thuat.
+ Tinh trang ngUdi benh trUdc, trdng va sau khi lam thu thuat.
+ Dieu dudng ky ten.
4. KY THUAT LAY NU 6C TIEU XET NGHIEM
Xet nghiem nUdc tieu co gia tri giup chan doan cac benh ve gan, than,
thai nghen... Co hai cach lay ntfdc tieu: ngUdi benh ttf dai dUdc va thong bang
quang.
4.1. Ky thuat lay ntfdc tieu ngtfdi benh ttf dai dtfdc
Tuy theo yeu clu xet nghiem phai lay nUdc tieu trong 24 gid ho&c chi lay
20 ml.
• Xem ho sd benh an - chuan bi ngitcfi benh
Thong bao, giai thich va dong vien ngtfdi benh ve viec lay nUdc tieu xet
nghiem de ngUdi benh yen tam.
• Chuan bi ngitdi dieu ditdng
- Dieu dUdng co du ao, mu, khau trang.
- Riia tay thtfdng quy.
• Chuan bi dung cu
- Khay chut nhat, gia dtfng ong nghiem, ong dong, hai bo men.
- Gang tay, hoa chat bao quan (neu lay ntfdc tieu 24 gid).
• Ky thuat tien hanh
- Lay nUdc tieu xet nghiem thong thtfdng.
+ Hudng din ngtfdi benh ve sinh bo phan sinh due ngoai roi di tieu phan
nUdc tieu dau bai va cuoi bai vao mot bo, phan gitfa bai vao mot bo.
+ Dieu dtfdng mang gang cho ntfdc tieu phln gitfa bai vao ong dong va
cho ntfdc tieu ttf ong dong vao ong nghiem khoang 20 ml, d&y nut ong
nghiem.
+ Dtfa benh pham va giay xet nghiem len phong x6t nghiem.
+ Sip xep va xU ly dung cu theo dung quy dinh.
- Lay ntfdc tieu 24 gid.
+ Trong trtfdng hdp l&y ntfdc tieu 24 gid thi phai c6 hda chtft bao quan:
Dung dich formol ho&c phenol thi cho m$t giot ttfdng tfng vdi 30 ml
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nU6c tieu, thymol trong rUdu 1% cho 1 ml tUdng ling vdi 100 ml nUdc
tieu sau do cho tang dan theo so" lUdng nUdc tieu cua ngUdi benh.
+ Dan ngUdi benh lay ca nu6c tieu khi di dai tien, day nap bo sau moi
lan di tieu va de cho mat.
+ Sau lan di tieu cuoi cung (vi du: 8h sang hom trUdc den 8h sang hom sau)
dieu dudng do va ghi so' lUdng nUdc tieu trong ngay vao bang theo doi.
+ Lie deu, lay du ludng nUdc tieu thed yeu cau cho vao ong nghiem, giii
nUdc tieu va giay xet nghiem len phong xet nghiem.
• Thu don dung cu
- S4p xep dung cu gon gang de dung ndi quy dinh.
- Ghi ho sd:
-(- Ngay, gid lay nUdc tieu, so lUdng.
+ Dieu dudng ky ten.
4.2. Ky thuat lay ntfdc tieu bang cach thong bang quang
• Ap dung
+ NgUdi benh dai khong tu chu.
+ Tre em khong tu lay nUdc tieu dUdc
+ Phu nfl dang co kinh nguyet.
• Xem ho sd benh an - chuan bi ngiidi benh
Thong bao giai thich va dong vien ngUdi benh ve viec lay nUdc tieu xet
nghiem de ngUdi benh yen tam.
• Chuan bi ngiicfi dieu diidng
- Dieu dudng co du ao, mu, khau trang.
- Riia tay thudng quy.
• Chuan bi dung cu
- Khay chu! nhat, gia, ong nghiem, giay xet nghiem.
- Khan khoac gap thanh hinh den xep, nilon trai du6i mong ngUdi benh.
- Bo, khay qua dau, tui dung do b^n.
- Hop hoac g6i vo khuan dUng: sang co lo, hai kim Kocher, gac, khay qua
dau, coc dUng bong t^m dung dich Betadin hoac thuoc do, coc dung bong
tam dau parafin, ong sonde Nelatol hoac ong Foley va gang tay.
• Ky thuat tien hanh
- Ngitcfi benh nam ngufa thoai mai tren gitfdng, trai nilon dtfdi mong ngtfdi
b$nh.
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- Phu khan khoac, bo quan ngUdi benh, xoay cheo khan khoac che kin chan
va bo phan sinh due, hai chan chong, dui hoi dang (tu the san khoa).
- Dat khay hoac goi dung cu vo khuan, tui dung do ban gitia hai chan
ngUdi benh.
- Md khay vo khuan, dieu dudng mang gang. Trai sang co lo de lo bo phan
sinh due ngoai ngUdi benh.
- Lot gac va dUng dting dUOng vat de lo bao quy dau (vdi nam), dat gac bd
tren xUdng mu (vdi nti) sat khuan bo phan sinh due bang dung dich
Betadin hoac thuoc do vdi nam sat khuan mieng sao, bao qui dau. Vdi nti
sat khuan moi ldn moi be, lo nieu dao bo kep da dung.
- Boi trdn dau ong thong, dung kim Kocher kep duoi ong thong lai dat
khay qua dau vo khuan vao gitia dui.
- Nhe nhang dua dau ong thong vao nieu dao ngUdi benh khoang 4-5 cm
(ngUdi benh la nti), khoang 15-20cm (ngUdi benh la nam). Md kim Kocher
khi thay nUdc tieu chay ra bo phan nUdc tieu d£u lay phan nUdc tieu tiep
theo cho vao ong nghiem khoang 20 ml khi nUdc tieu chay yeu thi gap
ong thong va rut ra.
- Lau kho bo phan sinh due, bo sang co lo, bo nilon, mac qu£n cho ngUdi
benh, giup ngUdi benh nam thoai mai va thay chan bang khan khoac.
- Gtii benh pham, giay xet nghiem len phdng xet nghiem.
• Thu don dung cu
- Sap xep dung cu gon gang de dung ndi quy dinh, thao gang va ghi phieu
cham soc.
- Ghi ho sd:
+ Ngay, gid lay nUdc tieu, so ltidng. *
+ Dieu dtidng ky ten.
5. KY THUAT LAY PHAN DE XET NGHIEM
• •
• Xem ho sd benh an - chuan bi ngiidi benh
Thong bao giai thich va dong vien ngUdi benh ve viec lay phan x6t
nghiem de ngudi benh yen tam.
• Chuan bi ngiidi dieu diidng
- Dieu dtidng co du ao, mu, khau trang.
- Rtia tay thtidng quy.
• Chuan bi dung cu
Mot lo mi^ng rong co nut day da tiet khutkn, mot tam bdng vo khnfln hai
bo sach, gang tay.
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