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项目十二_ 标本采集课件

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标本采集ppt 标本采集课件
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LOGO The guiding ideology should be guided by Deng Xiaoping's theory, the important thought of “three represents“ and the spirit of the 16th CPC National Congress and the third Plenary session of the 16th CPC Central Committee. 项目十二标本采集 LOGO The guiding ideology should be guided by Deng Xiaoping's theory, the important thought of “three represents“ and the spirit of the 16th CPC National Congress and the third Plenary session of the 16th CPC Central Committee. 定义 标本采集:是指采取患者少许的血液、排泄物( 粪、尿)、分泌物(痰、鼻分泌物)、呕吐物、 体液(胸腔积液、腹腔积液)和脱落细胞(食道 、阴道)等样品,经过物理、化学和生物学的实 验室技术和方法对其进行检验。 标本检验是诊断疾病的重要方法。 LOGO The guiding ideology should be guided by Deng Xiaoping's theory, the important thought of “three represents“ and the spirit of the 16th CPC National Congress and the third Plenary session of the 16th CPC Central Committee. v临床常见的标本有: v 血液标本 v 尿液标本 三大常规标本 v 粪便标本 v 痰液标本 v 咽拭子标本 LOGO The guiding ideology should be guided by Deng Xiaoping's theory, the important thought of “three represents“ and the spirit of the 16th CPC National Congress and the third Plenary session of the 16th CPC Central Committee. 教学目标 v1.阐述标本采集的原则。 v2.能认识血标本的分类。 v3.阐述留取各种标本的注意事项。 v4.会熟练地采集血液标本。 v5.能指导患者正确留取粪便标本、尿标本。 LOGO The guiding ideology should be guided by Deng Xiaoping's theory, the important thought of “three represents“ and the spirit of the 16th CPC National Congress and the third Plenary session of the 16th CPC Central Committee. 本章重点: v标本采集的原则 v各种标本采集的注意事项 v痰标本、咽拭子标本、血标本、 尿标本、粪标本的采集方法 LOGO The guiding ideology should be guided by Deng Xiaoping's theory, the important thought of “three represents“ and the spirit of the 16th CPC National Congress and the third Plenary session of the 16th CPC Central Committee. LOGO The guiding ideology should be guided by Deng Xiaoping's theory, the important thought of “three represents“ and the spirit of the 16th CPC National Congress and the third Plenary session of the 16th CPC Central Committee. LOGO The guiding ideology should be guided by Deng Xiaoping's theory, the important thought of “three represents“ and the spirit of the 16th CPC National Congress and the third Plenary session of the 16th CPC Central Committee. LOGO The guiding ideology should be guided by Deng Xiaoping's theory, the important thought of “three represents“ and the spirit of the 16th CPC National Congress and the third Plenary session of the 16th CPC Central Committee. 任务二 各种标本的采集 一、痰液标本的采集 ★痰常规标本 ★痰培养标本 ★24小时痰标本 www.themegallery.com LOGO The guiding ideology should be guided by Deng Xiaoping's theory, the important thought of “three represents“ and the spirit of the 16th CPC National Congress and the third Plenary session of the 16th CPC Central Committee.三种痰标本的区别 www.themegallery.com LOGO The guiding ideology should be guided by Deng Xiaoping's theory, the important thought of “three represents“ and the spirit of the 16th CPC National Congress and the third Plenary session of the 16th CPC Central Committee. 共同点:验单 www.themegallery.com LOGO The guiding ideology should be guided by Deng Xiaoping's theory, the important thought of “three represents“ and the spirit of the 16th CPC National Congress and the third Plenary session of the 16th CPC Central Committee. www.themegallery.com LOGO The guiding ideology should be guided by Deng Xiaoping's theory, the important thought of “three represents“ and the spirit of the 16th CPC National Congress and the third Plenary session of the 16th CPC Central Committee. www.themegallery.com LOGO The guiding ideology should be guided by Deng Xiaoping's theory, the important thought of “three represents“ and the spirit of the 16th CPC National Congress and the third Plenary session of the 16th CPC Central Committee. 能自理的患者: —晨起后用清水漱口 —以清晨第一口痰为宜 —深吸气后用力咳出气管深处的痰液 —不可混入漱口液、唾液、鼻涕等 无法咳痰或不合作者: —用吸痰法收集(集痰器) www.themegallery.com LOGO The guiding ideology should be guided by Deng Xiaoping's theory, the important thought of “three represents“ and the spirit of the 16th CPC National Congress and the third Plenary session of the 16th CPC Central Committee. 痰标本采集注意事项 1、如查癌细胞,应立即送检或用95%乙醇或用 10%甲醛固定后送检 2、不可将唾液、漱口水、鼻涕等混入痰液中 3、收集痰液宜在清晨,因此时痰量较多,痰内细 菌也较多,提高阳性率。 www.themegallery.com LOGO The guiding ideology should be guided by Deng Xiaoping's theory, the important thought of “three represents“ and the spirit of the 16th CPC National Congress and the third Plenary session of the 16th CPC Central Committee. 二、咽拭子标本采集 目标:从咽部和扁桃体取分泌物作细菌培 养或病毒分离,协助诊断。 www.themegallery.com LOGO The guiding ideology should be guided by Deng Xiaoping's theory, the important thought of “three represents“ and the spirit of the 16th CPC National Congress and the third Plenary session of the 16th CPC Central Committee. 操作步骤及要点 操作前准备 核对 点燃酒精灯,指导患者张口发“啊”音, 用长棉签蘸 以敏捷、轻柔的动作擦拭 两侧腭弓、咽扁桃体上的分泌物,取毕, 将试管口及棉塞在酒精灯火焰上消毒后 插入棉签,塞紧。 将棉签插入 试管中送检 www.themegallery.com LOGO The guiding ideology should be guided by Deng Xiaoping's theory, the important thought of “three represents“ and the spirit of the 16th CPC National Congress and the third Plenary session of the 16th CPC Central Committee. 咽拭子标本采集注意事项 v作真菌培养时,须在口腔溃疡面采集分泌物 v避免交叉感染 v注意棉签不要触及其它部位,防止污染标本,影 响其他结果 v避免在进食2小时内采集标本,以防呕吐 www.themegallery.com LOGO The guiding ideology should be guided by Deng Xiaoping's theory, the important thought of “three represents“ and the spirit of the 16th CPC National Congress and the third Plenary session of the 16th CPC Central Committee. 三、尿标本的采集 尿标本的分类 v尿常规标本 v尿培养标本 v12h或24h尿标本 www.themegallery.com LOGO The guiding ideology should be guided by Deng Xiaoping's theory, the important thought of “three represents“ and the spirit of the 16th CPC National Congress and the third Plenary session of the 16th CPC Central Committee. 1、尿常规标本 查尿液的性状,有无管型和细胞,并作尿蛋白和 尿糖的定性检测 用物准备:一次性尿杯 www.themegallery.com LOGO The guiding ideology should be guided by Deng Xiaoping's theory, the important thought of “three represents“ and the spirit of the 16th CPC National Congress and the third Plenary session of the 16th CPC Central Committee. 自理的病人:清晨首次尿,1/3到1/2杯 留置导尿:集尿袋中放出尿液 www.themegallery.com LOGO The guiding ideology should be guided by Deng Xiaoping's theory, the important thought of “three represents“ and the spirit of the 16th CPC National Congress and the third Plenary session of the 16th CPC Central Committee. 2、尿培养标本 用于细菌培养和细菌敏感试验 用物: www.themegallery.com LOGO The guiding ideology should be guided by Deng Xiaoping's theory, the important thought of “three represents“ and the spirit of the 16th CPC National Congress and the third Plenary session of the 16th CPC Central Committee. 中段尿留取法: 1、导尿术 2、按导尿术清洁外阴、尿道口→嘱患者排去前段 尿→用试管留取5-10ml中段尿液 www.themegallery.com LOGO The guiding ideology should be guided by Deng Xiaoping's theory, the important thought of “three represents“ and the spirit of the 16th CPC National Congress and the third Plenary session of the 16th CPC Central Committee. 3、12h或24h尿标本 尿生化或尿浓缩查结核杆菌 12小时: 7pm排空膀胱→翌日7am 24小时:7am排空膀胱→翌日7am 请病人先把尿液排到便盆或便壶内,再置于3000 -5000ml带盖的清洁容器内。 用物:容器(3000~5000ml) 防腐剂 www.themegallery.com LOGO The guiding ideology should be guided by Deng Xiaoping's theory, the important thought of “three represents“ and the spirit of the 16th CPC National Congress and the third Plenary session of the 16th CPC Central Committee. www.themegallery.com LOGO The guiding ideology should be guided by Deng Xiaoping's theory, the important thought of “three represents“ and the spirit of the 16th CPC National Congress and the third Plenary session of the 16th CPC Central Committee. 常用防腐剂: 甲醛: —防腐和固定,用于作尿爱迪计数(12小时尿细胞 计数)等 —每30ml尿液加 40%甲醛液1滴 浓盐酸: —作用:保持尿液在酸性环境中,防止尿中激素被 氧化。常用于内分泌系统的检验,如17-酮类固 醇、17-羟类固醇 —24小时尿中加5-10ml www.themegallery.com LOGO The guiding ideology should be guided by Deng Xiaoping's theory, the important thought of “three represents“ and the spirit of the 16th CPC National Congress and the third Plenary session of the 16th CPC Central Committee. 甲苯: —保持尿液的化学成分不变,常用作尿蛋白、尿糖 的定量测定。 —用法:每100ml尿液中加入0.5%~1%甲苯2ml, 使之形成一薄膜,覆盖于尿液的表面,防止细菌 感染。如果测定尿中的钠、钾、氯、肌酐 、肌 酸等需加10ml。 www.themegallery.com LOGO The guiding ideology should be guided by Deng Xiaoping's theory, the important thought of “three represents“ and the spirit of the 16th CPC National Congress and the third Plenary session of the 16th CPC Central Committee. 尿标本采集注意事项 —女患者月经期不宜留取尿标本 —会阴部分泌物过多时,应先清洁再冲洗,再收集 。 —做早孕检查试验应留晨尿 —留取尿培养标本时,无菌操作 —留取12h或24h尿标本,集尿瓶应放在阴凉处, 根据检验要求加防腐剂。 www.themegallery.com LOGO The guiding ideology should be guided by Deng Xiaoping's theory, the important thought of “three represents“ and the spirit of the 16th CPC National Congress and the third Plenary session of the 16th CPC Central Committee. 四、粪便标本采集 意义、目的: 1、了解消化道炎症、梗阻、出血、寄生虫感染等 2、了解消化道状况,粗略判断胰腺的外分泌功能 3、粪便隐血可作为消化道恶性肿瘤的诊断筛查试验 4、检查粪便中有无细菌感染,防止肠道感染 www.themegallery.com LOGO The guiding ideology should be guided by Deng Xiaoping's theory, the important thought of “three represents“ and the spirit of the 16th CPC National Congress and the third Plenary session of the 16th CPC Central Committee. www.themegallery.com LOGO The guiding ideology should be guided by Deng Xiaoping's theory, the important thought of “three represents“ and the spirit of the 16th CPC National Congress and the third Plenary session of the 16th CPC Central Committee. 蜡 纸 盒 www.themegallery.com LOGO The guiding ideology should be guided by Deng Xiaoping's theory, the important thought of “three represents“ and the spirit of the 16th CPC National Congress and the third Plenary session of the 16th CPC Central Committee. v大便培养 www.themegallery.com LOGO The guiding ideology should be guided by Deng Xiaoping's theory, the important thought of “three represents“ and the spirit of the 16th CPC National Congress and the third Plenary session of the 16th CPC Central Committee. www.themegallery.com LOGO The guiding ideology should be guided by Deng Xiaoping's theory, the important thought of “three represents“ and the spirit of the 16th CPC National Congress and the third Plenary session of the 16th CPC Central Committee. 采集粪便标本的注意事项: 1、采集培养标本时,如患者无便意,用长无菌棉 签蘸生理盐水,由肛门插入6-7cm,顺一个方向 轻轻旋转后取出,将棉签插入培养试管内,盖紧 送检。 2、病人服用驱虫药或做血吸虫孵化实验,应留取 全部粪便送检。 3、患者如有腹泻,水样便应盛于便盆内送检 www.themegallery.com LOGO The guiding ideology should be guided by Deng Xiaoping's theory, the important thought of “three represents“ and the spirit of the 16th CPC National Congress and the third Plenary session of the 16th CPC Central Committee. www.themegallery.com 五、血液标本的采集 LOGO The guiding ideology should be guided by Deng Xiaoping's theory, the important thought of “three represents“ and the spirit of the 16th CPC National Congress and the third Plenary session of the 16th CPC Central Committee. 血标本的分类和目的 全血:用作血沉、血常规和测定血液中某些物质的 含量,如肌酐、尿素氮、尿酸、血糖等 血清:全血自然凝固后析出的液体,用于生物化学 、免疫学检测等,如血清酶、脂类、电解质、肝 功能 血培养标本:查找血液中的致病菌 www.themegallery.com LOGO The guiding ideology should be guided by Deng Xiaoping's theory, the important thought of “three represents“ and the spirit of the 16th CPC National Congress and the third Plenary session of the 16th CPC Central Committee. www.themegallery.com LOGO The guiding ideology should be guided by Deng Xiaoping's theory, the important thought of “three represents“ and the spirit of the 16th CPC National Congress and the third Plenary session of the 16th CPC Central Committee. 采集法 1、静脉采血法 ★全血 ★血清 ★血培养 2、动脉血标本采集法 常用于血气分析 3、毛细血管采集法 常用于血常规检查 www.themegallery.com LOGO The guiding ideology should be guided by Deng Xiaoping's theory, the important thought of “three represents“ and the spirit of the 16th CPC National Congress and the third Plenary session of the 16th CPC Central Committee. 全血标本: 紫色—— 血常规,2ml 蓝色—— 凝血,2ml 黑色—— 血沉,2ml 如用注射器采血,取下针头,将血液顺管壁缓慢 注入有抗凝剂的试管内,立即轻轻摇匀使血液与 抗凝剂充分混合,避免血液凝固 www.themegallery.com LOGO The guiding ideology should be guided by Deng Xiaoping's theory, the important thought of “three represents“ and the spirit of the 16th CPC National Congress and the third Plenary session of the 16th CPC Central Committee. 血清标本 红色——生化检查(肝肾功能、离子、酶),5ml 金黄色—— 快速生化检查,5ml 血浆标本: 灰色—— 血糖检查,2ml 绿色—— 快速生化检查,5ml 取下针头,将血液顺管壁缓慢注入干燥试管内,避免震荡 。 做生化检验时,应空腹采血,事先通知患者禁食。 www.themegallery.com LOGO The guiding ideology should be guided by Deng Xiaoping's theory, the important thought of “three represents“ and the spirit of the 16th CPC National Congress and the third Plenary session of the 16th CPC Central Committee. 血培养 1、预防败血症 2、确定致病细菌,确定抗生素 3、监控抗生素的浓度和细菌杀死的情况 www.themegallery.com LOGO The guiding ideology should be guided by Deng Xiaoping's theory, the important thought of “three represents“ and the spirit of the 16th CPC National Congress and the third Plenary session of the 16th CPC Central Committee. 肉汤 琼脂 www.themegallery.com LOGO The guiding ideology should be guided by Deng Xiaoping's theory, the important thought of “three represents“ and the spirit of the 16th CPC National Congress and the third Plenary session of the 16th CPC Central Committee. www.themegallery.com LOGO The guiding ideology should be guided by Deng Xiaoping's theory, the important thought of “three represents“ and the spirit of the 16th CPC National Congress and the third Plenary session of the 16th CPC Central Committee. 抽血培养的注意事项: 1、严格无菌操作 2、检查培养瓶的有效期 3、一般血培养的采血量为5ml,亚急性心内膜炎 患者,为提高培养阳性率,采血量增至10~15ml www.themegallery.com LOGO The guiding ideology should be guided by Deng Xiaoping's theory, the important thought of “three represents“ and the spirit of the 16th CPC National Congress and the third Plenary session of the 16th CPC Central Committee. 动脉采血法——血气分析 血气分析是医学上常用于判断机体是否存在酸碱 平衡失调以及缺氧和缺氧程度等。 酸碱度(pH),二氧化碳分压(PCO2) ,二氧化碳 总量(TCO2),氧分压(PO2),氧饱和度 (SatO2),实际碳酸氢根(AB),剩余碱(BE ),阴离子隙(AG), 肝素抗凝动脉血2ml,抽血后要求严加密封,不 能接触空气,立即送检,天热可放冰箱中,并记 录当时患者体温。 www.themegallery.com LOGO The guiding ideology should be guided by Deng Xiaoping's theory, the important thought of “three represents“ and the spirit of the 16th CPC National Congress and the third Plenary session of the 16th CPC Central Committee. 为什么要选择动脉血? www.themegallery.com LOGO The guiding ideology should be guided by Deng Xiaoping's theory, the important thought of “three represents“ and the spirit of the 16th CPC National Congress and the third Plenary session of the 16th CPC Central Committee. ——普通注射器法 1、部位选择 桡动脉:穿刺点在前臂掌侧腕关节上2cm 动脉搏动明显处 股动脉: 腹股沟扪及搏动最明显处 2、局部消毒:直径大于10cm 3、抽吸肝素:抽吸0.5ml入注射器内,湿润注射 器内壁后,余液去掉。 www.themegallery.com LOGO The guiding ideology should be guided by Deng Xiaoping's theory, the important thought of “three represents“ and the spirit of the 16th CPC National Congress and the third Plenary session of the 16th CPC Central Committee. www.themegallery.com LOGO The guiding ideology should be guided by Deng Xiaoping's theory, the important thought of “three represents“ and the spirit of the 16th CPC National Congress and the third Plenary session of the 16th CPC Central Committee. 4、穿刺抽血 戴无菌手套,用左手的食指、中指固 定好穿刺的动脉。右手持注射器,在两指之间垂 直或与动脉走向呈40°刺入动脉,见有鲜红色回 血,右手固定穿刺针的方向及深度,左手以最快 速度抽取血液。 5、拔针按压 抽血毕,迅速拔针,同时用无菌纱 布加压穿刺点止血5~10min 6、处理标本 立即将针头斜面刺入无菌软木塞内 ,以隔绝空气,连同验单立即送检。 7、整理记录 www.themegallery.com LOGO The guiding ideology should be guided by Deng Xi
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