Don't worry about puncture bruises, just deal with them and get rid of them easily

This is the 4955th article of Da Yi Xiao Hu

Venipuncture is a common nursing operation in the medical process. Whether it is a physical examination, treatment or first aid, it may be necessary to draw blood or infuse drugs through venipuncture. However, have you also found that bruises of varying sizes often appear at the puncture site? Why do bruises still appear even though pressure has been applied?

Before answering this question, let us first understand how venipuncture is performed.

In order to accurately place the needle tip into a narrow vein, nurses usually insert the needle slowly at an angle of 15 to 30 degrees when performing venipuncture. Therefore, venipuncture actually forms two puncture points, one on the skin surface and the other on the blood vessel wall.

I often encounter some patients who ask, "I have pressed until the bleeding stops, why is it still bruised?" This is the first reason we want to talk about, the pressing time is too short. Many patients see that the bleeding on the skin surface has stopped, so they let go and stop pressing. In fact, although the bleeding on the skin surface has stopped, the puncture point on the blood vessel wall is still bleeding, and the blood accumulates in the dermis and subcutaneous tissue, forming a bruise. What's worse, a "small blood bag" will form immediately!

Secondly, if the pressing range is too small or the pressing position is not accurate, bruises will also be caused. In clinical work, we have observed that most patients use the "one-finger Zen" pressing technique, which can often only press the puncture points on the skin surface, but cannot take into account the puncture points on the blood vessel wall. In other words, the pressing range does not cover both puncture points at the same time, which is ineffective pressing and will naturally form bruises.

In addition, pressing too lightly will not effectively stop bleeding, while pressing too hard may cause capillaries to rupture. Pressing and rubbing will accelerate bleeding. Pressing once and looking at it will affect the speed of stopping bleeding. Pressing with bent elbows will change the relative position of the two puncture points. Too tight cuffs will cause poor blood return. These behaviors are the "culprits" that cause bruises!

Having said so much, what exactly does it mean to press correctly?

We can use the "three-finger pressure method", that is, the index finger, middle finger, and ring finger press along the direction of the blood vessel at the same time. During the pressing process, only press without rubbing, press continuously, and the pressure is uniform and moderate. If the puncture site is located at the elbow, the elbow should be kept straight and not bent. The pressing time is 3 to 5 minutes. Patients with abnormal coagulation function or oral anticoagulants (such as warfarin, aspirin) can extend the pressing time to 5 to 10 minutes. If conditions permit, you can also use an elastic bandage for pressure.

If you have accidentally developed a bruise, don't panic. As time goes by, the bruise will generally disappear within two weeks. What else can we do?

In the early stage, within 24 hours of the formation of bruises, cold compresses can be applied near the puncture site to shrink blood vessels and reduce blood seepage. After 24 hours, hot compresses can be used to promote blood circulation and speed up the absorption of blood stasis. If the bruise is accompanied by pain or swelling, potato slices can also be used. Cut the potatoes into thin slices, wrap them with gauze and apply them to the bruised area for 30 minutes each time, 3 times a day; or use topical medications such as Hirudoid Ointment (polysulfonated mucopolysaccharide) under the guidance of a doctor, apply the medicine evenly to the bruised area, and wrap it with plastic wrap, 30 minutes each time, 3 times a day.

Although puncture bruises are common, through today's popular science, we already know the causes, prevention and scientific treatment methods of bruises. I believe that everyone will be able to deal with it easily when encountering intravenous puncture in the future!

References

[1] Li Nan. Influencing factors and nursing measures of subcutaneous hemorrhage after blood donation [C]//China Blood Transfusion Association. Proceedings of the 11th Blood Transfusion Conference of China Blood Transfusion Association (2022.09 Dalian) - Blood Donation Service Special Topic. Anshan Red Cross Central Blood Station, 2022:2. DOI:10.26914/c.cnkihy.2022.088407.

Author: Shen Jiawen, Shanghai Baoshan District Hospital of Integrated Traditional Chinese and Western Medicine

Supervisor: Shen Biyu, Shanghai Children's Medical Center