MON TORI]LOF CALALROMAN E

Crpitolul ? IERAPII VASCULARE

7.I
.dete rului veDos p erifcric pcn tru pcrtuni c!turi in puncliondq unci lcnc rrirericc, in condlliiJc ascpsie ieuroasr.5j adnrjnislrdcd ur or solui i m cdic.men rorse, inlcnitcnl sau conrnr!u. in cnculad. vcnorsi. Accst carcrer ene lisar pc loc in tunctic dc ncvor si^atr in luDctic dc durala rml.rnonrutui.
M
0

ntN rcN

rbldri' .d.ldrulli

se faoe nurui la indmrt. mcdicutuij rctdsdrca sa va fi impcradva ti inodiari jnainlca oricrru slspiciuni dc inflamaric sou i'ifecic a loorlui punclionar sar in caalunor sdmnc g.n.rde dc intcc!ie suscctrjbiic dod ii lcFatc dc nre/enla cdetcruluil c.roterulmpolrc ii mcnlinur (in condirii n.nnaLe, firi conptidalii) maimulr dc 96 dc ore (3 zilc)jdc rcguki, sc s!.lrinbii locrl inscrrlei la .13-72 otoi solutiiLc dc bdzn cclc oii Lrilizalc sunr clorur.1dc $dtu 0.9%, el0cozi 5%. t0%. sotutii hidrocl.crolnicd (soLu!ie',geo: ba(d nrdiclnreDrctc soluliite rdiugarc sc imc$c.i cu solulia de bazi I'rirl

'

'. in solutic lrcbtric ncm nrre pc '".r.oJr..!!c ddrueare DcdicmdrcLc o bandi adczivlt llpiri lrc ilacon cu,lcnumirc. con.ri, carriraiea prcscrisi: nune, sar prcndraRr nnci Dcrtuzii mixlc si mnipulared ei, xbui. efectuoi. in .ondidi de ascpsic deoarccc soll(iic dc pofuzlo $Dr un ndiu bun pcnlrudcaoLlarur gcmenitori sc.trch'd dc ld dncftcun dcoricetipl - siinlol. si ddiladc de sangei - soluliiLc de aniroacizii
emulsiilc llpidicc: sotuiiilc conccmnle pentru toramcnl dstodric (muitor, osmonrndin)j solutii n.lrre pcDro corcct.rcd &hitibrutui acido-barc (hjcarbond de sodnr 4,3%, ri..t9l". clorura dc polasiu 7,45%)i data expilirii unci solurii rcbuic veriica$ inlotderuno Dcntu a eviia adninisiEnr nnuliidcvcnn, indcrvt sal bricrj sislcDul dc p$lizic cu lihru de aeristrc incortonl ir .anctu de piciruri. Ircbuic inchis ifai c dc intrddlceE! unor solulii nrediclDrcnloasc in recipicrtut dc rcrtur.. pcnrru a ovira hetea lilinlLi .u lichidul dc pcf0zic si a sc pisla lnic!ionatjlara rccnuia: .r,\:l .oJ. oi a o. - tL ni',u' o un ,o,., F

nFJt iF 1.'e hi.n'n.L'in'

ri.i

ea 'i 'lu -

' tr

..

a!.

r.

numir picarui/mi.ur:!olu'nul lotaltinpulin minurc x numir picaun/minur = vorrnuL brrL al sotuljci (in mt) x piciruriht sau dunl, pcdnzici (jn minure) E\anptu
de

!.rat = I liltu s.hrie Glurczn 5% D rut. Pe,ttEiei - 21h 4a1nr1.)

v.hrril

.u/.

|arc

. n ndntlti

.le

pi6tu

-i

./

pat

lLnnull

.1,n:

N rlantl d( pi( /nin t= t000r1lr2A/ 141)= t3,33((u. t4 pit/unn

covA\nlaAPl}l'\lob9btsll'.201.

I n

dicrtii $ i con rrdindi.rtii

- hidmtm i ryort clerrolitic: dinrcntalic parcnreali: - .po dc ucdicamcnlcl

tansluzjo.tr riinlo Jldcriv
c dc sdngc.

lndica{ii pentru diagnostir - prclcvin d. stngc, rcpctatc intu'un inteNal de tinp scuni adminlsrmrd de subMnrc dc conm$: Accstc indicatii lrcbuic limnare h sricruL necesr' $i r.vture ,ilnic in rirrctic dc n ca pacicnlului, si in panicular. in iunclic de aptitudi'!c! sa de r Drimi tmt!rrcnnll pc c.lc diseniyi.

Constraindiotii absolute
Nu
sc va

pETinti

puncfiona bralnl caE fi$Li anernJ vcnoasii

abLrlio ernBlionilor axilari.

brlrul este DaDli7Mu hrndi4rj erinn leziuni outdDore !i infec!ii a loourile

de puncliomrc.

se se

identiri.i Fdcrr!l: irtbflncazi d.sprc iDport!4a ridurah proccduii

.ri cvcnnrdl

Jcirrt lsp{rclc lce.rc

dc

{bonlcnzi dcngdr, bbtL ncdonindm nl t'cicnruluii insralcri conlonahil: dcpilcr, car dcDikrhre imporraDtii ^nain se explicd acstorilc cc rrcbuic clnae pcntu prolqarer abod sinnlomcl. unor cdmplicr{ii pdl.nrlale.
sc sc sc

tu

vcnos prccutu si

supon

pcnh pdliLzic h picio{rolc prtului. dc pRferinlt mobil daci peicntul

cstc

mlre al pentn protcctia patuhil o pcrehDdcninutld. unici f.losinlJi

conrprcsc stcrilc/timDoatrc dcvord:

soluliidnriscpliociod{rcs clorhcxidin alcooli., dact pacicnrul pungicu sdlulii d. pdfuar, indi.d. dcmddici

eslc

aldgic h iod;

xlcprc\-i.cpenradJn! 'reLlirr.c tnuadcpcftzxtncnli d dcbinnctn

irdt.rnrcru/.

si unr

eumrihlhe ciidc l)crluzdi

MONITORUL OFICIALAL ROMiNIE

pcDttu ncordrftr !inntr.ni al I)crl0zi tr acecasi inic vDnorsi: catoterc / hmntrlc dc dimensiu.i difcritc: plasnd, tdNancnre rdezivc dc rin folic sau plr\i:

robincr

tifizic

Dcrnc

phtu poziionar.j .\entual

alctc

pmruo pozllie corrinabili

braFtuinrairtcs lx

I'regitircn lini{i dc Dertuzio - s. verilicaUcsoriprixhrdiralii \c spili miituld si se i'nbnca miiu:i

' -

dc utrici tblosinlii scdddpbrzt (ubuhtom pnncipali lo pmgr cu sotutte scitii :c ddaugi robinctul la ciilc dc pcrtnzaft a $lulirkn. docii sunr Deccsre nrai m0trc dcnvati. .noi pElunginrrul cc vd lj.drprat la calere t/ bfrnLla cndovciorsi: se clrnpcad rubul llcrtuzo{Lltrij scutuple crNcm tiuu.ldtului h runftarei sc doschidc prcsubul /clcma penm a puria lrsambhrt liniei dc pcrtua!: se clam|]Nz-i dpoi {ubul pincipal xt pc.tirzorutri j sc rcopcri jeri i sc ,lor.az, rubulatura pincinrli ri sc schinbi la liecarc 2.j h daclt Dcrttr7i. duea; mai

se

lnbnci ntrusi $crihi

scnaselzdhmtLLl pa.icDrtrlui dcasupD mlrcrialrttridcDbrccrje: vcnd de punciion tuand in catcu princiDiuL \chimbrtud ldcunlor dc pun.lninrrc: s! .pli.t grrcul (nu s. menrinc rnaindr de 3 hinurc)si sc dcrrticteaza lar! zona dc
sc

rit.. mzr \!hoj\i ituhu an$ial Friliric

sd crcrcna o prcsiunc
1

se

priDcazi. in caz conlEr sc mat llibcsrc

.u nrlnd n.donririnri
J. nrtudu.. cotcrurul

usord rsupm etii Dcnrn a $abiLiz

sc

\rn!

brinlL! or vnrflt mandnnltui oneniar in sN lt

tunctjor.az,

. ll -i.i.L r"

oo

'.1

ctru

tr'

r T,. \,d!

t r inJ,hur:

n..drenul in rcoipicmut lpccjati \e admrcaTi anbotrl pdn4rului la broutar se dcs.hidc tubul portirdruluii
sc rtunca

tunxcazaclrcrctul/branulrcLunpansdtucnroclNivrerit,ituhztndncordu r.mi 'rJdJdr.dzinurctutd.1i i nr-., , L nc,tr J . ouor .bn c.Lndrdi

t.

i minusilc. sc spah menilc: \e norca^ F.ccdtrid in Fisa de procsduri (nmo. daii,

sc inde_pancru

or.

minijrini, tipul *rltrijci,

n,,-d.!\F.,..'.',J.o1 i teno,(. 'lu - inleclir locaLi dclccrdta pdn scm. i'rfllDarorii lo.ate: eriicm. dumr,
rc.m/.'
tu

cxtdvazarca $luliei in

\L'

drE lcrci ti

lrtrhcfiorcr du6r.$a azonci:

citdud locati.

mcticl ic s i lczdra funclici scemento lui rcspecriv: obslru.br crtcrctului / br$ulci cu chcaguri dc singc

rbscnh jmnerctor shndrrd dc

dc 7.2

cde'nul pulmonar & d prin hiDerhidr arc h cdztrl in.an nu se calcuLe,i corcct trtrmirut picfturi pe miDurtiN rc rctrccl,linpul dc pdrtu^re.

tlenrj.qe! si ingrijir$ unci linii venorse oxktcntc lnsrijirca unci linii lcno$c prcsupunc:

vcrili.m pcmcahilii4li &leteduii pcncabiliTareacalctcnluil schnnbareapaNancmclor si a nxatorclori schnnban rfu/offi lor ii a s.hrliiLor pcrloz$ilc
iixaioarclc sddsi pansrrcnrdlc se sohiDbi arunci cind scudi scnld5rc{, sruodrri cu r$cnra untr1 nou da(ebr: l! picicnrii cu adninisrr.re iftavdoal' coniinui, I)crlu2or te se schinbi la 18 orc jar

. c.lererului tlchuic schnnbar ta fiecarc ?2 orc ti lrcbtric insDedar l. fixatoDllEnsFrcn! sis.nipcmeabil: pcnncabllilater canulci/bratr0lci ln caz de pcdnzic/adminhtmrc i.tmirenra sc ve.ifi.a pnn asphrrc inoinld ori.rrci MDini$rai inravenorse
l..ul
de inscrlic
ficcare 4 orc nnn

Penrruvcincucasi pcmelbilizma bftnulei:

dc 5 nl c re sterilc: fiolc cu serliziologic. heparinij niru$ dc uni.i rolosinla:

sfingi serile

Penh schiNbarca pflrsamcmrtui / fixdrontni

0adrri dl.oolizarc suucu bciadini: bdnd,j xdelivlcuco xsi .ompEsc $crl lo sru fixaior tmn spa rum si se'niperDcabi t. Pcntu schbb.r., $lu!iilo! laconu /puneo cu solutia dc ddhinistrati

Pcnltu schinbarea

bcnziadczivcphtd noErea cvcnu elo. Drcdicrmc periizonlul

rrusi dc

c inrodusc in sotulh

porfuzabiti.

pcftz.r (erili:

MON TORL]L

OFCIALALFOMANE

s.N

S. prcg csr Darmrlele Dcccs.r. pc ciflci.nrLdc tuctu respc.rind..gtrlx Jc baza in ce l].jrcnc

cxmarerillclor{.rie\i.u'iird..clcmudrrcildcrecipidrL.lcdecolcci.re

'

{ \rr li.a prcsripria medic.lai rc id.ndlci lr]cieffuli ic oplicli plcicntulur. in renlcni

p.ntu!.i din,iu rnxidatcrj
sc

a.(sibrti

procedura penrn

obrinc col.borrrea sr

inbradr, ohli8rhnr.

'niinusi

(cilc ci.d r hcrrui

nr zona

d. jiscnie I cxr1cf,r,,i

Pcm.ihiLiTarcxbfundcr serfiziololi. sc d.!cr2li sdringr cu scr tirnJ ogir h birtrulii rcspcd,Dd rchntcr rscDtrci: sc rsp,ri si\c obscFa dacii 1lpi.ur sitrsc in so ingti: - dlcii m rparc si.s. i'r si'r:., qticli on grrou de!$Drx locu 0i dc i'scn1c nt [rcrcn,]rl trmp de I nriiur. dwi cJt sc rsp .:i Jin Dou: dfti nici dc dah accxno fr rprc \iDpc in se,in!i. sc injluerz.l t<nr nn ii- ,3,!

itr!rtuul: d.ci \c jnriopni rczi(cnri la injecirrc. sc ijrrctupe otorrft .onrjdc

5i'nplu dupi .c s. dcs

trd brrnuLl

P.r.ubi, .rbrxfucic! hqrarini(d.ca h$annr c$c conPaiiblii.u seddmi,r *,art r! lr.Lr d tr!. tulreoa. ni ri \c. ltznnogic h bnfuli Bpcdjnd rchnrca xrcpndi
\r:nrr.ru7.l.nr \olulia 0ini !iid uiserra t. rnjech cjc dimirnuri siIruuis.
rcia.

\!lnmbxEa p.n:lrnctrNLLri *tr llxakrruLui se i rdcpinerTa vc.h I u I lixrrrl !e dczinftdcaTa mlnnlc cu un gct mrt\q'ic sc iftbnci Dri'n'silc ncri e:

set..grrcicnoulfi\ab(

s.ll\cd2:i crrereNl.t nina Dcdo'ninanhrcnh x trey.ni hisciilc .ccidcDkrtc unnarc dc ic!rua din lcra sdtr pcdn'arcr vcrci. sc.Lddcn.ronric z.m ctr padLri aLcootj/xre satr n, bdrdina. prin nrtscrriciLul.rcl se lasa nieler si sc 0n'cc \i alo sc .tlici jixalonrl nou sau nrn\rDrcmLt: ieci la locul nrDr{ionini !e obssvi \cnnc dc nltrmaljc (cofqcjic ruDrcticrie dr0i

. tlj..., .p ... ",1,,,,rDiltJ,rocrr. jcil si se cxrrJge .ddn.nrt ni,) s. rcopcri zon. dc puD.rioD0. rtr u poN.mcnt ".,.,.
conn.rni lo.u naf i sc optut re sirg.ru rca: sc.plicia|Dlu b rj ie/iv...mprcsir: sc urtio !1'/t. rhi lcni si sc'
se

MON TORULOF

CALAL ROMANIE

Schi'nbarcr solutlcido po.li zx{

s. instccrerzi pu4. sau U.conul ctr soluria pcnh a iieriUc. cvenrLrtelc 'lc FrtirzoL modilican: dccoldirer $lurlei, astrct hr burc, cxpi.ard remrcNlui de vatabititoic.
fisumrer flacooulul sru purgii:

pcnu^nrtul pcnrtr d impiddica pahnderer a.n'tui nr siycm l esie adoplai L n.c.n); pc.rtuciorulJe Lucruse pregtrege nxconuls. pmgadcschiDb sc inddpireaza ceacnl sar ddnulnaconuhri t sc dczinttcrcr^ cu DadllcooLiarr se indcpartc.zi n.... tr I vec h i dln $rr ir si sc scoah noc{nrl pffuzorului d ii a. csn: sc inrodtrcs imediat tocarul pcinzonrlui in ll.c.tr0l pcrftrrorului in flrc.nut sau Frgr idui iisc suspcrda in nlri\i se dcclanrD$7.i ltrtarl pcrluzdrultri larcnric \i nu dxi$c .( nc 1ub) ,si sc tis, rohlid st curF ld rirhrl dnifior su l. .lr nh rrescris dc mcdic.
se clampciz,
cncu Ldor (in

ru ul in c,r pfinrzorul

hl

sc chDrpcaza pcrtu2orulcu

( iurc,0..'n

ic

sc sc

dczinlccren/i dopuL ilacoDului nou sisc lnrddurr rocarutDotrlui rsrfuzo. nr n.!or: cwuerTj rcrul dc ubuL ncrllzonlli si apoi se inctridc prciubut:

n.o" ili' p

crilcra de Dicumlc pcjumaturc plinil

nJ..n i.. .!rF,n r.'tr

se spala Draini c cu

ui.euN

dnriscpric:

s. nnhacii nidtrsi icnlc: rc ptrnu o comp li {cnli deasupm lo.rlui de insenlc . cdclcrului fi j. pr.u/a rL ur J.gd pcrh a DEveDi singeHeal s. dcconeure!z.. cn.rcntic!c.hiuLpeduzor lirii sii s.!dcm rrjd.nratj bnnLt3l

?,3

scindepinc.zicnpxculprotecto.rlfouluipcrlnzorsi{adoprrziLrcd.rcnrtlcnos. se lixcazi c.teterul ;i nib(l pcrlirz.tul$ h bglment .u un fix0lor r.inspdrcnr !i senipcm.i b i L avind griji sa pcmi(ilibcnarc de mifarc padientului ri slt prcvi ie$iEa .areleruLui diD vcM l{ o mis.arc bnr$i: sc indcpi caza pcnizonrl v cchi si sc lruncd ir r..inr.ntu I coDranimr.i 'n.lfialc pa.j.nluhi. se supnlcelicszi ntrldcscurgcre,loort pui cr ionat I j compoiranrcniul

ind$nrtrrer disp0znivului intrrr.nos Derife.ic

tucvcnnda co'!pLiciliiLor locrlo.

rcc il' icr

lc pcnlr0 .olcdarda dcscln or.

disDouilivele intL.lcnoasc !'nr schi'nbai. nr unniiro.rutc \iruatii la indic.F mcdicrLuicdt inrcnrnclcrapia rr\emasii rhfthrrer locuLuiDundiclh 72 dc orc DeDbua co.rinur ic.iDtx nnnvcnoasil

. .

da.i li tocu puicriodarn rparqeala. cdc'n. durere sau tflituric suhcuhnaa: d&i bdidr rdczirii 4licrrii deasupn loctrtL'i punciici nu .rc(ni suficicfi lres uc: pcnh a prc\ cn i sin:erarca sr h.mrbnru : ntr \c schi'nba [crodfti nn d*pTitiv irrmv.ros in ttrncr]unc lx un rucicrr ii std! cririca piii ciid Du \e e\ecuii cu nr.cs. o rlri runcrie lcmaril

prcgiics. toorc trDlcridlclcr lcri llcii dui orJ nru I dc lc.nin rre sc nluliliciprcicD{tr1:
se

sc

a rcraplci

i.v

x fonaLo.xr:

s.cxplidiptucedlr:plcicntuhrs1s.rveniTcrzinmicDrlcivasimtiouy iscr/iiicdr
s. id.hidc rrc{ubuL,..m D.ni'z.n'lui. Jaci telfu/lx csrc in dert0rci

'. 'i \eohr$;1\ t!tror.:zatrrcaloctrluiNnclioialiialesutuuidi,rjur \c as.a7a o onpr.ii n.nli dcxsutQ locuh'i puncrnrnat. .r.tonind o usoari nre\iunc: r. indcrran.id ,rul din !rni sisc coilnrirni loo'l: s. vurilldi drca dlspozirnal din ycf i c*c jnft ri ' xr indcpincyi corrpr.s. cind s:ingcrrcx sc oprclc si se a'u.i in rccjp cNt Jc Jqieuri: sc asepriz..z, locuL si se rpLi.i i c.nrprsli rcnti. utitjziid rchrtcr ascprici,i b.ndr de
$ irun.i
sc
se

Jr',

,.

,ptr i. u... a

\.rifi.i

echiPaDrfh'r: diD n.! dupa 15 nrinu{c ocut pnn.hei. rcnrm

sii evire oricc

. tu

rsisun cll stn!c.0,ca sa

s. n(n cic r errul

i'xtrui.r{c prci$rul

rcrivilarc Lr nir!tul {gnrertotL,i rtccra! sa nnunl. rsisrcnk tucdicali Jaca sinlc.rrc. jlaDarc ta l.cnt

scinrtuieaza pldcm'tsi c'casci i|g.indc Lidridc d.ci cje tosibit: sc norcrzi |lrtJcedurr dc nrd.piirlirc a Jispozni\rhri inhlcios in t;ira dc pruccdn.t

7.r Plrtictprru l, puner.a ii lndcpnrhrc, catelerului vcnos ccntrst lqxpr \cnorsicerral c$c o nn).edfti d. D.to rchnicirare ctrrc ifti j,r dribdijtc nredi.n ni ,,d. ieip'. 'u' '-.J . Crrererul rcnos cenrml .$c utr c.1cr( vcnos neLil. corLciomr (L crlciuc potnrcrar sN silicon..rre sc iorod0cc lansrurrn. tnr o \cni ccnra;i dc.itrb

MONITOFUL OFICIALALROMANIE

colaps.ifullror Dcriftric (lenele pcritncc

{nr

cohbarc Dri[ p.]busirea oncutarici

4lnrinislrarc. unor c.nlilfui n.i de fluidc ir !rgcrtci hranenl intavenos indcluneai; nutrilicparcnlcnid cu soLuiipolinumi!c (or. Krbilcn)j nroniroiTrrca prusiunii vonoasc ccmhlc.

d\h mai costisiroarc

dccfu

lcrapiavcnoasipeifericil rombii

risc cr.sculde complicntli, pnermotoEx, scpsis.limrrca dc pcrfiJmrea de orgrnc FiMscnr timpul nrorlirili scidcrca srdului dc mobilizrrc a pac onrulli.

P.nt0 inscrri. ca brcru lui venos centdl : rc lor prcCiti pc caflciorul dc lucn'. seDarind circuiru] malorialctor sre
nratcialclor

rnrd,r rm'.,nr..

tc cuixre cu cel at

rrisli chnursicalci

cdmrurisLcilo: padlri alcoolizrcj

hsa dtpdflrdrl
ccnti.lc dc 14 16c: seri'igi dc ditarir nrnni (eile (1.5. t0 mt)i sohlii salineneriLeinpungi sau lhcor.ci solLtii inesteTice: Xilini l%l co'nprcsc dc iilon scrilci rli slcrild pchltu strrurij
2 caiere! renoasc

tiarlc.n
li xdlor

iciilt:

tansp, icm si scminencabi ll

$i cu

tiolc.u hellind

soliziologictcnlru vciliodrc, \jspil.rc. daretcDlui:

uns ent c! !trlibi.tjci Maicrialele sterilc sc vor.tczr pc un.:nnp rcriL.

Pcniru

nnbpiimra daiererului venos cc.htl niinNi dc unicd folosintii

lrus, cu pcnsc ncriLe. bisruriul paduri rlcddLi4te / comprcsc slc lc: prnsamcni n an$r rcn r. {dczi v i forrticc $qilii. M$.nr cr bcbdini: rccipicnrc acrilc n,edii de culturi ncn1ru insitrraDhrd singctui iccotrar dc pc vartirl catcrctuluiextr\ drct cdc ic.c\xr

MON TORUL OFICJAL AL ROMANIE

. scoblinc$rsiDrirliir'l
s ficc.,r iic/r
sc x\cr7a

sc

nlmhlici t,rcleri,l:

prcicDh,

ri(..ft.mcd]c pcnh r.\:jLdc

lo.Dmirl na.rcnru tri fxnrili.r

0tr

$srull

isrorir

- \r irno !.

rl.7i sub rc!nru r.rxhci I pxci.rrLttrr pcnru a pror.ir .rjcra dc prl: cipulF.irnrunisprc |nicr optrsi inrolcnljci renhn r n,c\.ni.oiiimrar.r rNidc ris.iic I crrcrnLli.u !\mr[Lixlenri piiogcnr nrovcfrh din c]tk rcsntxhis p.nrto x fx Tora mirc!!s bill (o Nnrenra \. cnrn. Fci.{t in rceaji lo/ir.): \r Dagfun. 7.r. d. i'rc..nri.: raderc tr nehie. d.7 rltchc i ! /or.h iiihr!. i'rllM r: tr'.tliorlcrcllfhr \i \iptrM Nscx. bhrl. Drnnaitc. de idcncni. .u uf .irp j..il decup.r I n ioc. antct incitr.
o

Itr { is.xrii

f.licrtul pozilictrrni.lcnblrgpcntruap,oduccdtLrhrcryefcL.rcc[:lcsi .r, t'.F ho' ,

. -

n,odiculLriscrinsn cL \ili'i ric rn r.tNcrrarclr/rn L.crtii: \c d.schrdc si se olcli rn.din' tritr nrod {oilc[i. r!.]r.rnr : in riDn .. rnedi.trl nmdrcc cxr.rctul irr vcri. a\nrDh tjcsrr.j. sotorx de FrtnT h .rto rdrpr.rTi ru!r d. prtiLznr ilclmiii rcn'tdc 0c llnnn pcrtu/oo LLri: fcdctrl rixr.r/rxpoi nbotrl t)c'luzofl'tur tr.ar.rrr\i rrbilcsrririnL tt.scurl.rr: Drcd l i\crziipnn{Nria pioar.le uictcnrtur I picL.: s. tu alii si \! Jrri,a.cuzi I ^nr s.triiDcncrhiL si cr.rrrr cr rtirx in\enicj rderctr,iu s! xpli.i rpoi tiutonl rinsprrcfi.

scol.ri

i.r\!izitNionn i'nr.n./iri.!ooJnnrbiUijs.rc.!atu..zri jr!ari!rne.al:i:

.l:i.r.rnnir
Lri

ritri

,L L(rL

I tuprnal.rnldc

soLL,rrcsrtinr)

s(

\e, iiTnr olrc

iuprlcsh.ru rrktrului \i I plcientutui .. i:i rbr prn\rnrorut ! d.ruLui tr ri.cn,..Jlt \+ri niir drr, Dtr \! trdi sNr \. Druxlrr{c:
J(on!!r k.r,,rr
sc

orc.

i.r liuronr tr :l /ite

dLLntri

Mu o

d.

J)c

n.rrnronLs. i.hinba tr Tt or. si$ttrriilc lrcrirzrijrt. dc Lrtrru

t.24 o,t

Lr

h/iIrl

..
i

. n,"ct. -

L r,,,lc

Nrr nri7.r7ii

dcDri. rrcie[h]t ltnh . {urpi,rdc Dreco.c s.mict. .n'bol:c paL.rre. ciiiozi. rNe s.rci. dispfcc [hi.mdi.. sirj!opii. pncuDalora\: r.s nhc rurc.ri.h r. Aimcrtr Dscil.Lor knxcicN.
ctr

- $rnultmldicu .si{
ie.1|

irrc^,ir). rtrrL.DIn] u/decoDrf irrrii

icii p'o.cdon nrrlennLhi: s. .\clu ii prci.ntul i! d.orh dor{l: s. sprl:i rnili'rilc. sc nnbiLcil nitr si\ \rrnttdr

rrsc.

pe

frii:

rc rnrFItiitr/.: . { n cpiiac,zisi \.anNi

\r indqrir r.r/i rnrn\ie si\c fricLirnryi miiDilc cu un !ctrniscp{ir: 5! irbft!a ipol nratrur:s.rLc: !r mNcter/:, /ofr de rnscrfe r.dter.ruh p.n.x r vcdcr drci ntrr s.trtrr.dc inl]rmdir: r rric iirclcdcmhtr. uriliTtndbi{n iulsi. nrDsi n.. r.l sr..dc cd.lcn'rn'dr{ trr{.tu f!r,x: sr rphcli nn.! rnr { b.LrJi'i pr lo l dc inscrri. :c x.olkri cu o connr.$ n.riii s s.

pan\rm.nLul vrcri. fixxlnul:

'\,i

5e inspccrc.zi

."l

' '.'e. perN x 'it \cllm dcnrl nrdcpanlr d.ci c{c nlrtg

r'1t."ri

!i drri

prc7irfi

in cx/tr1 in .re \e {LsDecLe'i r inleclie \e rri! ltrlLLl cdcrrnrrrL c0 o toulrc nc.lii. s. nrodu.. n, ncriLctr ,n.diL, d! .uLrtrrd. sc dididcx/r sr \. rinn. h Lrborr(r

'c.i0i.Dh,l \c.turcr tru(c.id.lc lblosilcir,.c Dirncl. d. colddtrc

l*re o !'b!itun], .dflitui(ri c! scopul dc. r.r.clr sau mii nnrlli corni(ucilir sinlclL'i.
Sc

tr
lri

d.fic r coDgoinrl s.r

tri'nr

cijrlxl

nr unul

hr^riperfLizrrcrde.lcivrr. \ang m

rurcsEctrrcrt,i',.illilo,voL,Lnhrx.'lr.hci.wrtrrlLL.rionnnatultri\ir

Drl)xmrc

d.

\ lltlt

tr'nt itrhttn tk tlDn ittr. u t".i rrdpii n"rh.i, t t1,\ ulnr at it Futtltrhst)1dtjtI tt..j. lr tii\t\nnrhhkn!( Dt&lnthti !! ti" d.n tq4ra.<l l tinarri Int,ir
tat \i dn'|"1i

dc i:iisc cFlnrafi ips.ldcbcfcfiotr h.Lri. lriand J. h rhli ,

Lr

! Jonrr.

tl.rit.ti:ntri l.nhatr hEi.,tal.d tuth "/)ti

^t

t !,\lt:,ti

cre un c.i,foD.nr sxilrirL sin.lc dat rccohm dr lx u pxci.Dr.. dofur'. enc irni'iisnriunri tr't dcri dolrl.ruL: Autohgn fo.cltrtu pri'i (to m comnonlnr sxnguitr r sing. nnrt rc.ohl dc ta o Jr.x.s'ri. sDrul aroi scop crc ,dminntd aceleirri pcsornc
rtuocdur:i Pin

llomologi

( lrsilic{rca produsrlor !,nguirc

x)lrodn\c srn-suife rbil.(Ps

Prin priJtrs sangtrin s. nrlclcec oricc nrbnr i rerrpcurici nrc|)aidii dnr satnc. PmdNele $Dgur. sc in d.trii rnr..ric!.rli:

ihtrl

): silrgciordl.

roi..nrrr.rcltrlrc:a!!urnc.rrnnii

Nr.lxb,lr1 . ilrtNx ni rnnp siroDdiliirrlcr dccotrscnarci .dn tri$turo: lorla pi'niL..n!rr\ir;.esfedarc. rclrhlormumto!r.c
b)
de

d.jnrr I aJtstrra

Ift,Jtr\c srn!0iic $.b1lc prodnsc d.n\xr di'r sans. (rl6rini'l]j. irrLrcgLlnru i$. co .cnh(e

lidorvlfl.

tudor

rx

erc )

- .o d,lndcconsnrr.DLiDrLin

varxrirtrar. cnirNi nr rir p.

s.rere:

xdn,inirrrdLontrnecesitielecu caflcaLrhiiiar.Qkndcc.utDribilnrl.

MON TORULOF C AL AL ROMAN E

lndic.tii ri prec.utii in uiilizarcr produsetor sanguine

l..r''.o dnr.Ln.u Jr,t(p..jc F,t.. tu!r dctroi,,oo. L.{c.,qr.e. ,, JTi\'tL''!c40urr0500m . ,.,l , I'I U 'i ''.1 ' ':.rdt.,n!!r!
Dr

.o,

alc

rlc prnn

Den

rru conn.nenic

san

g! inc tu caz dc dunralis rmc. hemonli i sau

x^rri

- r n-ribrh'1.J i..1,"/ -t r,. rL,L, r d, ini, rot.,tphr r, r, i,,hrfl ni'oalr .rlpd.a1- iu, \."...ni\.8!, prr r ai."p.,i \B^ va priini o, iind nccceri si c.nporibiln.ba dc licrorRh l: /irn r'nr q,.tu: .e" ,. ,r'u,1. urt? . ,.,t,Jn.N !r ' "t , ,n i.,1. -"0,n ,.r,,v. m., , ro. 'a.d coDJinunrl "".or - vcriticrrua,spccruLuipnngiisi inain!edca fi adNnrij.d:
v$ific.rl
!alabitlrftii (ccr l5 zitc)
b)

daloritarca eucocncLor, si o crnriratevanabiti dc rohbocire.

lr.oh'i',uro .i'" J..:(.cer.,rq,otrsr.4r fJ,,.,n ,.u., rc oul,0. { r''.. .nr 204 .J r1l. L. . .u J,.., cc or. ,,,.r.,

conccntrrt $ilrocir,r

Dir.de,

rnlunc pondiiDrgi.dtc.
FL

., ,D hl . . , r' r u .,,,pr1 't r' 1or r' L -..,P'- .'. onhgd

oAB-

tu-ri
a

\.nhcrrea rspccr!hi plnglisi a conliNrutui inainre dc \erfi .rrer $ !biliradi (.ca il2 zitcl
c)

rj adnini\rrarl

Con.rntmt trdmbocitar shndard Sc oblinc pri. cdncernr.a rnajoliratii tombocn.to,iiDrFo uniratc redus d! pldnu. O uiirrtc odutr cdnrinc 50.60 nn.
rom blc itopcnic

de

sirAc torat inr ur rohrm

sd

vcri.

.ompdribiliraiea O B si Rh c! pri' rotut cnc id mhil ririlc rcne rrrc dc romboci rcl filrru pcnru nricroagNsrrc: timp dc rdnrinhlr.rc: hdr 20 nin./uniirr.: vcnficrre aspdulli pungji si , coniiNlllri veriucarcd vrlabilirilii (cc.. 5 ?ilc).

jrdi.di d.r

MONITORUL OFICIAL AL ROMAN E

Sc obrinc din dinse

inreA"l din carc s.n crhsprin ciraferczd

c hcnclc

- htEr
sc

hrancdrul .danribioticctingrnulociropciii,.tid (dc anminiiia d lnitrtc dbidd lio nn), zll'ic llnt de 5 zilc sau pln la rdhrdr t)o.h
sctsisu lui carc nu risDtrDdc lx

- ldnrishr

de aniipi.eric intrucir nanstuzia dc cofccnrar tcucocitar dcrcnnini

tcbli

aeila.ca usoari

ntuonuhri/punsii

imi.rc, pcntru onogcnizaft

fi

pcrrru prclonirca

Plnsnt proNspitn .ongelari sc obiine fie dinlr.o unirarc dc singc lohL.lle prin pLosnutcrcTi. sc.ongeleaza t.o remDeratuli ( 25'C) ti iot-un inrcrvrl de rlmr caR Fcnnil nrcnlirsca ddccldri i flcronlor de coaeutor! jn soLc linctionili. O miratcconiirc 200100 ml.
e)

rulbu.ir i dc coagr ldru (hcmotil lc) l

' -

con,patibilnarc o AB !i RLI nllru pcntu microag.c8llc: hn de rdmirrishrc: mdr. 20 mitunilrter sc utilizcazi inlali{l Jtrp, dczghclare Gc dczgherti inrr-un ncdtu co.nolnli, ld 37 'C. jn l0 ninuie)l vclilicarc{ aspccnnui pu'gii tia coDFNtului nrairtcdcr fi dhini$'ari lcri6cdcr vilabilir,lii (l2luri in car de corscrvrrc td 25 oC).

cn rhDenturi

(pm{cine phsnaricr) in conccnlDtic dc 5%. 2s%

in caz dc tmum{r(mo, rsuri, intcclii sevcrc. Nu c$d neocs.6 nici un feldeconrporibiLilo!c.

taiarlo hipoprorcnchici
cnirca hcn

cu sau

ocoD ce nicli Drcv riabilirca lolunuhi cr.utrnr

6$cdme:

- tusiic

hnslirz.l sl.Co. psvizdi

cu

filrn pdrtu hicrcagrcsaro ricu

rub sinDtusru

i[

MONITOR L OF CIALALROMAN E

frngi eu

r:lac.n ctr

s.rf7n,tolrr:

ptudusrl sxfgui[: 1ii"!c lora \au dcrif c d. siiL! ct1bcr1r. (t. llfcnLt de hrnsln, i \ugufrc iPls) dn spirrl p. hrz. b.nnhil.$crc:

{r \t,or !\p!rJJ cr!u r-!' l rnit ,,t..rqud. l'. , Io.. ." .' '.

s. cxpljli pmc.dnn [cicnru]tri !r s..hrjm..'si,nliiDrnrtrl !crr:

.r/ut nriorilo,

ninr. nrdnl. \irx c al. Fcientu ri: . .,. t'r ,!pr, ,,,.ct. '.t ,,d.' !, , !. : tE\ !tnr.Lt AU r. L,l.'b'ltrJr 'rn,lLl< r! rr'.dtr.,r prlh dc mnn' hi ird. crtrbrcxu irrrc
sc

!.,.,,

.1.

- "r

mi itc. scnnbn!iminusin..tc: d(c lidr nM dc rr\auz sr se rd4r.azii tr pus. .tr scr liTLologici d.ri taDdn,onl mc r crli.r! 1r.Mnu/o' i| t). un crfii sc xdrpreyi h 0 n8r.L Sci tizioogic ir .rl:iLrtr .rnllr rtu gr .u n(lr(l ixfgri[: { R'{f .ndi rtrnctr,pm!ite iLr drli!: s. urpl. crnr.r dc picun'. t.lLniifure N Sef 11,! tr n n| .! bL roit.tr tr
sc sc

"

.,

to,

{.,

{ii,j-!clo llcicnrLh/Drjruirortr ui lsc

sprti

DLrga ru

s.

lllniM

sar!!.ft ilcrr(l
adlLldc

D.

ndn rnnsnr..uhi

ari ri cujli clrc\i pi.iiror

din

sorfx di

drla tu\a n. ifuinn/r. rre 0n sinstrr n'tl. sr irrch {tc prdtuh]l \c $tri,nbi ptrtrlx.u \.r izn, o!..,,.N,u \in!. r! ,Lrii../i t'por prn rrnrcx r{fh.l. rntrorL r,nsln7on,ltri l1 bnfuLi { cdetq s s

r(

N.!il.:

irr

r..!crl. {
r..hi
\cL

ni.hd. rlbul.dxprai r nmgx.uscr\

p' ,J '|l .4 ',''''''''',''l''''.t.

".
sc

dc\.hiJc tubrt

itlrdH I

tu!lcr. ftnruld.

sr .a.ducrzi

[n]to.Lrcli O.lc.tte. lisitut \ii ruLlti in r.r 20 rnL rs.rN t3 lo.ls n c jn tr rimD de s;ri,ntrc:

srrgr dr0r crrc

,L't 1
'

!,"".
'

n'n .i!{!h{^.,orr.rmtr

'cJ .'jL'
..

, p.,i
{'ll'

'i

. ,."o.,J .r.,. ' ll,.i ' ir nungr cu - ntr-rc rdni'nnr!r/a pr,dtr\ut5.n!uin

duti

dxci xprr rucrisd\.r\r r sdnrc tu nconprhbilihrc sc oD,c\r. hansh,,r cu sril!.. conriN'ripcrnyh ru $ urii stini \is.. Lnlu i,ncdir( n.di!ut:

,,t.., ,,r I

sc

rncdj.anrcnr s.u rttc \ohrrii DcLhzxbrh:

rctr rrxn Niacisemrca/iniiinjpxcicnruuion.dajlr,lcnerilarprcteftrlL,i. Juti scinrihnNicnr.i cr.acf.cru r.,)s1iL7ir:

,o,\dufJ{rJ.trLl

MONIORUL OFICIALAL ROMAN E

titun. lr onihled de hnsfuii san8lilc imprcuni ctr o hici clnrirate dc singc (5 6 ml.) ri sc ptsrrcazi a8 orcj sc surnvcsfudTi prcicntul in unniirorolc 24 43 drc poiftansfuzic.
punga sc
se oprcSrc

7-6 t,rotocol de

inv$ligrre/ inregistrare a nrci rc.c{ii rcutt trinnnzionrle lrddnzia !i sc pasteui aborduL vends cu ser fiziologi. ji rimp cc

sc lhcc d

cvxluare lniridli r toicrlei acure:

' ' i -

' -

sc mponcoTii inlrli{L Lorlc r!.ctiilc tdnsfuzion o rcsronlrbilului cu hcilovisiLenh \i ocnhlLi Jc tdnsluzii dc singc lumizor sc in giirca/i in tuaia dc obsdrvdie ! paclentulu i iipul reaqici (ftbrili, aldsici, soc)l cna hr l intc inccpnto I d. nsfuzici si marirl. rercrici: ripul si voLLmnl Dn hnsfn/ati c.dnrile uniccrle psllmns&zre: i$cdilr dul,i ith rc.clici sc rccoLrc.zi unnftoarclc Drcbe ic singc. se coDrplctcazi lormul.nldc ccrercJo rndlia sl sc tinirc prs/cb hmiTorl o probi fir.i anricoigulan| o pbbi pe rniiooagulant(cdra) dc h bratulopus: hcnoculturi daci se luspecrerTi ros sepric: uniraiea psl + tnua dc tansftzici pirna cnisic dc niini Dos rcele prcbr prcrrnsliziotr.ti pacienrului lolosni L. dcrcdninarcr gtupei sanguine !l ncomtalibilitdliii sd conpLctcui un lormnhr dc ml]onirc d ndlilor trnsfuTiomlci dupi inkstie4iilc inithlc sc trinit la prs/crsi nrohc dc singc (l+l/cdk) (cdlrxrc ia 12 ore J 2.1 orc dc lx dparitia rcictidi (dd la bdul

ip

roaro

disiild

dd

unni (probe
n.

r volun)din umtrDrclezl

orc.

?.7 A utotrlnsfu zia

(r.

fuzir rutobgn)

Aurorransftzia cnc relnfuir prcprinlui sdngc dupi cc a tb$coteud ri lrsteefcctu.ri lnlnle. in rimpuliitilpi ir crvctrtiitcchtrtrryicate$ulnum'risDr..

'lhl

nu

rpf r&lii poinnstuzinrlc &iorit!

inc.hpxribttitilitor

sou

grcsclilo {tc

nabih r

Dietlerca dc sin8c

cic inl.cuitt imcdlatj singclc rutotanstuzar .onrinc ur trivcl n nnal dc 2,3 dlportqliccrar cdro djuri It orrceuer icsuturilor.
rccolrarca de sAnse

. .oc, n:.

Dacientilorcu

peN! autornnsrL're 5e Fatc ii.c prNpc.dor J cnc iccdmandati incflmtii chnurgicrle odopcdicc, nr rimptrl cibm se picrdc mutr sinpci .in.-! roJ l,.i irf.' ho\i.D.n.:r co.,,|rJ c,
'ndir

mlle ori, in intcpdtiilc .hioreic,te ou piqdoi m.i dc srnsc s fotosclre m apdt conFht in{ruopdatd !i postopeEto! to lubut tre drcn al ptisii, me p;a sangclo
de

lcbxicbmiro 20lndnohrio titaradcsansec@eautorrftsfi,rzi; pa.ienlii crc an donat pmDmror .nnge vd fi s,Etuiji si rrnnn! in rcpaus ta p{r tnc, I () ninulc dwt donc, sd bco c6l bai nulte lichide in orale ihcdilt l]ftrozc p&'m'i' cr rub$tufu'c vd' f Don n izzricr aEnr c.l riDputb4:tuz.cr s dJns ee inhcJlnor$ apra ra.1:iqsvag:te rhirorsy dc. brdMrJic sr hrpovohnie; spdEl

paoiotului, Il lmcesesd

Si

ll anror'ustuzeaz4