P RTEA IV - INIERVENTII LA C,{RE

LATIJRI DE IIIEDI.:

crpitolul

I t^Ruclt,tRf,A

P!NCTNLOR

,{S'S-I'ENTUL MEDTCAI, PARTICIPi

AsIst,[NTlLUt MEDICAL LA

EI,f,CTUAREA

rIlrundcu cu rjlirDl !fli ac !u no@ inr-o cdrir& mr@b s0u bcofomau (polotolica) ori
inr utrlrgan nuFnl mar\ru ronc\ptunrorsu rcDperi(
11t,. rt| \L4t.l \'ltt 4.,.r ak Jr'. ut \ u . plio ph . rt i..n,.,..

.
.

Drc.)/% *i.rcntc .ar'i.dDc!tutu' ricoaooz i. iJ,l rui drnu nt"nr,r.

( ourcs ilh'Jd iF.ruc itr ncbrochr'.c barno'oeic(l.iroobcr
inrod lcar r ci tu {dc d..urrJ.r' r v.deE crhiEr,:
o er\315 _ L. .su'..nrd" re..i rqrrufrJr!0 h,,boJ.tou.r.

c.dcld

c,l. .lrltr'd. o.

inmLldfrr unorm- rano. 'ui-.indo{drr.$.nr1purcria tor.cioii (roracoc.nlcza)i

- tucliare

oicah(paacdreza0bdominati)i

punclia

prncdarczicii uin!rc]
pLnctia colatiilor purulcnbj

co4i {mdulri);

sdbile$c indicaliilc ri coi I aindic.li ilci

explicrDaciontului derulam ptooc&;il
obliE consim6nnniul:

MONTORL]LOF CALAL ROMANIE

0Mrcirlclo oon!! p!nclio:

h Ptugi&crFrcicnt'lui:

rrcrirn.
pttrLcipa

pdniciF

'

la !cn'1 puncfici irdcplini0d unnaioar.lc

sar.iii:

asiEuri pozi!. p.cicntulxi Si sutfr!.ghcr/i luncriiLelihlc:

seBe$e medicuLui nMrerirelc nc.csarc. dupi ca7 (,narcridl.
mal.rirlc D.f rru rc.li2orca tuncticl ntupir!1 s!.'n{rcndl. p.Dtu.e!olrin):
n'cir frd(r inlul rdolhr, ilDru4ircic pdmtu ridirrcr la lahorator:
i.dcpiri.nza si colccrcazinxldriilrlr fino\nr coDlo'nr pFc.!tiitorunive^alc:
asigfi ingrijirca prcicnruLtri dtrpi Iunclici
nolcaza hpl.Dnl dcn4riin sm ir fb.ix dc obscrv{ie(dupi caz),.spcck lcgrlc dc
px nct ic ii c.rc lin dc conpcrcnl. si.

I'Nrticip!re xsht ntului m.di.al l! tnrN.0.cntezi

hlccdu ru c src dcscrisi l.c.DlLLnu l:(12.1Tohcoc.n(cr)

9.2

9.3

l.riicip$c!

Piitnnderer

ir

rsisrrnlului m'!di.el

covihrca pcrnoncali cu

lr

eictnurs! punctici pcriton.rtc

aj on'l

unui rc sdu

tocar.

(Paracertezr

iri lravdsrra NrcrLL'i

L!kMrcnllchiduhri,lcrscil'cdndcincmrilalcdarcrijc cazcir!uldtiil
Lr l]icicrtuI p0litk!ndriz.l:
in !bdomcntrl dcu( chinqlcal:

pc ttr shbilncrc\isrcnlei lichidului abdominali

p.dturcaliarcrdialiTli pertonellci
cxp oraror prccizafi di.lno{lcului terupclIicj
reftpcuti. - ncnru evruEa lichidului clrc prdvd.!, rulbliiiri rcsJ)n[trij )j ci.crtororij
prin nrcsn'ne exercibta asupra diaiilgNrLIi.

llola cu solrrir rnc$ezldir

icc lcntu so. si i.D.:

PDnhL punrria cu :con

acc i.nr.

*u

diigtro$ic
sp..ilicci

rcoanc $erile penm cxomcnbacMlol.gio tianaionrico

PerB punqi. $rcoikffe

acc

inr

sau slrccilicc

sN crtcrcrrctusi

tdo osic.

MONITORUL OFICIAL AL ROMANIE

fldcon

snuliedczi ccri

.ol(tdrpcntdrefolositci
sac

lcri

len{u colc(a

rca I i.

id.lo!;

a:

pcnru eliDin.rca dclc

uri

ld

reptir c.

l:
ve,iuct rc.onhidarcri

sc ideniiJi ca p. cicnrr
se

'scqpli!:lpr.icntultriimpoflai9proccdlrii\itrcccsjlitiinrcdicatea.ccseia:
tllicntul cic prcvcnn. e{e ajrnar slt se i'Nlalc7. jn dccrbir dos.t in tirtut punclicj sj

sr nnbmrs/i pacfntul ctl

procedum duroaz,

rpDximliv l0 min c pcnru purctia

r!.\pli!i pozirir in ri'npul0!trcr !isics.rugarsa nu se mirrci

i:'naso.d rift.unrfc.in'a blici ri sc cin,lE$cpacicnruLi
rcrccdm de Dacicnrrllisi si golcasci vczicr finarai
sc nisoad LA. rio0lsul indinrcaEalizirii cxrDlcDUln:

'
- s dcgaja zo xpmclio E
l^taLLr")p.1anB nlt.li.tlIi.

at utle

Pdrliciptc| rshtcntului nedicil

forsa itixcii

12

$i!gr

n:in."ti

pc ti0in

sptno-onbilicrlentlgii tr l{jcutdc

ati.dli.

ld p.ocedurn

.te@i p!cicnLLrl in dccubir donal la hnrgircr ndnga d paraluij usorinctinaisprc singri

se dczinltcrcdz locul urdesc laccruncria (insa ili.., nrngi)i
Drrgiilli. $ringa cu ancnczi. sid ilmarcn^ tuMicatuipcnrur tacc anc$c/a tocali:
dtcd ncdloulu i .!n I sxu rocJ rul pcD ku puncrie:
nuliolnun.rioneazipclcFlc c! dcutdricnrar pcrtcndicut circa I 4 cmi
sc rct ge Duldrcnul, sc cvrcrcdz, lichidut. cn se colccrcdz:ltD epnbclc sreritc_ pcnru
cxrDrn dc lahoBtrr'
asirrcnlLLl

dcdical preia eprubcr. cu Lichid!l cxrrnsi

ar ao['A\rEjPAorEr

in puncn. cn s..n cvacurror h r..c sc ihscdzii un rub de poticritcni pcDtru I $ilura

scrgerer lichiduLLri in !an,l co ccror:
xcul sN Itoonrlsc ixcazald qrnrcm:
osislc tr'l hodicil trnnitu{c scree.ea Iichidnlu:gdcre rerLizcaza sub intrcnla prsiLLnij
rtr abdo'nimle. lira s, depqeasca 4-6 I Ln prnna ptrnct c:
h \fi'litulpunotici sc scoarcrorl sfu tocrfll. sc coDprimti lodrl u mi'nn:
Dclo4linlcniluniserDliciu'rDrDsaDcntstcil.

ingrijir.s pacienturui dupt ptrncrie

DN".icnlulr;hincidrpds:

'

inopatplln, Drai su!:

sc nuriroi/eve locul pun.tici pchttu stn-qerrre. scncrca nr cdnli'rurc a lrch ului.
rPfiir]x se' clor dc intlturtic:
$ asignii LiniSl. ri lcmremrun optiori:
sc supr.vcgred/i funcriile liiaLc 2.t orc, sc n rii rncdicul laoricc $\ricn'nc:
ndcleniul va il sc'1 tla|a1.sca i'ncnrcx2:i lr pali
5e Drasoard lircunlcrirt. abdoiin.li sc cimire$r. t1 s conrpad N cc. dinrinrc de
sc dslzii ctr ldcul

dpirc, i,] 1i'npul puncjlci s.n dvi punclie:

lcTrE! vasclordc singc satra mselor inrnindL!:
- lczarc. lrriciiurinarc. motiv ncnrtu c.itdc.rnd $ g.l.nc nrji1 d. nrnclju
- $octuLbur:rn hidroclccnolilicc.!rc $n( p rcDirc tnn .liminfe Lcnlil

Pol

9..1

l"riicip{ren nsistdl!lui mcdic,r l, efeciunn. punrtiei peric.rdi.p

$ideDrier.. lichidu tri in cnvitarer Dcric diclt:

.v&uarco lichidtrlui ir carihtca pcri.xdici cind p$icntot [ezinti dispncc rccento.ri.
ripor.rsiun. rneirli- Drn.iir r+rczcn1itul o inrclcniic dc urgenii
Punttii !n. de.r4tu le ke.h .rJnk tt totn usit. t. ttati.(l.. Ladt tu .tili .t. dl.\ rt.
.ahute,l itrhnd nui(r,rlt1tdi.l.gi. it,h tLlie de \ip -ti crrtituted d! tiL.ltid

cituF pcn rru plltcclir p.nr tui i

mrroirl ie dczinfrtic hmpoane. soh(ij dczi.trdanle (bcradini);
naroi.lc ncntn punctiq ? I lcc d0htrlnnc 8 t0 cn ir .u dirmcrrut dc
dc:0 J0ml-scrinsadc5 ml. &c rcniru aDe$cnc:

ninNi

dc

scringl

Ddfini. lortc{rdjcc

sotutii

unici nnosi,rlii

mcdlcamcnrc ncnru |rreveniru accidc(cloi] ntoPine.

Lnrn.2.l

trri1i rcnrli

sau

cofl!ir]c' pcnrtucolc.rarcJ ndrcriolcl.r follsitc:

MONITORUL OFICIAL AL ROMAN E

epnrbcrc nentu coLccr0rca iuhtrtrldi

prrcntrl csc inlo, nrlr $i inNmj.r. r\aDd jn rsd(c

rc licc ui ex ndtudnJoglc:

ifca $

\c rlrTa p.cicnrulin rroTiriarcco'naiddii dr medi. itr

- s.mis.z:l

pc nr plrcli:
r|rcfdtc.r'ri\itn l

evacuaroarc

hncfe

dc boaLi:
dc sc.0:

cind toc0t

at.s

d..Libn noAal .tnd iicul rlcs csr. sprriut 5 iflcr.osrat *ttrg tx

nlrlii I i.nrunLi (penla pnnclia expLodoiN) sdu spariuL6.T a

dnrc linio oxilili .nbnJrri ri d.r trrdid cbvicutari ninli

lichidestc m.ic

r, rticiparcx

ns

pm.ttu

se

hlcn tu r ui
lapro.cdurn
tncc irrFo 'nedicnl
nlciipd. cd inrrldriedc 02:

' .,1 1 . r...ru .. .. i (.o. dn..' ,.,t.

'a.,.
'. ol.'
- paucntr'leieajur.rsiscde/b.accs siscascz.nrpd/lrlaatc.stidcDctic:
rc scneJrc Dcdi.ului \crirSr or rtr!nczir p.ntu! rcatia ancncTi::
rsi$cDta scrve(e canNl chiturgic.l pc carc nrcdi.nt it asrTi s,b l.cut pur.tiej:
sc drnfecrcazi loc(l p0ncrici si nedicut c\ecuri lruncr .:

J. r'- lrrie -..r.p rl .'.i!.'.

- se obsni l.cic$'l spnr a- pulsnl. aDrrii x disDnccil
lichidIt a5piar .{. tr ncmr in cN'tr.tu s]di.h.rxL tenm a ti e\l]cdial tr lxtroErorl
.!i!rRrr

Ll!7irricfi .izr tNut si rpttcii

!f

pansdrnerr

$cnt cu barda adczivl

Ins.ijirea piciontului d!!i prndie

pacicrtulcie r{z ir dccrbn dorsrl- rorjcctcnsor inticar:
\e asilur tuprun'l tizic ri psihrc:
' sc nonirorizcrTii putsul (cnsiuDca nnsirta. r.spir.ria pentu a idc iica c\ennntc.
feDdnorc dc iJNficGrF c.idirr pin dccompirmr. brusci prodrj de ctiilinrrca

li

Lccomandarca

m.dicuuircidDr nier.r/il

I i.,rdnt

q.. Prrricipa'os !"i\rrn'uldi mrJicrt l!

tcchm,ca nuncriei rsh,di(00

l'1 ."rnd,
niv.l

,.,. 1.p'.

., p.i

lombrr( nrtu ldnbars):

ronc.l (Pucti! roraca :l)i

!ub..cip tol (ruicria suhocciDihti)
ni5!rarcrntosiuDii lichitrlui cei o{hidrnn(r..C R.)i

ru.f.,.ut nh,..,,,iJ."r -

MONLTORI]L OF CIALALROMAN E

prulcvrRr uncicaniiriit pennr ex.fcnc: cno oglce, hio.hlmi.o.bxclcnoLogire:

i', b"u kmclc ciinb ccrebftle si accidcDlclc Hrdrhtu ccrcbratc pcnru 4reci.rea
aspetulli L.cl.R GrDguinolenr scDnr i. hcm.ngr.) si peDrfl rnllrurxrea pr.snnji

inlcctlrc. urorrLbndnlc dc com.r$ in micLograjie slu a izobpiloi ladioic(ivj:

niiiristr.o: dc ucrczicc. andbnnice iu!alcrdlor.dnnitorici:
dccomtrimfe] in clzul in oare prcsnrnca L.C R. cne crcscurii

A.VC.. boli dcgcne tire rle SNC

trufrarisme crilio .crcbnlc si llridctrlc ydscuh c.rb
dirgnorric .a scl!D,cL nn'llinlc. r rlord'nilor r dimune:

le:

ctru.nr rular. pentu ratcmlc sau hlll nredicali.

mitruti $silc. cirnntrn {crile,..'nprcsc $crilci
..ccsrcri.penirupuncfic.hngiicli-l0ch.$'briri,cubi-urcur.prcvizurccuntrtrLtr.n$

mcdricu,.irt.od!.cll
solurii dczinlccr.flc (bcr{di'rii

scrlngin$ilc

dc

I jmll

*!

dlcoolnrdd):

mmonctuClaudc pcnrfl fiastrrarca presnrli L.C.R :

s.luriide lnicdarci d csrc cxrtrl.

sc

infonn$d Fcicrrulou privirc li cfccra'er

scobii0c gonsn

rolo'n

pLoccdurir: neccsiklcn.

ibintr'l inlonnlscris.lracrenr

ihpo

anta.

dunr,

ulr

lczicr ri rec[Ll sat1cg..le:

scds(uripdrilircorcspurrfuoarinconbnnilrccu $'cd sr. cu scdprLsi ocurptrlcrici:
iczind ru crpul rlelIar. nncrii dptecali, spaictc inddir. ljdelc sor ii,rh r! ecrrn.hr
sc

:i ca

\e atcnlion.r/t pricnn:lsi

nrrriili pozi!ia cuNll. !arin rimputpr,ccdd s! nu s. tri5rc:

in d(ubit hicol li fldlinra nrsci de opcrilrc sru r pah'tr. ctr njrpsrl. icchk p.
abdoNcn sildmbcl. n(hnpcc.rpsc. c.putin fldxic r0rihx.c.lo rlcncbrrLi arcuLia.
uDrcriiitr plrd\cni.dl:
sc dsildri i nnnate! pacicntolui.uprrr"nj dacr nroccdtrn sc exccu|l txralor.

Pxrtiriparea asisicntului mrdi.rl l! proceduri

ha..AR 41?.L'..uJ\1.,tu ,krl hli

sc identiticd prlicrtul:
sc
..l\nn,id,ni

vcili.i

sc
se

alui

nr.dldli

prricnrul i'rHna

iin

poziriile rnrift tc nr ['ncdc de

rooni.ndi nacidolui si rcspic ldritrc:

jarc. \j

rcco]nrtrtarch

MONITORIJL OF-ICIAL AL ROMANIE

'

dinrari si sc nolc./t functiilc v hl. si vcgcrarivei

secontolcr/jcrrcmnrmrmcx crlisafiedccnc.20!(clsi$i
mcdicul nxeaTa locil prncrici idrc Li,l.5i
se dczirridc.za lo0!lpmcrici cu behdiiii
s. olcli d.dictrlui mdnusi $crilc:
sc oltri nrcdic ulu i lcul dc pundie scil:
sc s'pravcgrc.zi nftienhL tor ii$pu pdncrcii
sc oind ikdicuiui nntroNtrulClridc pcnru masuLrrur.esiutrij t,.C.R:
s. .led Drdicului Dc ri]ftl cpnLbc{cle pcnrru rccokarca L.C.R in \edoc. diferitetor

sc

sc

cnnr.nc dc hh.nh
s.EcolrcdTiS l0nnLC.lt i',relelcptubelc.iaratoiscrcop.riepnbcrete:

.[uberlc !i s. rmn ]nredirt li kh.bror:

olci, medicuui scrirlilc.u nnuiii
rcuorsc ilca punciir sc l!c. in rrlp
'ncdicr

sc .1i.hcrcx2ii

scerhn8c bftN. irulpuDcricidc.irru hcdic h stlsnut proccdnii:

se nasca/, l0cul pun.rici:

scinlici.c.nrprcrasciliipclo.dllrunc!ei!1sclixcazicu'o

r0lrn:

ing.il;ro, pacienruhi arpl punclie

scriizi prcicniulrrempc caflciorin

pozillc ornotrklii b tet

in prt:

nerni:c cctp !.6 ok Dtni ta 2:t o..:

sc dlnn.neaza pacicnru Liprtnunmidrpi 6or.:
sc dfe$ pi.icituluiperna dupdlc or0:
sc obsc i cu denlie mircailc c\rc'niriikn. sc anrnli Drcdicut ddci aD.r tumi.itu,i \xr
sc

mcmincFcieDrll Era pcni

- s..\xLueszi rqr!n .rJrmi.liuDerpacicnrLlui:

- { nron(or/!izii pc.mncfrfxri.ntul:
:. r.r.Bii iri r!n\unk Drutr.llchide
'

d.temindi

inrodDc.rt. d.fdcrlorla a icuhLii

lcnil. hchrdut!i dincauz, hiporensiunij l_.c.R.:
imtoslbift ca puciiorari t urk iiccvenEl. \irsriici dr crua osindiii

fmcrir

rLb,

dc

:ctrrldrc tuan

pnn.ria rDurn lcii lprin ac se ex(n..7eazii siing. ca rcartu

aL

ctricrici unni vrs

I nivclul Lnui ncnbtu p.tviaf Dir puncftrnare.une]$dicirti icno.sc:

llpoinic. mli.lcslr prcienlicr.c otr au f.d redai ancno. ri I cxrc puncrij sc r.. izcaz,

durcrc

cefatcc si tuhialgic-

c.nplioalic

t-rccvent

inritniri. crrc pdc a fi dcrcmirali] dc scidcEa

(.r"P.e...ur
9.6

l{rticjpftcr xsls.nru,ui Dcdjc!l ln ef.ctmrea DUnc(ici ,rricut.rb

cu alLrt.n'luruii. er rocar nr cavirxr.. dnicutari.

E(c pituDdcrcr

dON-OP,LOCC'ALAI FOVANT

'
-

p Dcrcxincv:dsltd llch ulul rricuhr Gercs- puDlcnl, srngl,i'rolc )1

rccolrrred llchidului pe.ta shbiliEa dia8n.siicuhrl ri oricnldrca r$riDr.n(sLui:
evrcuarc! llchiduh'l cafdjcnco/i n,irxtud. ptudtrr! discorlbn. in t4'na!isnc anictrlrr.u
adnjdslntua dc mcdicrmcnrc in

dnr

.
-

alczi.nuiarn penix protctir Drhlui:

rnn r,iale dc dczoriicr i.:

marerirlcpcniruPuncric:

N!

dc 4-5

cd

licureiioonide)

lurliici

- rcnnsd ql/.
ie 5 nrl penru mestezie:
.',.J
,lJrluld u 'injcnrn:.fr..'..
- sci nln rc ntru',1.'n.i'r.
.n, narca lichidtrl'ri:

qrrubclc pctrlru cdlcokbx lichiddril

m.dicrncnld

rncsei.e. dinfamato

an biori.c, {'hsraDrc dc

!0nkn ldrii

.{.

pah.roonic gaddr.

s. inloneoza paciotul ctrtnvnc li scopul ,si nro,lul de d$uhrc I nrccedurn:

se lnformc.zi paci.nrul ctr prir;e laelc.narmptrNtlci strb rnc{c/ielocati:
ccrc consinlimnnhl iDlonmr aL pacicNunri:
sc aicrri prcicntol inno pozir c carc si pcmir, .lccruarea putrcriei, dei cnc !rz0t. .u

P.rticipa.cr rshtentului Dcdic.l la proccdurn

P nldtat .!e lc (,rry1lnt nait. h1j

scvcn6ct reclnr darcamcdicrli:

se alcazi prcicnn'l in luncric dc rnj.ula{ia afeorara. Iisr. ajral si isi nrcnlnilpozllja. dncr ntr
sc lizcxzi locul (aniculntia genunchiuhi.

uminlul. corulul. en !lczncj. dupi crl)

infcdcazi zoi x. tucdi. ul e roctuerzi u cstczi0 loca li i

sc.$azictmp l stcrilsnb loo'1Nrcli.l fi sudlzinlccrc.zainciod.ri
se dez

nrcdicul cxccuri nufclid:

t..

t:

nr zona dc

MONITORUL OFICIALALROMAN]E

xsniennrl medlcxl flnnclre llchidut cxltus ri

xsisrcnn,L nrqlicrl tri'nircpmba h taborjior phh! cxan.n oiroloqic
*u brcrcnokjoic:
s. ffiso a.amibrea dc lichid si sc dbse'l,t rspccru I ( sctuj. pnrulcr I, sansh
hotenii

'' 1.1..rix.,1to

tuztrhru ftrn!rc \r

iutrrr, ,loirrdc;t,\^r

ir

Ingrijn.u pacientutui duD, pundjc

s. 4rlica un bxndal cor!.esv Lr lo.ulpuDcii.t:

J',i , .r. D.,r, ....,

r,,i.un,, 4. ,,rJ,tu .,,r,t,rid-f.r..auot JrJ. -q

bindrjulconpresi! tiijndbiti2rea scnrcrtir

rc $Lprvcaherzish'ca ldcrrlii

24 ,19 orei

\.obsc^;ievcirurlclcsc'nlcdciniidlc

9.? Parti{inarer rsilrentului ocdicat lr rdizaro

runclici mduh.c (osod!e)
[stc piirurd.rcd rtr aiuton't unli tr.cf nr /oDr qroDrr.rsar unur os scun sru lai

c\pl{&rcr anomatiilor tcnarotoSice:

.,t.,,i

-f'"

rL,rci'crcr r.trrupar

...,.,

connrn rcr
rc.lla rca nid u!. i de l.

lrn.

IJn.rc

gel pcnrru

']tirru

rreEoa trc siinaro! sc in \rdc

!,Jn ro,ntrmauptr).

.noi.zie toeti:

- acepcnrd i'iectii suhorduri

' .ccp. f inreclji i'rraoNctrhrei
f..on

i.u.it,.tonj.,

Ltillz!.r! snLrtu,ne!rtr!.
di.gdoeicnhj urorhoti iitccime:
ci

JexiLocaiD! Z%.

miDuii scritc dd Lfica fokrinlj:

.imp soil cL deschmer. ccnr.tii

solutic dcTiatt.hnb:

'

oon(in9penrto.cctbl{isi.c

j_...

ni nicn,t.,t,,,.d,

Frnsfl,/irt i/tansptxi liri i.

' sc tirc. conto ul hqnosbzi imiDrcn phcri.i:

- n ncriancccsiri tir.aarirc txihologi.i dcorrece produ.c aixtehri
cdc durc'oasi !i nrcu ri.tuedzic:
- s. cxplici dcruhrcr rlscopslputrolicir
' $ obtinc r.nsi'nrin,iiDtuii
uniipacicnll nr ncloi. de.dmlni\rrrcanNik{nchiti2anr punb.u orcgcrc, confonrhi:
- sctrcgircirc L.ctrlrunctici:
La banrail dtrcd cnc .i/! sc lil.c d.pi rrer d]trd locLt ,tes csrc lchul L nivctul
pcnIr ptrirria srcmali Iaci.nrul cne alez.r indcluhtLlanr r L!tuL!r!.u Idr

|c

Ptrticip,rcr asislcntul l nrdi$l ll proccduri

se

\c
sc

p.orjcrt krcuL punqiei cu u cinD ne l:

irhdlcc tocrrul nnvc8ind pcrn\tu I i a0 ol mcd ir
s

.\pirl

tr

turrge man&.nut:

niduvi cu aju6r!l0trci surnrgi:

se punc nrndr.nul inai'r. dc a rctagr ac!l:
D'ldusul cxris:e p nc pc o ii.li dc ccdsomicj
asnrcnlul Drcdical lrcrx p'odr'sul tocolrrr !i rcalizcrzi un tiorju Jin eslnrio. cnrr !a ti
c\rmiDd nlli! I ni silrmclri
a lo.ulirlcpalu $ Irc dtnfccti. si sc rpliciun tlBrmonl
s.

idcNiUci n..idnruL:

scrcrifici indicrrir Drcdlcali:

se 4\ut pr.icrtul nr dc.ulilldoKrl:
sc pr.8ilcn! locll: sc spxli. !crlccrtrex/idczinfcclixi
mcdic! lltcc dncyczic locrli:
une$anrio0 din

nradu!. c\1ft si sc timire inredlar lx t.boraro_

iD

condi!iilc cctu.e dc nedic

irrrijihr p,ci$t

lui dupn punrric

p.cicnlul'i'nanc in rcprus la Dai:
s. ohseNa locrl tunclier ri ru snnActuz..

'
o.3

!i

nL

rprlj

honnroDr su pod!

flre o n

n-(i !u

sDsqrrav*|caza llncliilcairalcl
du.crilc mndcnrcsc comhar cu aiakcTicer
dici uronlc\unr DurerDicc. sc.nhri mcdicu

P."ri(iprr.\ii'onrutu' mdn,t tl.G,rurrp! putr$io, trTi.ii urjn. r

lb.ne

m.

dircrdirrc2icr

DrcLcvnrca dinci
ukhsi rohL posiliititats

rimla Dcrtru cramenntdc aboFhrstr rci

conramif,riil
eoliu vczicii in rereniitc Ntrc de urini cttrd sonJxju vczcat nu D.dc lt .\ccurar:
$ictun uFhlc. hrpcnn)fie d. Dr.s.ti. rddDndsme urtrte sar.tc \rginuhL lclind
cend tcbtric

sof dajr I cac .ontunrd icll )

MON TORIIL OFICIALAL ROMAN E

rn.inr

petriru i.onorncx zonci t. carc sc fxcepurclir:

nulerialc dczinlt.ric: bcldini- r3'!po.nc:
Dutcr al ioril Fotru pundie:
- trucar subtc ctr mrndr sru un rc pcrru i'rtectic

inra$lscrtrl' .u ungnrc t0 ll

pcnsc anabmice 5l hc.ron.icci

.:l rtp chntrrgicnl cu dcschidcrci

mr

lcrid

pcn rnL

xnc$czic:

rcepeDtn'iDjcclics.c.i
so ulic {nciczicri
n.r$ialpcdru ir epidarcapilozntlii:

\c rrunlii pxcrcdrll \isc exrlic; scn/Iir dc !suN.ji cr de rqcmi.:

rc iidcpia$zirilozlb... din zona supEpubidii
dtur scoptrlc(e recolr.rc. unnei. prcicrtut.ic rnunlor si nu urin.2c .trcvr orc sxu drci
\.zi.r fu e pl[i. cre rugrr sa h.i L 2 prhrE de tich . irr liind rinichnrl nu c\.rc!i
ruli.i.Dr. .cdiou ruaic rc.oDDida drdice:
r. rJizi ticr.niul itr dcctrh rdoArl:
sub bn/in !. 3saza o pcmi rarc.

P.niciprrca asistenrului medicat la proroduri

Pu,.ti1 -,lietui1t2
ittat de t t a\j.jot

"t..li

nrbilcSF locul, dedosltm slmti,cr plbtenc

nDbrdcimiiiusi{eritc:
c Fdu c.zi anestczir lo.alal
izolcx/t l!c!l prir &opcrnr cu dlmpuL serit:
.xecuti Dtrndiai ddapreazi tubnt de $re.re
nrgild5le masa pcnh puclic:
si scj\eTc in pozitir

- . [ir&ie!tul

l.
al

ali

linia Drcdi.iii

rnn.i

nr

t,I

cor dMsupn si,nti2ri:

van,tcolc.M

cd splizaro.rc (decubndob,])

ljurrl nacieDtuIs ridc2brdcc

'

scrrcyc hcdictrlui marcriahl tcrrru arcsczic:

scrvci. nr.dicului scnnga .\i rcuL pcnlru pul.ric:

trrlu

,tt

i0icnoarr rcolpuL0i:

ou o

pernis,b zo

MONITORUL

OFICII

AL ROMANIE

pnrcgherli prcientu in tlmoulpun.rici:

n,irc*c scurlcr.i u trci/f rim.stc |]!obclc rccolr.lc drci.{c c/tr1:
nor!i2i rdrirxl.i. rspcdl Ltrr trci.

- irpa drgcrcr .cnhri dc citc nrdi. $i d.zlnle.tl. locu ri \c anlict trn |nNr
- s...ndrcep ient'lh|)rli
.tt.nr.l ,, o.
n, .l. .iil.i .n.
- scnrii$!r lr'iqiic vih c.
0.0 r

inninln r r\nrrnrurui n'edi,rL

i.n{i

err(ruare, puncrici r,i0piico

Pard.iparcr .si!tcntului hldic.l l. punclir bi{{dcat hcp*i.i

f, c inroduccrer mriac specirltn leruru hepatic p.rhx c xhgc rcr trtrlilidlrncnr
Ptr.lnr.n.l!.. |(rk,ttu 1uli. hti
a)

5tubiln$ LiLalndiicllui in:

l,!nr(rnegrlle de eddo!ie necuDoscurai
.r/l n. l,cpaticc crcscurci
{\ftrm. dc tunon. nrctasazc:
. L.r$ dc .liologic n.cmoscrti:
{Lsricnuc dc lr|rdita
( inJ n un.r.$c oblincrca urui ti:gnr.ir tln{.d

lvlughini (Ltrne de 7 cin cu dirmctnl dc

nrror cu I chid consc^" r:

ac

Mrfirii /rni

1.4

'nnri
geLpen!!.ncnczicdc..nrrclsiuflacon.uthdusar.iczianL(\ilociin.tsaut,/.):
acc ncitu inleciii subcuirnaic:

ncib Ndru mcdici

nifusidr trtrioi lolusidli prnh rjur':
.a rp d dcs.lridcrc rcri i
nri,nnsi

.
'
'

cim| pcnru bva de !r.roialc:

nuteri!le dc dcznfc.rci
nrarmrlc

Peih

uvr pcnir

pansarrcnr:
Dralcrlalc:

.o tuinlJPcnh a.r:
cdfuc

'

\e poft. nrto\i ghtdrj

br

pcn rru ce lela Lre

malcrirlc.

apanr d. t.isn'ne rdonra(ic:

ctn'.lor l).irtu 0rycil.. p.ribilirdr.

dc oligmoreruple

sN

MONITORUL OFICIAL AL ROMAN E

nr ptorlibil un bilrrl rl coagrtini: ri'np HoNcLt.ljdp Qrick. HLc, gnp s rgvji

plr.hcb singvlne i
sc ldrifici ellntualD rxl.ncnre tico.3trta 10 slr dnrilgrcga e pLachcloj! Mcdicut
poatc ciirdur nr prerlabilo.clmemtic dbdonn[:i tenh] dcni{arcr rror conra i,jdi.atlj
tiscni. le/iuni vascuhrc):
selini$cisrcp.cicnrulcxpli.tnddiderularocxancntrtui\inrodtrtdccoLaborar.i
sc.binc corsih{iidintLl:
rrcicitLlnu miDinrr l2 orc:
prnrru conbatcrca xNicritiisc administrcaza un$lnar cull)minurc inJntcdc
Dh.cdrril
i i',fonnc.zi paci.ntu ci, prccdula durc.Tli dprori'na(iv I 5 n:n!1e
sc

'

tir!.

Rh.

Pnrtictpnru Nhrcntuh'j nedicnl l. prdccdurn

- prcicnsl cnc aN/xr i dccubnJ.*rLsiuindc.obnL.GnLslaDgi

lirc dcTinlccdd tcLtrintului.

prouod, 2ond dtr crmpul icril:
Ndicul face rnesrczjc lo.ilii
sc
sc

pdci.ntul eic prs si rslnc rnrpl .apo c{c flLsrl sri rcs|rne fo4d si ri raNdM h
$nN:
in cxpir bloc.r mldicul lntoducc acuL ir spdriul i,l.rconMl ,\i chirr mrijos in crz dc

hcp.tom.gilie inponarl.l
sc rctrge rcuL{ pc locuLfunclicisudplici un paDs.mcnlcomF.siv jditl
lngrnentul c.lcdd ryo ransLrar din unrnrl ..uhLiiD |!.oml.u |ohid..n\cryrfr

lngriiirex prcirnrului dupi purctie

- tucicmLl c{e n$ruir sa rimin:i in rc|)xu{. I or. ni d.ouDir tarerut drcpl pcm r rcduc.
ns.uriL.hcDongi.i \irk scurg.r'ii biL!i,,loruindecubirdo*at:
i. \Lpir!c!h.x/i tuncriilc litul. tA. P. R. r ti prczcnra durcit ti inldrvate dc 15 nri,julc

'

drca.\n!..isc

- s dnnti
hcDom!ic.

dc h.'no'reid. s. pune u

na.l

cdrcL dadi rruar durcrc. $euratc

pf ibiiti rhi'nicii

rL qh r

i li lulu nU (lR

if cxpriiic

in h

|.\.n,Lf,l

oi!trozi dcoajec por qrirea:

- p' .
rr ,JJ f ,ro
i.rL r',reo n,
'lr
'.
- l{ rcdmardiLc.
mcdicului sc t.t !dmrni{ hemo$6rirc:

laie$irccstcsftruii\Acaircclorrulizic(ridi!ar..EcuriiiLor)cctpurinosinrirnilna.

P.rridn'.ca
E$c recolhrc.
b)

rs

hlenluh i h.d icrl Ia ptrnclir

otul unui ac d. puicrie a

.r ,ti

uf i 1i.! c

diD pmenhimut tomt peDtru

shbilircn ebdlogici insrticicf lci runrLc:

noniroriTirca siftlrotuuhi nclrdric:
shbi ir.a ghduhri JcalecraE lupusdnreDrrossisrcni (L!S)i
suspi.iunca dc neopla$ rcMl.

MON TOR]JL OF C AL AL ROMANIE

marcn.lcpenhancstczic:
nnconcu solulic

li*rorru:

ceDNri chiroUcalcl
m.reridlc pcn ru Jc, I ferlie:

.
'

seinfomcaziNrpm rD.csn,tii $i dcn'lirii lrocedu li

sc i n li nncx^ pdci.dtLlr, rslpft n dului de .olab.rarc:
s. oblitro r.nsnnli'n:lnd:
prci.ntul nu miDinci cel puti! l0orcinai'neapmceduili
!c culueaz, rcstclc dc .o.gtrlrrc (inrp dc pr$omhiM.
hemoblobini. homrtoo nr
sc dcrcmini gtupa smglirt:
pMclln se poatc tircc sub cortrol ccog.ilicl
0oTitia csrc dcc0bn !.n{rdl c! o pcdi sub rbdofc!.

' i!

titcc dczinlcciii

locrhir rceixicr lunbJrr tr

dadinuexista o .onrmindicalie. sc Drclari

ri

rnq na4i.l

d(d Ll.r!lu'.
'l

chid Ltrcpl pcnru

mcdicul tuce ancshzic locali:

sc.conerizonacu un cdtrD rldil dcschi\ in ccnh:
tacienn,lc$! iirlirdrtircspirsisi raDininr aDnee:
edi.ul *c.utr pmcria. rspiri resutul:
sc rdrasc xc!l si sc exelliu pFslxnc rsupm Loc0hriiircpirtrrilcct
themunrdlo Jc rcstruri sc irdcpinerzi din ac prin inslnuc
udailcsc renu! labontor

insrijirea pacitnrului dunt pundir

prcicnltrlriD;ic in rcnaus ln pdr.cllrul0:4 min ddcubil do^dtl
- .ne sJitun rl rjrn{l s, con\un1c irhidc din $undcoia:
scoDlici pmg, cu ghealS pcihr tcvetrnca hcnro gici:
sc .odtolDrzi llf ct iilc vir.lc:
- nr prinrle 2,1 orc poale rpirea o usoaili lthdlic]
dacn aparc Lbn sntr hematurh dcpriJcic 2,1dre se arunti medicutr
- dupi crlernarc. pacicnnrl.scrEtuir si .vt r. ctarturi t. fizicccxrcdurnu

dc h.nrho0t.sli,ri.

Prrtiliparea h puncti. bioplicn! unui n0dulninnr

E{e p nrdcr.n unuiac sau tro.arh I rchrl(dtLi nddtrlhrna cu s.olut
uD mic fnerneni dc la nivcl rcsnc.'lv
SD eleci!crzd .u sconrl labitnn dirgnoniculLi ti o sonduirci reutcuilcc
Pcntr0 ptrtrcliobdcr h.r Lcliuni inaDcliricc (nJrne mici). 13 nivctul
Droccdurd scrclLirerTe sub oonrol ccogntic.
c)

..c.n..ihd.grosirc6/10
dc/inrccldor
fu

?/10

Nn

si

lrngiine dc 25,ltt

mri

p.!h (.grmd.

nr. dc nicl! ru'ate. der.sarci

flacono sub{mli fixrbare

Denr'x tia8ncnrul dc L.surrcc.hrr.

b.umjcvn p.crcnh crpli.indtr idi singml dfconfdr esic tr.ccd0r. dc inrep*ur,:

|acictrk Ni. ar.urr, in dccubir do$at stu tderut. cu hratcLc ridicarc delsupm crpltui.
Nnlru , .rah -sl dam$iari pcplannlokrr ioocchrl.
sc

Px.liciprre! asisr.niului ndir.l h proccdurn

t:\1.,1..o" vdrntd
u h t i.
"t..1i.
se dczir fccl.r/.t telu mc nicl. cu bcr i'ral
. in caluluncitbmr!riunidri$icc- dc.rir \e nrobilizcrzi

in.i7!
-

tiJmhriLnii rum.rdLc

. o{i iL.:

1.. -

$ide.

cu

ntn! sringi. \c pu0ctioncar.

pnncria se ErtjzcaTi dupi i,nob1|2xre.u mdin

p'T

rd.'rr.

'nn. sitrlc:
!. nFni.L o to4a rDdcmrilrcnh a DU.rrisc
drci foiin.lun.r .$e chisdci si in carr.rs tichi4 dupi cenirituerrc sc cxrmio..zi

\.dimcnrll pc lami. ii cr^ in crrc lichidut cr. sangvifol.nreu nu

m.'li!trl poar. recoDra abotsh pr n c\crzi.l
- scrcxli/ea?i uf ilr 0.lana sc r$di ri $ plascni in flrcoNtgoll
- lirgfrcnnrlrccolrxr sc ptrnc in nacoDulor suh$frafix o{N:
sc cxpcdiaz:i

sc podc ftce aspir.tic.

pr.ba la laboraror:

l.rc conrpaiure pcnrfl

a nn pcnnirc

scnrlcr$ ti.hidtrtui sau srinselui:

D. urp'c cr rm ii i i.. torcir.a'ot t . em u, , r :...,.,,,
't
""

sc

N! smr occceic ingritiri spcciali

rct di

sinpli, d,rdc{ulde eracrii

n.i mutrc lo.uri

rcaltdc edincatorr:

rccoLhrea din
unor

dupa DURoc.

pemrire

c\ptohr* rprorpd

coDrplcli r tczju i si oblnrcrca

cnc mDldi- NTulrslctc por li Dbrintrre iD cercvr minure iD cv d0 lcziune 0splaz.i.

|dcicnh cii iivc$igaii elensiv pcntu .daprlu celcimnibtrtrc.dnduirc rcrapculicsl
r.llr.rclc * corclcazi cu cclcl.lr. inre$igalii(cx clifio. fta$osrna. ccosiJfia)
s. portc fonnr un nic

l[nrhf

lorrlpnncridi

d) Puncrl. bioFsicn n.dulrrn

Este obtincrca irui lialmcnl cilindri. in carc se oonsdaa nLdum ncd0tdr.i. n]lorrurite
dinn ehrlc. lobsind utocirspccidl.

'
-

Nrluartr n.rfoLogici midurci. cnifl dru crirtupoie/!i ti n jctoroiczci j

stJbiLcslcctioogirmornrudr'.tii{notralcdce rocirc. tNcocire sau ntidrcrcj
ldcnrlricii hiclotrrl dltdrihi linlo sau niclo prolilerarir.orcrNaza mcduta$:
complerareadatclor oblinnt nrin puncric:
pcnnnc

.plri.

mcdnLari (bilartdc.xtcnsic

ir linr'orul Eodski'r

san

non,Hodskinl.

rtucf Jldrhidi sru Murbrand:

nrrotr cu lichid c.nsmabnentru fEgmcf(Ll rcolkr
gcl pcntu aDencTic localii

ascncituinlectiislbcurrn :
.ceper(n ifjc.lii inhntrsdrlm:
Urc.n lo \ild.dina 2ril

minrsi deile
cinrp slcnl

.!

dc niciinlosinrii
de$hidcrc ccnnoLij

$luticd.rrfechnla:
conhircrrutrtu

acc

lblositc.

so

'
.

c$cduftrcasisi fcccsir..nrslczic:

fjl.c contulul lcmostuxi inlinrea Duclicil

plncria ncccsiri nregitir. psihologi.a, dcomce pruducc aixteilrcl
sc erplica

dcrulircd si rcop0l puncrici:

sc obiirc corsi$tiDentul:
Miipaci.nriru ncvoie de adDintuhrer

muihtrlhiltinr

pcnhu crcire,ea

coftrrulli:

lo.ulpcfuupunclic csr crcana itirci:

F/itia p.cicitului este dc.lbir EfL l p. un pl.n dnr cn o p.rni $rb abdoDcn. srtr
dsubir l.renl ru gcnunchi ncdili:
. rritrn - . A.n' d,..,p'r"nrrd\ep.Icr,
ru,1n i

l\,loNlIoRUL oFrclAr AL RoMANlEr, PARTFA I NL 669 bisr

Parai.ipa@

.dlrslulut n*dlcrl

- k identii plcicnlul:
' re Ycnfict indicali! n didl4

ra

X:0i3

procedud

a$zt paci4dl in dcclbitdoisalt

iq prcg ge lodl s rpili. e cfccle,/a dczidoclia:
nedicul facc eesczic loc.l4
sc

- st rmtjer/t lool pucfi.j cu un cdhp slrn:

- ie introducc nalul navcBind Dqiosttrl $i apoi Bcdicll ctuasc nhtunul:
so aspid un csantion din btduv* ou ajtrrdl @ci sriqqir
- sclrc oddMUI indinb dc a rcrsgq acul;
- pedusl.rtas sd lune !e c slicu dc@somiq
-

drisrertul bcdical pEia pod! l ftcollai ii re.liaua m ftoriu din qddor caE vd n
exadimr inrc laol $i ]rn.li;
la ldul inleDinaii se fae.dczilfefje $i se oplici m panenent
frasnmtul rccollat are tods&er ia nd..nul o suhltanF conseryarr.;
locul punctici sc pqcrrl rolosind un taq)d ti s rpli.t un Fansmml sldit ad-iv.

lngnjia! pacie

trltri iltrpl}uncgc
prciqntul rrhtne in rpaN la paq

5cobetui

lMl pucljcisnmsan8cE,sid

aparl herotob.

SeDe&turcaphgdcu

supmrceh.vi iunltiile lirdc;

durcnb nodcralc rc Mnbdr ou ,nalset&:
d&a duunc 5unt pnmidc.
ocdicut.
'nuntE

k--".id.&ltunlNqs

ca

uryari

c!@n!!!nd

ostrltri.