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MON TORI]LOF CALALROMAN E

Crpitolul ? IERAPII VASCULARE

7.I M 0 .dete rului veDos p erifcric pcn tru pcrtuni


ntN rcN
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.

- 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 $dtu 0.9%, el0cozi 5%. t0%. sotutii
hidrocl.crolnicd (soLu!ie',geo:
ba(d nrdiclnreDrctc t
soluliite rdiugarc sc imc$c.i cu solulia de bazi I'rirl
. nFJt iF 1.'e hi.n'n.L'in'
'".r.oJr..!!c ddrueare
DcdicmdrcLc '. in solutic lrcbtric ncm nrre pc
o bandi adczivlt llpiri lrc
nune, sar ilacon cu,lcnumirc. con.ri, carriraiea prcscrisi:
' 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 ri.i
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 ea 'i 'lu - n
o. - tL .oJ. ..
oi a ni',u'
' tr o un ,o,., F a!. r.
numir picarui/mi.ur:!olu'nul lotaltinpulin minurc x l
numir picaun/minur = vorrnuL brrL al sotuljci (in mt) x piciruriht sau dunl,
pcdnzici (jn minure)

E\anptu de .u/. |arc . n ndntlti .le pi6tu -i ./ pat lLnnull u .1,n:


v.hrril !.rat = I liltu s.hrie Glurczn 5%
D rut. Pe,ttEiei - 21h 4a1nr1.)
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 puncfiona bralnl caE
pETinti fi$Li anernJ vcnoasii
- abLrlio ernBlionilor axilari.

brlrul este DaDli7Mu hrndi4rj


erinn leziuni outdDore !i infec!ii a loourile de puncliomrc.

se identiri.i Fdcrr!l:
se irtbflncazi d.sprc iDport!4a ridurah proccduii .ri cvcnnrdl Jcirrt lsp{rclc lce.rc dc

- sc {bonlcnzi dcngdr, bbtL ncdonindm nl t'cicnruluii


sc insralcri conlonahil:
sc dcpilcr, car dcDikrhre imporraDtii
^nain
se explicd acstorilc cc rrcbuic clnae pcntu prolqarer abod tu vcnos prccutu si
sinnlomcl. unor cdmplicr{ii pdl.nrlale.

- 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 eslc aldgic h iod;
pungicu sdlulii d. pdfuar, indi.d. dcmddici
xlcprc\-i.cpenradJn! irdt.rnrcru/.
. 'reLlirr.c
tnuadcpcftzxtncnli d dcbinnctn si unr eumrihlhe ciidc l)crluzdi
MONITORUL OFICIALAL ROMiNIE

robincr tifizic
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:
Dcrnc phtu poziionar.j .\entual alctc pmruo pozllie corrinabili a 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 se priDcazi. in caz conlEr sc mat llibcsrc

.u nrlnd n.donririnri sd crcrcna o prcsiunc usord rsupm etii Dcnrn a $abiLiz \rn!
J. nrtudu.. cotcrurul 1 brinlL! or vnrflt mandnnltui oneniar in sN lt sc tunctjor.az,

. ll -i.i.L r" oo ctru tr' r T,. \,d! t r inJ,hur:


'.1
- sc rtunca n..drenul in rcoipicmut lpccjati
\e admrcaTi anbotrl pdn4rului la broutar
se dcs.hidc tubul portirdruluii
- tunxcazaclrcrctul/branulrcLunpansdtucnroclNivrerit,ituhztndncordu r.mi t.
'rJdJdr.dzinurctutd.1i i nr-., , L nc,tr J . ouor .bn c.Lndrdi
- i minusilc. sc spah menilc:
sc inde_pancru
\e norca^ F.ccdtrid in Fisa de procsduri (nmo. daii, or. minijrini, tipul *rltrijci,
cxtdvazarca $luliei in drE lcrci ti lrtrhcfiorcr du6r.$a azonci:
rc.m/.' \L' n,,-d.!\F.,..'.',J.o1 i teno,(.
- inleclir locaLi'ludclccrdta pdn scm. i'rfllDarorii lo.ate: eriicm. dumr, citdud locati.
mcticl ic s i lczdra funclici scemento lui rcspecriv:
tu
- obslru.br crtcrctului / br$ulci cu chcaguri dc singc h rbscnh jmnerctor shndrrd dc

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

7.2 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 s


scnld5rc{, sruodrri
cu r$cnra untr1 nou da(ebr:
l! picicnrii cu adninisrr.re iftavdoal' coniinui, I)crlu2or te se schinbi la 18 orc jar
l..ul . c.lererului tlchuic schnnbar ta fiecarc ?2 orc ti lrcbtric insDedar l.
de inscrlic
ficcare 4 orc nnnfixatoDllEnsFrcn! sis.nipcmeabil:
pcnncabllilater canulci/bratr0lci ln caz de pcdnzic/adminhtmrc i.tmirenra sc ve.ifi.a
pnn asphrrc inoinld ori.rrci MDini$rai inravenorse

Penrruvcincucasi pcmelbilizma bftnulei:

- sfingi serile dc 5 nl c re sterilc:


- fiolc cu serliziologic. heparinij
niru$ dc uni.i rolosinla:
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

bcnziadczivcphtd noErea cvcnu elo. Drcdicrmc c inrodusc in sotulh porfuzabiti.


Pcnltu schinbarea periizonlul
rrusi dc pcftz.r (erili:
MON TORL]L OFCIALALFOMANE

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


s.N 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 a.(sibrti procedura penrn I obrinc col.borrrea sr
p.ntu!.i din,iu rnxidatcrj
sc inbradr, ohli8rhnr. (cilc ci.d r hcrrui nr zona d. jiscnie I cxr1cf,r,,i
'niinusi
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:
5i'nplu dupi .c s. dcs
d.ci \c jnriopni rczi(cnri la injecirrc. sc ijrrctupe otorrft .onrjdc 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
",1,,,,rDiltJ,rocrr. . tlj..., .p ...
s. rcopcri zon. dc puD.rioD0. rtr u poN.mcnt ".,.,.
jcil si se cxrrJge .ddn.nrt ni,)
seconn.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'
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:
se clampciz, hlpcnu^nrtul pcnrtr d impiddica pahnderer a.n'tui nr siycm l
cncu Ldor (in ru ul in c,r pfinrzorul 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.

sc chDrpcaza pcrtu2orulcu crilcra de Dicumlc pcjumaturc plinil


( iurc,0..'n ic n.o" ili' nJ..n i.. .!rF,n r.'tr
- sc dczinlccren/i dopuL ilacoDului nou sisc lnrddurr rocarutDotrlui rsrfuzo. nr n.!or:
- sc cwuerTj rcrul dc p
ubuL ncrllzonlli si apoi se inctridc prciubut:
- 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
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

?,3 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 i
.
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

se prcgiics. toorc trDlcridlclcr


sc lcri llcii dui orJ nru I dc lc.nin rre a rcraplci i.v x fonaLo.xr:
sc nluliliciprcicD{tr1:
- s.cxplidiptucedlr:plcicntuhrs1s.rveniTcrzinmicDrlcivasimtiouy iscr/iiicdr

s. id.hidc rrc{ubuL,..m D.ni'z.n'lui. Jaci telfu/lx csrc in dert0rci


. Jr', l ,. ,ptr i. u... a
'. '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 echiPaDrfh'r:
sc \.rifi.i diD n.! dupa 15 nrinu{c ocut pnn.hei. rcnrm . tu rsisun cll stn!c.0,ca sa
se i'xtrui.r{c prci$rul sii evire oricc rcrivilarc Lr nir!tul {gnrertotL,i rtccra!
s. n(n cic r errul 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$c o nn).edfti d. D.to rchnicirare ctrrc ifti j,r dribdijtc nredi.n ni
,,d. ieip'. 'u'
'-.J .neLil. corLciomr
Crrererul rcnos cenrml .$c utr c.1cr( vcnos (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


- risc cr.sculde complicntli, pnermotoEx, scpsis.limrrca dc rombii
- 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 tc cuixre cu cel at
nratcialclor rnrd,r rm'.,nr..

rrisli chnursicalci
cdmrurisLcilo:
- padlri alcoolizrcj
- hsa dtpdflrdrl
2 caiere! renoasc 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
tiarlc.n iciilt:
li xdlor tansp, icm si scminencabi ll
- tiolc.u hellind $i cu 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

sc nlmhlici t,rcleri,l:
. scoblinc$rsiDrirliir'l lo.Dmirl na.rcnru tri fxnrili.r
s ficc.,r iic/r prcicDh, ri(..ft.mcd]c pcnh r.\:jLdc 0tr $srull isrorir

sc x\cr7a f.licrtul pozilictrrni.lcnblrgpcntruap,oduccdtLrhrcryefcL.rcc[:lcsi


Itr .r, t'.F ho' ,
{ is.xrii rl.7i sub rc!nru r.rxhci I pxci.rrLttrr pcnru a pror.ir .rjcra dc prl:
o
- \r irno !. 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
\r Dagfun. 7.r. d. i'rc..nri.: raderc tr nehie. d.7 rltchc i ! lo/ir.):
/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.
. scol.ri 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
.rto rdrpr.rTi ru!r d. prtiLznr ilclmiii rcn'tdc 0c llnnn pcrtu/oo LLri:
FrtnT h
- 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.

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 orc. i.r liuronr tr :l /ite Mu o d. J)c
\+ri niir drr, Dtr \! trdi sNr \. Druxlrr{c:
n.rrnronLs. i.hinba tr Tt or. si$ttrriilc lrcrirzrijrt. dc Lrtrru dLLntri t.24 o,t Lr h/iIrl
.. . n,"ct. - L r,,,lc
J(on!!r k.r,,rr i
sc Nrr nri7.r7ii dcDri. rrcie[h]t ltnh . {urpi,rdc Dreco.c s.mict.
ctr
.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.

- $rnultmldicu .si{ irrc^,ir). rtrrL.DIn] u/decoDrf irrrii

ie.1| 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 pan\rm.nLul vrcri. fixxlnul:
\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.
'\,i ."l r'1t."ri
5e inspccrc.zi ! '
dcnrl nrdcpanlr perN x 'it '.'e.
\cllm d.ci c{c nlrtg !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 tr d.fic r coDgoinrl s.r cijrlxl nr unul
sau mii nnrlli corni(ucilir sinlclL'i.
Sc hr^riperfLizrrcrde.lcivrr. \ang m Drl)xmrc lri tri'nr d. Lr ! Jonrr.
dc i:iisc cFlnrafi
rurcsEctrrcrt,i',.illilo,voL,Lnhrx.'lr.hci.wrtrrlLL.rionnnatultri\ir ips.ldcbcfcfiotr
tr'nt itrhttn tk tlDn ittr. u t".i rrdpii n"rh.i, t h.Lri. lriand J. h rhli ,
t1,\ ulnr at it Futtltrhst)1dtjtI tt..j. lr
tii\t\nnrhhkn!( Dt&lnthti !! ti" d.n tq4ra.<l l tinarri Int,ir t !,\lt:,ti
\ lltlt tat \i dn'|"1i tl.rit.ti:ntri l.nhatr hEi.,tal.d tuth ^t
"/)ti

llomologi cre un c.i,foD.nr sxilrirL sin.lc dat rccohm dr lx u


rtuocdur:i Pin
dofur'. enc irni'iisnriunri pxci.Dr.. 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
( lrsilic{rca produsrlor !,nguirc
Prin priJtrs sangtrin s. nrlclcec oricc nrbnr i rerrpcurici nrc|)aidii dnr satnc.
PmdNele $Dgur. sc ihtrl
in d.trii rnr..ric!.rli:
x)lrodn\c srn-suife rbil.(Ps I ): silrgciordl. roi..nrrr.rcltrlrc:a!!urnc.rrnnii
Nr.lxb,lr1 . ilrtNx ni rnnp siroDdiliirrlcr dccotrscnarci
.dn tri$turo: lorla pi'niL..n!rr\ir;.esfedarc. rclrhlormumto!r.c d.jnrr I aJtstrra
b) Ift,Jtr\c srn!0iic $.b1lc prodnsc d.n\xr di'r sans. (rl6rini'l]j. irrLrcgLlnru i$. co .cnh(e
de lidorvlfl. tudor rx erc )

varxrirtrar. cnirNi nr rir p.


- .o d,lndcconsnrr.DLiDrLin 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. .o, e


. ,.,l I'I U , ,, JTi\'tL''!c40urr0500m
'i ''.1 ' ':.rdt.,n!!r!
Dr alc rlc prnn i 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) conccntrrt $ilrocir,r
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.,
daloritarca eucocncLor, si o crnriratevanabiti dc rohbocire.

Dir.de, rnlunc pondiiDrgi.dtc.


., ,D hl . . , r' r u .,,,pr1 FL oAB- tu-ri
't
r' 1or r' L -..,P'- .'. onhgd
\.nhcrrea rspccr!hi plnglisi a conliNrutui inainre dc a rj adnini\rrarl
\erfi .rrer $ !biliradi (.ca il2 zitcl

c) Con.rntmt trdmbocitar shndard


Sc oblinc pri. cdncernr.a rnajoliratii tombocn.to,iiDrFo uniratc de sirAc torat inr ur rohrm
redus d! pldnu. O uiirrtc odutr cdnrinc 50.60 nn.

rom blc itopcnic sd vcri.

.ompdribiliraiea O B si Rh c! pri' rotut cnc jrdi.di d.r


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).
MONITORUL OFICIAL AL ROMAN E

Sc obrinc din dinse inreA"l din carc s.n crhsprin ciraferczd c hcnclc

- htEr hrancdrul .danribioticctingrnulociropciii,.tid


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

- ldnrishr de aniipi.eric intrucir nanstuzia dc cofccnrar tcucocitar dcrcnnini tcbli


aeila.ca usoari a ntuonuhri/punsii imi.rc, pcntru onogcnizaft fi pcrrru prclonirca

e) 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.

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 cn rhDenturi
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).

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

- taiarlo hipoprorcnchici cu sau 6$cdme:


Drcv ocoD ce nicli
cnirca hcn
- riabilirca lolunuhi cr.utrnr
in caz dc tmum{r(mo, rsuri, intcclii sevcrc.
Nu c$d neocs.6 nici un feldeconrporibiLilo!c.

- 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: t .r/ut nriorilo,
sc ninr. nrdnl. \irx c al. Fcientu ri:
. .,.
'.t ,,d.'
!, , !. : tE\ !tnr.Lt
t'r ,!pr, ,,,.ct.
AU r. L,l.'b'ltrJr
!.,.,, I
r! rr'.dtr.,r prlh dc mnn' hi ird.
'rn,lLl<
crtrbrcxu irrrc {ii,j-!clo llcicnrLh/Drjruirortr ui lsc
. .1. - "r ., to, {.,
"
sc mi itc. scnnbn!iminusin..tc:
sprti
sc 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
DLrga ru sar!!.ft ilcrr(l
. s. lllniM 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( p' ,J '|l .4
',''''''''',''l''''.t. ".
N.!il.: irr r..!crl. { ni.hd. rlbul.dxprai r nmgx.uscr\ sc dc\.hiJc tubrt itlrdH I
sr .a.ducrzi r..hi [n]to.Lrcli O.lc.tte. lisitut \ii ruLlti in r.r 20 rnL
tu!lcr. ftnruld. \cL rs.rN t3 lo.ls n c jn tr rimD de s;ri,ntrc:
srrgr dr0r crrc $
. ,L't 1 , p.,i .
'cJ
.'jL' {'ll'
n'n .i!{!h{^.,orr.rmtr ' 'i
!,"". ,,t.., ,,r I ..
' dxci xprr rucrisd\.r\r r sdnrc tu nconprhbilihrc sc oD,c\r. hansh,,r cu
sril!.. sc
conriN'ripcrnyh ru $ urii stini \is.. Lnlu i,ncdir( n.di!ut:
' ll,.i
- ntr-rc
. ,."o.,J .r.,.
' ir nungr cu -pr,dtr\ut5.n!uin
rdni'nnr!r/a rncdj.anrcnr s.u rttc \ohrrii DcLhzxbrh:

,o,\dufJ{rJ.trLl
duti rctr rrxn Niacisemrca/iniiinjpxcicnruuion.dajlr,lcnerilarprcteftrlL,i.
Juti scinrihnNicnr.i cr.acf.cru r.,)s1iL7ir:
MONIORUL OFICIALAL ROMAN E

- punga sc 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.

7-6 t,rotocol de inv$ligrre/ inregistrare a nrci rc.c{ii rcutt trinnnzionrle


- se oprcSrc lrddnzia !i sc pasteui aborduL vends cu ser fiziologi. ji rimp cc sc lhcc d
cvxluare lniridli r toicrlei acure:

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
' i 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 ip 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
- I
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

- roaro disiild dd unni (probe r volun)din umtrDrclezl orc.

?.7 A utotrlnsfu zia (r. n. 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 sin8ccic inl.cuitt imcdlatj


- singclc rutotanstuzar .onrinc ur trivcl n nnal dc 2,3 dlportqliccrar cdro djuri It
orrceuer icsuturilor.

rccolrarca de sAnse peN! autornnsrL're 5e Fatc ii.c prNpc.dor J cnc iccdmandati


Dacientilorcu incflmtii chnurgicrle odopcdicc, nr rimptrl cibm se picrdc mutr sinpci
. .oc, n:. .in.-! roJ l,.i irf.' ho\i.D.n.:r co.,,|rJ c,
'ndir
demlle 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
paoiotului, Il lmcesesd Si ll anror'ustuzeaz4
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