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2013年1月13日星期日

Hemodialysis patients Guide


l Why establish arteriovenous fistula?
Hemodialysis, the body's blood need to quickly enter the dialyzer flow back into the body through the wash and then. Shallow vein easy to puncture, but due to the blood flow velocity is too slow, the blood flow is difficult to achieve the requirements of dialysis; arterial blood flow, and can meet the hemodialysis requirements, but the deeper parts of the puncture is difficult and not easy to be used repeatedly. Hence the need for surgery to connect the artery and superficial vein, called arteriovenous fistula surgery so shallow veins flow of arterial blood, the blood flow to the dialysis requirements. It is the "lifeline" of uremic patients need to take to protect.
l arteriovenous fistula surgery several?
Generally divided into autogenous arteriovenous fistula and graft vessel arteriovenous fistula. Autologous arteriovenous fistula directly since the the shallow vein and artery anastomosis, hemodialysis, superficial vein puncture in clinical preferred forearm radial artery and cephalic vein anastomosis. When the patient's own not suitable shallow vein puncture or obese patients with superficial venous position is deep puncture is feasible to transplant arteriovenous fistula surgery. Is about to be buried in subcutaneous vascular graft section, both ends are connected to Autogenous vein hemodialysis puncture in the vascular graft can. The most common material is PTFE artificial blood vessels.
l after surgery how to care for?
² daily with soap and water to prevent infection;
² elevation surgery limbs promote venous return, in order to reduce the degree of swelling;
² replace the puncture points each hemodialysis;
² surgery limbs try to wear loose-fitting underwear, do not wear tight ornaments;
² Do not sleep oppression surgery limbs;
² avoid hypotension;
² surgery limbs to avoid blood pressure, blood;
² Do not lift heavy objects;
² do some health fistula operation to promote fistula as soon as mature;
² learn to judge fistula patency, vein upcoming non-surgical side hand touch operated side palpable tremor or hear the vascular murmur prompted smooth. The daily check fistula is smooth.
l how to do the operation Kin fistula?
Day with the operative side hand pinch grip rubber fitness ball 3-4 times, every 10 minutes; hand, tourniquet or blood pressure Table cuff pressure gently to the top of the anastomotic vein moderate expansion until every 15-20 minutes to release the once a day, can be repeated three times. Hot compress or forearm immersion in hot water 2-3 times daily, every 15-20 minutes. The above methods may be used alone, may be mixed to use.
l blood pressure is maintained at how much is appropriate?
General requirements for systolic blood pressure remained at 130-150mmHg, diastolic blood pressure maintained at 80-90 mmHg, blood pressure is too low will lead to fistula clogging.
fistula can be used for a long time after surgery l?
Autogenous fistula arteriovenous fistula waiting period "mature", ie vein dilation, the vein wall thickening can puncture hemodialysis, which normally takes 4-8 weeks after surgery. Artificial arteriovenous fistula theoretically do not have to wait after vascular "mature", can puncture immediately, but often local swelling after surgery, and can not find out the artificial blood vessels running yet healed, and artificial blood vessels and surrounding tissue, hematoma puncture prone and secondary infection, the impact of the use of the fistula, therefore, generally in January after use.
l hemodialysis attention to what issues?
Select the correct puncture point, avoid anastomotic puncture, venipuncture should be left artery puncture site to reduce blood recirculation. Avoid puncture of fixed-point, so that the entire arterial veins good enough for equalization of uniform thickness, vascular avoid the fixed puncture or a small range puncture damage caused by the use of multi-vessel lumen. Correct haemostasis hemostasis arm slightly elevated, in order to reduce the resistance of the venous return, speed up to stop bleeding. Appropriate pressure to stop the bleeding efforts to not oozing and can be palpable tremor and hear the vascular murmur is appropriate. Good personal hygiene.
l may occur after complications?
Postoperative complications, including infection, thrombosis, intimal proliferation, pseudoaneurysm, limb remote ischemic heart failure. The high incidence of complications in the general transplant vascular arteriovenous fistula autogenous arteriovenous fistula.
l encountered situations that require immediate diagnosis and treatment?
² tremor or the murmur disappeared prompts fistula blockage;
² local swelling, chills, fever, wound the liquid oozing prompted infection.
l significance of vascular ultrasound.
Used before surgery to help choose the arteries, veins, detectors blood vessels without stenosis and occlusive lesions, improve the success rate of surgery. The postoperative monitoring fistula narrow, such as stenosis> 50%, early balloon dilatation or placement of endovascular stent method of early intervention to reduce the occurrence of thrombosis and improve the life of the fistula.

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