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2013年1月13日星期日

Note blood purification treatment


1. Establishment of vascular access: pediatric vascular fine cooperation difficult, blood purification key to success is to establish a good vascular access. Acute renal failure is appropriately selected chronic renal failure waiting to move arteriovenous fistula mature, required the establishment of a temporary vascular access, currently the main application of central venous catheter. Common femoral vein catheter, jugular vein, subclavian vein catheterization. Pediatric commonly neck, femoral vein catheter. Is the most important complications of central venous catheter infection was reported abroad m1 195 patients with temporary venous cannula average retention time of 35.7 d, the infection rate was 9.6 cases, 1,000 catheter days. Semi-permanent vascular access with a cuff of central venous catheter reported the the longest application in 19 cases of children 11 months (mean, 117 d), 10 cases of co-infection, six cases of catheter thrombosis. Permanent vascular access pediatric autologous subcutaneous move a venous anastomosis fistula is the preferred selection of our hospital cephalic vein and radial artery end side anastomosis, the success rate was 93%.
2. Pre-filled piping: pediatric physiological characteristics, light weight and absolute blood volume, blood purification have proper priming volume occupy dialysis tubing and dialyzer. Pipe commonly used isotonic saline, a small baby, anemia, heart and circulatory system function unstable prefilled application of albumin or blood pre-filled to prevent the incidence of hypotension.
3. Dialyzer and dialysis tubing choice: sJ 'JL blood volume the hesitant mVkg, dialyzers and piping volume should not exceed 0.8% of body weight, or 10% of the blood volume. Select dialysis tubing and dialyzer children. According to the weight choose dialysis <20 kg of 0.1 ~~ 0.4 m2; 20-30 kg, 0.4 - 0 .8 m2; 30-40 kg ,0.6-1 .0 Ⅱ 12;> 40 kg, 1 .0-1.2 odd dialyzer.
4. Anticoagulant therapy: the first dose heparin 25 to 50 u / l [g intravenous injection and continuous infusion of 5-15 U · l g ~ · h ~, to keep the clotting time of the test tube method in 30 to 45 alkali activated clotting time at 120 ~ 1808, subject to abnormal clotting or bleeding tendency, given low-dose heparin 2.5-5 u · kg a · h ~ thrombocytopenia or heparin-induced thrombocytopenia optional application of prostaglandins or recombinant hirudin (thrombin inhibitors), coagulation dysfunction, dialysis without heparin.
Primary disease, clinical status, the children blood purification select should be considered in children hospital equipment condition and kidney professional training. Peritoneal dialysis is a relatively simple, simple renal failure and technical conditions applicable to small babies are not allowed to do hemodialysis or continuous renal replacement therapy. Intermittent hemodialysis in the treatment of acute renal failure, hyperkalemia should be preferred. Continuous renal replacement therapy for critically ill children and provide a safe and effective renal replacement therapy. Blood Purification in pediatrics will have broad prospects for development. Parents of children If you have any questions you can make an appointment telephone consultation contact me.

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