Analysis of internal fistula complications hemodialysis patients and nursing

Vascular access in dialysis patients is the "lifeline", healthy vascular access patency is effectively its long-term survival of dialysis basic conditions, patients on chronic dialysis fistula from the body to use more, and now fistula 3-year survival of 65% to 75% its success rate in addition to the length of the patient and vein conditions, but also with fistula postoperative care and use is appropriate related.

Thrombosis: the performance of dialysis is inadequate flow, vascular anastomosis pulse, tremor disappeared, vascular murmur disappeared, such as venous thrombosis, the venous pressure significantly increased; fistula stenosis: the performance of dialysis blood flow than the original reduction, such as the proximal vein stenosis, the venous pressure, and even lead to forced ultrafiltration; fistula infection showed partial superficial skin inflammation, the formation of cellulitis or abscess. Systemic manifestations, a small amount of bacteria or toxins can enter the bloodstream causing sepsis and bacteremia; fistula aneurysm showed abnormally dilated blood vessels near the puncture site, prolapse, diameter> 37.5px

Form (a) thrombosis

Early (after 24 hours) thrombotic vascular conditions are poor reasons (such as blood vessels too small, there is phlebitis, vascular spasm, etc.); 2 intraoperative vascular endothelial damage, arteriovenous anastomosis when registration and poor; 3 hypercoagulable state; less than 4 hypovolemia, hypotension; 5 primary disease with vascular disease (such as diabetes, lupus red scar on the skin, etc.). Late Causes: [1] Use of improper or wrong way to stop bleeding; [2] local infection; [3] hypotension, dehydration, blood loss; [4] use of erythropoietin, the blood viscosity; [5] of the arterial vein intimal hyperplasia.

(B) fistula stenosis

Stenosis occurred in anastomosis vein, its reasons: [1] repeatedly puncture the blood vessel intimal injury caused by fibrosis; [2] hemodynamic factors, eddy anastomotic site to promote the deposition of fibrin and platelets, causing thrombosis formation and stenosis; [3] infection violate the vessel wall; [4] hematoma and hematoma caused by vascular stenosis.

(C) fistula infection

Predisposing factors: the dialysis patient's immune function is low, malnutrition, repeated puncture, strict aseptic technique can cause.

(D) the formation of aneurysms: immature fistula premature application, long-term fixed puncture the blood vessel wall damage, poor flexibility and easy prolapse; sustained hypertension or venous pressure; bad puncture technique, repeated formation of hematoma; suture technical defects or suture is not sufficient.

Fourth, prevention and care

(A) thrombosis prevention and care

Early thrombosis should immediately open the anastomotic suture forearm as local thrombolysis embolectomy or thrombus has had to give back the machine of fistula; patients using heparin saline flush lumen, such as patients with hypercoagulable state may be 20 ~ 40mg intravenous heparin and, if necessary 24 hours after systemic heparin. Wound dressing should not be too tight, to avoid pressure, dehydration and low blood pressure. Attention to the protection fistula, do not measure blood pressure in the fistula side arm, blood and transfusion.

(B) Infection Prevention and Care

Puncture skin strict disinfection, aseptic technique, try not to repeat the use of the needle, otherwise they will be strictly disinfected. Hemostasis at the end of dialysis have aseptic technique. Suspend the use of local infection within the fistula, use of temporary vascular access, strengthen local skin disinfection. Incision and drainage of abscess formation in a timely manner, systemic antibiotics.

(C) a reasonable puncture site selection

Arterial puncture site should be away from the fistula 5 ~ 150px, and radial deviation, so the patient wrist-induced vascular bleeding puncture before the first observation of fistula blood vessels line, and then find out the blood vessel punctured tube arm thickness, elasticity and depth. Vascular arm light exposure can tie a tourniquet is unclear, but the tie should be short time. Puncture with the right method, remember to use fixed-point method, a new needle puncture needle points from the last point at least 25px or more buttons into the needle may also be used, such as buttons, like clothes, fixed several puncture point, rotate their use.

(Iv) take effective methods to stop bleeding

When the angle of needle injection angle puncture to the same oppression strength necessary to effectively stop the bleeding but bruit appropriate, hematoma occurred within 24 hours prohibition heat, to prevent congestion worsened recommend cold packs immediately, help make the blood vessels to stop bleeding, If hematoma should be suspended fistula use, so as not to puncture injury worse.

(V) strengthen health education of nurses should be in the former fistula patients do missionary work, the importance of the patient made it clear to the fistula. Fistula typically requires four to eight weeks before using mature, especially the elderly. Prevent fistula site thrombosis, controlling high blood pressure, do not use the side of the arm has a fistula heavy lifting, to prevent lateral pressure, fluids, blood, and blood pressure. As no bleeding after dialysis, may in the second daily Hirudoid ointment and gently massage 2 to 3 times a day to soften the skin caused by repeated puncture scar.


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