Pruritus in hemodialysis patients how to do?

Pruritus in hemodialysis patients how to do?

In hemodialysis patients, pruritus is a common and difficult to tolerate the symptoms, the incidence rate of 60% -90%. With prolonged dialysis, the symptoms gradually worsened, the patient anxiety all day, very painful, seriously affecting the quality of life of patients.

First, the electrolyte metabolism disorders cause itching

Chronic renal failure patients the most common, due to the discharge of phosphorus reduction, repeatedly elevated phosphorus levels, blood ionized calcium levels drop, thereby stimulating PTH (parathyroid hormone) secretion and lead to secondary hyperparathyroidism.

Studies have shown that secondary hyperparathyroidism Beng can cause itchy skin, which can cause increased hypercalcemia, skin calcification and stimulate the skin mast cells to release histamine, which increased PTH is considered to be an important cause of the disease.

Responses:

1, limit dietary phosphorus intake is recommended phosphorus content is preferably less than 600 a l200 mg / d, avoid eating soy foods and animal offal.

2, the application of active vitamin D calcium. Adjusted to an appropriate dialysate calcium concentration to prevent hypercalcemia.

3, change the way scratching. Hand pat play, Qin nails. Special attention to maintaining the integrity of the arteriovenous fistula movable side arm skin to avoid infection within the fistula.

If local infection, should avoid puncture and prescribed use of antibiotic ointment Bactroban.

Second, the quality of nitrogen retention metabolites cause itching

The quality of nitrogen retention metabolites skin irritation and makes the sebaceous glands and sweat glands atrophy, with varying degrees of skin dryness, scaling and cause itching.

Ichthyosis-like skin-like appearance, skin itching, constantly scratching, and even scratch the skin and can not be relieved.

The main cause of nitrogen metabolism retention are: inadequate dialysis, selected low flux dialyzer reuse and so also repeatedly.

Responses:

1, to reduce low-flux dialyzer reuse times, increase the number of dialysis (3 times / w), conditions permitting, can be used in flux dialyzers (ultrafiltration coefficient of 15-30 mL / mmHg · h · m2) were Dialysis.

2, the dialysis process, close observation of the dialysis machine functioning properly, try to make early discovery, early prevention and early treatment.

3, the operation must be standardized term care, attention to aseptic technique when performing the treatment, to ensure safety during dialysis treatment.

4, guide the patient with cold water, ice, wet towels relieve itching, skin can be treated with a lubricant and use soap when dry skin cream.

Third, allergic reactions resulting in itching

Allergic reaction occurs mainly because of heparin hemodialysis tube passage plasticizer to soften and disinfect the dialyzer and a trail of ethylene oxide and other dialysis patients to stimulate the spleen, bone marrow and skin cell proliferation and hypertrophy, resulting in increased blood concentrations of histamine induced skin itching.

Responses:

1, the use of anti-histamine medications eased.

2. Encourage patient comfort, reduce patient tension.

3. Choose good biocompatibility dialysis to reduce the allergic reactions caused by ethylene oxide.

4, choose saline predialysis full pre-punched dialyzer reuse and pipes, when the machine do the disinfectant residual testing to ensure the safety of the dialysis treatment.

5, these allergic itching rash caused many accompanied by guiding patients to avoid skin damage caused by hard scratching, you can use some of the cool medicated oil treated, alleviate the symptoms.

Fourth, the dialysis care pruritus

1, psychological care

Patients because of skin itching and scratching leads to the self-image of the defect, so that patients are very anxious, as aggravation of symptoms by day, affecting the quality of sleep at night, can be sedated under the guidance of a doctor, so as not to be too emotional anxiety.

Because HP (blood perfusion) combined with HD (hemodialysis) than the simple implementation of HD treatment increased the cost of treatment, patients will bring a certain degree of psychological pressure, resulting in dialysis patients receiving HP combined with HD treatment compliance is not high.

Therefore, health guidance should be prepared to work to improve patient treatment compliance and ensure the smooth progress of the treatment.

2, day care

Guiding patients in their daily lives to wear cotton, loose underwear. Bath water should not be too hot, usually with 40 ℃ warm water bath is appropriate to avoid the use of alkaline soap and bath gel.

To avoid dry skin, causing itching, local moisturizing lubricant can be coated, but good personal hygiene, bathe, wash clothes, not drinking, eating spicy food.

3, other

The correct guidance of patients taking phosphate binders, regular blood tests indicators, nutrition intake of education, improve patient treatment compliance, delay the onset of long-term complications.


kidneyhospitalabroad@hotmail.com
WhatsApp:+8615511395691
Viber:+8613393010526