In fact, hemodialysis is a very complex system engineering, can not well complete a patient's dialysis, there are external and internal factors.
External factors include:
A: Factors of water supply, power supply and safety.
1: The water supply should be in accordance with the national health standards, and the water supply pressure should not be less than 1.0 kilogram.
2: The power supply voltage should be stable, net voltage 220 volts, 50 hertz. Distribution switch capacity in line with national standards, good quality.
3: The ground connection of water treatment machine, reverse osmosis machine and blood dialysis machine should be firmly connected, and the resistance to ground is less than 0.2 ohm.
B: machine maintenance, maintenance, use, human factors.
1: The conductivity of the reverse osmosis water is less than 10?s/cm (the conductivity of reverse osmosis water in our hospital is 0-10?s/cm), and the water pressure is not less than 3 kilograms. In order to ensure the quality of the reverse osmosis water, according to the provisions of the regular replacement of the water treatment machine, the front stage of the water inlet and the back stage of the soft water filter. Regularly complete the water treatment machine's sand filter tank, resin tank, activated carbon tank maintenance, . Backflush, regeneration. Regularly complete maintenance, backflushing, and sanitizing of the reverse osmosis machine. Strictly comply with the replacement time of activated carbon, resin and reverse osmosis membrane, technical requirements.
2: A/B liquid concentration standards should be accurate, strict mixing ratios, stirred A/B liquid clear and bright, B liquid is bicarbonate must not be stored to avoid crystallization, regular cleaning and disinfection of the stirrer, replacement of filter cartridges.
3: disinfectant and pickling solution (decalcification) with the proportion to be accurate, safe storage, detailed records of the configuration time, the number of configurations. Day machine mounted hemodialysis machine use: 16% peroxyacetic acid 560ml + 500g solid citric acid to 1000ml of solution decalcification, disinfection. For Beltron blood dialysis machine: 50% citric acid solution for heat sterilization. Jinbao hemodialysis machine use: 3.5% peroxyacetic acid solution sterilization. 20% citric acid solution decalcification. And the above models should be used from time to time 5% sodium hypochlorite solution, disinfection and removal of protein residues in the machine.
4: Hemodialysis machine should be disinfected after use, or after the previous patient treatment. Decalcification is required after each daily carbonate dialysis treatment. Decalcification and sterilization should be completed carefully and the exterior of the machine should be kept clean. (Precipitated material is calcium and magnesium carbonate produced by calcium and magnesium ions in fluid A and carbonate ions in fluid B. Calcium precipitates will damage the machine.)
5: Regularly do the machine fan filter, A/B liquid inlet filter cleaning, check the internal piping has no liquid leakage, and the machine circuit board dust cleaning. For each maintenance and repair, do record filing.
6: The treatment room is clean and tidy, medicines and equipments are arranged in an orderly manner, and the liquid dispensing room should be isolated. Dialysis treatment room temperature should be appropriate, summer temperature 18-22 ℃, winter temperature 20-24 ℃, there is good ventilation. Patients with infectious diseases should have dialysis isolation room.
7: Cleaning and disinfecting reusable dialyzers must strictly follow the operating procedures and do a good disinfection test. Our hospital uses Lunatron automatic dialyzer reusable machine, the reusable dialyzer capacity requirements are: not less than eighty percent of the capacity of the new dialyzer. The pressure requirement is: in the dialysate chamber, generate a negative pressure of 250mmHg, and according to the different dialyzers, in 20-30 seconds, the negative pressure change is not more than 25mmHg. this work is automatically completed by the automatic dialyzer reusable machine. If not qualified machine will have prompt.
8: Strictly abide by the system of three checks and seven pairs, especially the reuse of the dialyzer should be dedicated to the special person, check carefully, can not be wrong. Unusable dialyzer, strict medical waste management regulations, proper disposal.
9: the technical level of medical and nursing staff, service attitude, operating habits, as well as good relations with patients, is also a necessary condition for good dialysis.
10: For the hemodialysis room with more than fifteen machines, dialysis work has a certain scale, and the workload is large. Should be equipped with full-time engineers, to do timely maintenance and repair, and strive for the initiative of maintenance work, improve the efficiency of the use of machines.
11: hemodialysis machine in improving the quality of hardware at the same time, should increase the function of the software, enrich the content of the software, improve the comfort of dialysis, more therapeutic. For example, increase the control of balanced blood pressure system, the function of selecting more filters, and enhance the performance of stabilizing ultrafiltration.
The influence of internal factors: dialysis patients are in a serious condition and are accompanied by many complications. Patients may end dialysis early for many reasons, or change and reduce treatment parameters during dialysis, so that the effect of the current dialysis is not achieved, which will have a negative impact on the next treatment, and the next dialysis.
The influence of internal factors mainly reflects the patient's own physical state, the setting of treatment parameters, and the choice of treatment modality:
1: Long-term dialysis patients dialyze on average two to three times a week, and there will be a certain amount of physical exertion. Therefore, the patient's rest and diet are crucial. Scientific and reasonable diet, adequate and good rest is the necessary guarantee for dialysis patients.
2: The endovascular fistula of dialysis patients is the basic condition to ensure long-term dialysis, and it is also the lifeline of patients. Use, protect the endovascular fistula, is the patient and health care personnel **** the same responsibility. Every operation in the treatment should be light, steady and accurate.
3: Hypotension or hypertension of the disease, dialysis has a greater impact, dialysis should be timely observation, the whole monitoring of blood pressure status, to make the correct and timely treatment. Each nursing staff should be able to skillfully operate the dialysis machine, accurately set the parameter values, and be able to deal with simple malfunctions.
4: The parameter settings of dialyzer, ultrafiltration volume, transmembrane pressure, dialysate conductivity, dialysate temperature, and heparin volume should be determined according to the condition of dialysis patients, and some treatment parameter quantities should be adjusted at the right time in dialysis. For long-term dialysis patients can choose their suitable treatment parameters and ultrafiltration curve to achieve personalized treatment. (Ultrafiltration water volume = ultrafiltration coefficient * transmembrane pressure * membrane area * dialysis time).
5: Record in detail the physiological indexes of the patient during dialysis and the mental state during dialysis. Regularly check the biochemical indicators and blood gas analysis indicators. Carefully record the weight of the patient before and after dialysis. And have certain emergency medicines.
6: In order to make the dialysis effect better, it is recommended that after a period of regular dialysis treatment if the patient's condition permits, it is better to do a hemofiltration to remove larger molecules, so as to improve the efficiency of the dialysis treatment and to normalize it.
7: Some dialysis patients need blood transfusion and other auxiliary treatments in dialysis, dialysis room medical staff should actively cooperate with each transfusion and treatment.
8: Keep in touch with the patients after dialysis treatment, and understand the patients' dietary status, rest status, mental status and physical status after treatment.
Hemodialysis is a complicated and detailed work with high technical content, which requires medical and nursing personnel, equipment maintenance personnel to have high responsibility, patience and enthusiasm for work, as well as to have exquisite technical level, in order to guarantee the completion of hemodialysis work. To provide patients with good dialysis treatment services, improve the patients' ability to survive and quality of life.