I. Individual dialysis machine and pipeline:
Disinfected once a day after dialysis, time 1 hour, concentration: the original 5% Venus disinfectant, into the machine diluted to 1000 PPM. disinfected with reverse osmosis water rinse for 30 minutes, the next day before dialysis flushing 30 minutes, once a week with rafter acid cleaning.
Second, centralized liquid supply system and pipeline:
Dialysis after disinfection once a day, time 6090 minutes, concentration: the original liquid 2.5% Venus disinfectant, into the machine after 35 times dilution, after disinfection with reverse osmosis water rinse for 1 hour, the next day before dialysis rinse for 45 minutes, twice a week with the beryllium acid cleaning
Third, the water treatment system:
RO Water Sterilization by infrared irradiation for 24 hours, disinfection with concentration of 5% formalin once a month, and cleaning with rafolic acid every other month.
Four, A liquid, B liquid barrels and containers in contact with dialysis fluid once a week 1% formalin soak for 24 hours.
V. The room is disinfected by infrared rays once a day, and the air is cultured once a month.
VI. Indoor air disinfection (formalin 40ml/+pp powder 30%)/m3 smoked for 24 hours.
VII. Dialysis machine and pipeline concentration of 5% formalin disinfection once a month.
Dialysis consumables reuse room work requirements
1, strict compliance with the reuse operating procedures:
2, keep the reuse room clean, daily operation is completed in a timely manner after cleaning and disinfection of the pool, countertops, floors, walls, there shall be no blood, dirt
3, treated dialyzers, blood circuits should be neatly arranged, placed in the cabinet, and should be sorted out and cleaned once a day. Disinfection once a day;
4. Monthly cleaning of reuse buckets and garbage cans;
5. Monthly cleaning of the reuse room (synchronized with the day of disinfection of the dialysis room);
6. Separate reuse of consumable products for patients with hepatitis C. Strictly segregated;
7. Staffing of the reuse room of two people, a regular employee is responsible for a sanitation officer to assist in the work.
Disinfection and isolation system of reuse room
I. Wear working clothes and special shoes when entering the room.
Second, the strict implementation of the reuse operating procedures, to keep the room clean and tidy.
Three, the room is irradiated with ultraviolet rays for 2 hours a day, with records. Every day with 250MG / L Jianzhisu disinfectant wipe desktop, cabinet, floor once.
Four, reuse dialyzer, tubing, dedicated, dedicated box, fixed placement, giant clean at any time. Cabinet cleaning and disinfection once a month.
Fifth, the patient used dialyzer, tubing, with peroxyacetic acid disinfection twice, spare. Disinfection is valid for 7 days.
VI. Dialyzers and tubing that are no longer used by patients are soaked in 500MG/L Kensin disinfectant for 10 minutes and then put into medical waste for centralized disposal.
VII. The room is fumigated once a month with formalin 40ML/M + potassium permanganate 30G/M and air culture is done once a month.
Note: This system is supervised by the reuse room reuse staff responsible for the implementation.
Treatment room disinfection and isolation system
I. Entering the treatment room should be neatly dressed, masked, hand-washed, and operated formally.
Two, daily ultraviolet disinfection 2 hours, and special registration of the use of time, ultraviolet lamps twice a week irradiation.
Three, indoor clean area, sterile area has obvious marking.
Four, sterile items and non-sterile items are placed separately and fixed position, indicating the date of disinfection disinfection period (winter October 1 - May 1 for 14 days, summer May 1 - October 1 for 7 days) marked clearly.
V, every Tuesday and Friday to replace the forceps jar, disinfectant, iodine sprinkle, alcohol, each sterile items are labeled and disinfectant date.
Six, the treatment car layer out of the clean area, the lower layer of the contaminated area. Used up items, car, disk clean and tidy.
seven, medicine cabinet drugs placed in an orderly manner, oral medicines, topical medicines placed in separate cabinets, labeling obvious.
Eight, after the use of disposable syringes and other supplies, with 500MG / L JianZiSu disinfectant soak for 10 minutes, syringes, pull open the pin, so that the syringe is full of disinfectant, disinfectant liquid surface over the syringe, dialysis special puncture needles used to open the sub, so that the tube is full of disinfectant, soaked in 500MG / L JianZiSu disinfectant for the first time in the first elimination of 10 minutes. Disinfected disposable supplies, into the medical waste bag, daily by the hygienist, closed transport to the supply room, centralized treatment.
9. One tourniquet for each person should be soaked in 125MG/L Kensin disinfectant for 10 minutes after use, and then washed and dried for spare.
Ten, domestic garbage and medical garbage are strictly separated, and medical garbage is packed in black plastic bags and sent to incinerator for burning.
Xi, monthly indoor formalin 40ML/M + potassium permanganate 30G/M, fumigation once a month to do air culture once.
Note: This system is supervised by the staff of the treatment class of each team **** the same responsible for the implementation.
Nurse station disinfection isolation system
I. Entering the room should wear special clothing.
Second, at any time to keep the room clean and tidy, items placed in an orderly manner, put back to the original place after use.
Three, the desktop floor twice a day, special towels, mop.
four, dryer in the laboratory single line double elimination, formalin fumigation disinfection is completed and pasted on the medical record.
5, the refrigerator placed in the medicine, can not store personal items.
Sixth, wheelchairs once a week with 250MG / L Jianzhisu disinfectant wipe.
Note: This system is supervised and implemented by the nurse of the delivery shift.
Hemodialysis room disinfection and isolation system
I. Entering the room should stand in overalls and wear special shoes.
The operation should wear masks and hats, and strictly carry out aseptic operation.
Three, air disinfection methods: daily after the end of dialysis, ultraviolet irradiation for 2 hours, early in the morning before the patient dialysis window ventilated for 1 hour; fumigation once a month; formalin 40ML/M + potassium permanganate 30G/M, respectively, placed in the indoor corners of the room, the center of the room, fumigation for 24 hours after the opening of windows and doors to ventilate the air.
Four, the ground is cleaned twice a day, mopping cloth special, regular disinfection. Disinfection method: every Thursday with 250MG / L Jianzhisu disinfectant solution soaked for 10 minutes after washing and drying.
V. Dialysis machine and bed table are wiped with 250MG/L Kensin disinfectant at the end of dialysis every day, and towels are exclusively used for this purpose.
VI. Patients' hand towels are soaked in 250MG/L Kensin disinfectant for 10 minutes at the end of dialysis every day and then washed for spare parts, so that there is one towel for each patient.
VII. Sphygmomanometer cuffs are cleaned once a week; infusion baskets are cleaned once a week and then wiped with paraffin oil; hemostatic forceps are cleaned once a week, and blood stains are cleaned at any time; oxygen humidification bottles are immersed in 250MG/L KENZHIYO disinfectant for 10 minutes every week, and then cleaned and dried for use; oxygen tubing is one for each person, not to be mixed; thermometers are disinfected by immersing them with 75% alcohol; and disinfectant is changed two times a week.
Eight, monthly air culture and record.
nine, bed sheets, covers, pillowcases weekly replacement of a hand, in case of special circumstances at any time to change, beds with 250MG / L Jianzhisu disinfectant wipe once a week.
Note: This system is supervised by the nursing staff of each group *** with the implementation.
Responsibilities of the nurse in charge
1. Responsible for the dialysis operation, observation of the condition of the patients in this area on the same day, data recording, and keeping the equipment and bed units clean and tidy.
2. Responsible for the deployment of nurses in this area and the arrangement of patients' beds. Responsible for scheduling and checking the work of nurses, hygienists and reusers.
3. Responsible for checking the setting of temperature, concentration, blood flow, dehydration, heparin amount and other conditions of dialysis machine in the district after the patient is on the machine.
4, participate in the rescue work of critical patients, responsible for personnel allocation, condition observation, treatment, records, to ensure the smooth progress of the rescue work.
5, is responsible for doing the ideological work of the patients in this area and reflect the patient's ideological dynamics to the director and physicians in a timely manner, and actively organize the nurses in this area to improve the quality of service, and try to meet the needs of patients.
6, responsible for the registration of the day of the patient's dialysis costs, and timely delivery to the accountant to settle accounts. Participate in the collection of outstanding fees.
7. Undertake the guidance of holistic nursing care for dialysis patients.
Treatment class nurses
1, responsible for the preparation of dialysis heparin dosage on the day.
2. Prepare dialysis supplies (puncture needles, dialysis cassettes, sterilized items, etc.) and clean and disinfect them after use.
3, responsible for the cleanliness and neatness of the treatment trolley, to ensure that the items are fully equipped.
4, bear the day patient hemodialysis operation, observe the condition and responsible for measuring temperature, heart rate, blood pressure, respiration. Clean the dialysis machine and organize the bed unit after blood return.
5, participate in rescue work, responsible for the supply of rescue items, disinfection items replacement and disposable consumables processing.
6, every Tuesday and Friday to carry out items of disinfection and indoor air disinfection.
7, responsible for dialysis blood transfusion, transfusion and all kinds of treatment work.
8, improve the quality of service to send service attitude, do a good job of dialysis patient holistic care, strengthen psychological care and health education.
Monday, inventory of treatment appliances and medicines, timely to the treasurer.
Tuesday, Tuesdays and Fridays disinfection.
Wednesday, check the expiration date of sterilized items and replace them in a timely manner.
Nursing shift nurses duties
1, responsible for the day of the patient's dialysis treatment, observation of the condition of the patient, vital signs observation, registration dialysis form.
2. Keep dialysis equipment and bed unit clean and tidy.
3. Participate in the resuscitation of critically ill patients.
4. Responsible for the holistic care of dialysis patients. Understand the patient's physical condition, diet and living habits, psychological condition, social relations, dialysis effect, and improve the level of service. Actively carry out health education work.
5, to assist the class **** with the management of "blood dialysis" and dialysis preparation.
Priority work:
Daily cleaning and disinfecting hand towels, cleaning towels for dialysis machines.
On Tuesdays, change sheets and drape covers.
Wednesday, sterilized thermometers.
Friday and Saturday, clean sphygmomanometer cuffs, clean hemostats and infusion sling blues.
Field Nurse Duties
1, responsible for all external things to contact, coordinate with the relevant departments.
2, responsible for the exchange of sterilized items, delivery and inspection, pick up medication, transport patients and other work.
3, responsible for the management of the hygienist, instructing him to keep the environment clean and tidy at all times. Maintaining order in dialysis room and discouraging family members from accompanying.
4, responsible for dialysis patient's life service, improve meal management, and consult patients at any time.
Key coal work
Monday, Friday, inventory change work clothes, quilt
Tuesday, supervise and guide the work of the hygienist.
Saturday, check the period of disinfection items.
Blood purification center hygienist duties
1, under the leadership of the head nurse and the guidance of nurses.
2, responsible for the "center" belongs to all indoor and environmental hygiene, keep it clean and tidy.
3, responsible for the disposal of contaminated garbage and common household waste.
4. Drinking water supply and management.
5. Be responsible for changing and washing of polluted clothes and bedclothes.
Technician duties
1, responsible for the management, repair, debugging of all instruments and equipment in the Center for maintenance and disinfection, and find problems to report in a timely manner.
2, each class dialysis to patrol the equipment running condition 3-4 times, found fault timely elimination, and make records.
3, strict implementation of the rules and regulations and technical procedures, accurate, timely and standardized completion of the technical operation.
4, responsible for testing the quality of each batch of dialysis fluid. Checking the quality of dialysis solution with physicians to prevent the occurrence of errors and accidents.
5. Assist nurses to perform various technical operations and provide technical guidance.
6, responsible for the development of the purchase of equipment spare parts program, keep equipment spare parts and maintenance tools.
7, participate in emergency, overtime, duty. Attention to economize, strengthen the fire prevention and anti-theft measures.
8, responsible for training, guidance for advanced students, interns.
NCS --- 200C centralized liquid supply device operating procedures
I. Open the main power switch.
Press the ｛protection｝ and ｛dialysis｝ switches at the same time, and the machine starts to work.
Second, after dialysis is completed, press the ｛Protection｝ and ｛End｝ switches.
Three: Press the ｛Protect｝ and ｛Wash Afterward｝ switches to start the wash afterward program.
4. After the post-cleaning process is complete, the instrument enters standby mode.
The next morning, the machine automatically enters pre-wash and waits for dialysis.
Duties of the person in charge of sterilization and isolation
I. Supervision and inspection of the implementation of the sterilization and isolation system.
Two, the last week of each month is responsible for doing hemodialysis room, treatment room, reuse room room disinfection.
Three, after the monthly room disinfection, responsible for contacting with the relevant personnel of the Laboratory Department, to do indoor air culture and centralized liquid supply, reverse osmosis water single machine outlet of the bacterial culture and save the laboratory report.
Four, is responsible for the staff of disinfection and isolation, nosocomial infection rules and regulations and a variety of knowledge.
Hemodialysis room common items disinfection work schedule:
Time Items Disinfectant concentration Disinfecting time Disinfecting method Responsible person
Week Medical record folder 250mg/l / rubbing each nursing class
Tuesday Hemostasis clamps, baskets 250mg/l 10 points Soaking each nursing class
Wednesday Oxygen cylinders 250mg/l 10 points Soaking each nursing class
Three 250mg/l 10 minutes. Soak All nursing classes
Friday Plastic bucket 250mg/l 10 points Scrubbing Re-users
Saturday Bed 250mg/l / Scrubbing All nursing classes
Saturday Wheelchair 250mg/l / Scrubbing Nursing staff
Purification center is the base of blood purification technology; it is the window to show the development trend of the imported dialysis machine and dialysis consumable; it is the base to learn how to maintain and improve the quality of blood purification.
The Purification Center is a base for learning blood purification technology; a display window for the development trend of imported dialysis machines and dialysis consumables; and a classroom for learning the repair and maintenance of dialysis equipment. We hope that we can learn from each other and improve together.
All to the "center" for further training must submit an application, get the "center" leadership agreed to go through the procedures for further training.
Second, to the "center" for further training must have the following conditions:
1, nurses, technicians: with secondary nursing school culture level, engaged in clinical work for more than three years, with a certain degree of clinical experience, technicians should have a certain degree of knowledge of electrical and electronic engineering.
2, physician: with a bachelor's degree in medicine, engaged in clinical work for more than three years, with rich clinical experience.
3, work actively, willing to learn, eager to serve patients.
4, respect for teachers, to comply with the rules and regulations of the hemodialysis room.
Three, the nurse learning content arrangements (shall not be less than three months).
(A), technical operation:
Three months of training:
1, familiarize themselves with the environment, learning to flush the pipeline.
2, learning to install piping, replacement flushing.
3, learning on the machine, blood return, vascular puncture and other techniques.
4, daily maintenance of dialysis equipment, maintenance methods.
Six months of further training:
1, on the basis of proficiency in the above techniques, learning the handling of special situations.
2, simple machine troubleshooting method.
3. Learning the operation of hemofiltration, plasma exchange, CAVH.
One year of further training:
1, understand the basics of blood purification, HD basic principles.
2. Basic knowledge of water treatment.
3, dialysis indications, contraindications.
4, Dialysis complications.
5, uremia, renal transplantation after the rejection of patient care.
Four, technician learning arrangements
1, familiar with the environment, understand the technician's daily work schedule.
2. Familiarize yourself with the basic operation of the equipment.
3. Familiarize with the preparation of dialysis solution.
4. Understand the working principle of water treatment machine and dialysis machine.
5. To learn the troubleshooting of common instruments.
V. Learning Arrangements for Physicians
1. Understand the basics of blood purification and the basic principles of HD.
2. Basic knowledge of water treatment.
3. Indications and contraindications for dialysis.
4. Anticoagulation therapy in dialysis.
5. Management of acute and chronic complications in hemodialysis.
6. Study of ultrafiltration, sequential dialysis, high - low sodium sequential dialysis, low humidity dialysis, heparin-free dialysis, hemofiltration, hemodiafiltration dialysis, hemoperfusion, pediatric dialysis, CAVII, plasma exchange, immunosorbent.
7. Establishment of vascular access:
Temporary: jugular vein cannulation, femoral venipuncture.
Permanent: endovascular fistula.
Arranging for counterpart teachers with clinical experience in dialysis to be responsible for teaching, and hiring specialists above the attending physician as theoretical lectures and counseling.
Medical management
I. Scope of medical treatment
Treatment of acute and chronic renal failure, acute pulmonary edema, organic carbon drug poisoning, alcoholism, immune system diseases such as familial lupus erythematosus, neurological disorders such as Guillain-Barre's disease, myasthenia gravis, multiple myeloma, hyperlipidemia and other conditions.
II. Medical treatment
Progressively carrying out: bicarbonate hemodialysis, hemodialysis filtration, plasma exchange, hemoperfusion, simple ultrafiltration and other blood purification therapies.
Three, hemodialysis indications
1, acute tomography
1) high catabolism (BUN rises more than 25 per day) immediately.
2) Those with anuria (less than 100 ML/day) or oliguria (less than 400 ML/day) for more than 48 hours with a weight gain of 20 KG/day.
3) Urea nitrogen BUN>80MG/DL
4) Serum muscle law SCR>8MG/DL
5) Blood potassium K>6.5MEQ/L
6) Nitrogen dioxide binding rate CO2CP?>15MEQ/L
7) Those who have obvious edema, pulmonary edema, nausea, vomiting, lethargy, drowsiness, parchedness, consciousness disorder.
2. Chronic renal failure
1) Endogenous muscle clearance CCR less than or equal to 10ML/MIN (less than or equal to 15ML/MIN in diabetic patients).
2) Serum muscle method SCR is greater than or equal to 8-10 MG/DL.
3) Urea nitrogen BUN is greater than or equal to 80-100 MG/DL
Four, Contraindications to hemodialysis
1, Relative Contraindications
1) Elderly high-risk patients, uncooperative infants and children.
2) Severe bleeding or severe anemia.
3) Severe hypotension and shock.
4) Heart failure and pulmonary edema due to severe heart disease.
5) Renal failure due to advanced systemic diseases such as tumors.
6) Those who are mentally abnormal and unable to cooperate.
V. Complications of hemodialysis
Medical complications of dialysis therapy:
Low blood pressure, hypertension, cardiac arrhythmia, imbalance syndrome, fever, headache, nausea, vomiting, muscle cramps, acute hemolysis, respiratory distress, loss of consciousness, generalized convulsions, psychiatric anomalies, skin rashes and itching.
VI. Indications for emergency dialysis
1. Hyperkalemia: serum potassium >70 MMOL/L, anuria.
2, severe left heart failure: dyspnea can not lie down, need oxygen, cough pink foamy sputum;
3, severe acidosis: COCP <20MMHO, PH <7.2, severe electrolyte disorders, conservative therapy can not be corrected.
4, drug intoxication deep coma, and has been in the emergency gastric lavage, under the urinary catheter;
5, meet the above conditions, please pay attention to the following matters:
1) Emergency dialysis fee of about 1,000-2,000 yuan, (including brand-new dialyzers, tubing);
2) hemodialysis fee of about 2,000-3,000 yuan, (including carbon dioxide) -(including carbon kidney and tubing)
3) Before dialysis, please have the following tests: hematocrit (>5.5G%), platelet, coagulation time, and blood type;
4) Emergency dialysis time is usually no more than 3 hours, except for hyperkalemia;
5) Outpatients must go through the emergency room;
6) Patients' blood pressure is stable, high blood pressure is 100%, high blood pressure is 100%. ) The patient's blood pressure is stable, with a high pressure of 100-90 MMGH or more and a low pressure of 70 MMGH or more.
Hemodialysis device operating procedures
1. Turn on the main power switch, connect the dialysate suction tube to the dialysate A and B buckets, and press the dialysis and prepare blood syringe keys;
2. Install the dialyzer and blood circuit to the dialysis device.
3. Use 0.9% saline for injection 500ML to flush the blood circuit branch end, heparin tubing, arterial jug, dialyzer, and venous jug, and vent the blood;
4. 4. When the ready bypass key stops blinking, press Bypass. Connect pins to the dialyzer fluid chamber inlet and outlet. Press the exhaust button, exhaust the air in the fluid chamber, and then turn off the bypass;
5. Set the target water removal volume, water removal rate, metabolic maintenance volume, and machine temperature between 36-37 degrees Celsius according to the doctor's instructions, and the knob bubble monitoring and negative arterial pressure monitoring in the working position;
6. Puncture the artery of the endocardial fistula in aseptic operation, and then, after seeing the blood return, exhaust the air, and then connect the arterial puncture needle to the blood circuit artery port and then connect the arterial puncture needle to the blood circuit artery port and then to the blood circuit artery port. Tube mouth and blood circuit arterial port and fixed. Turn on the blood pump at 80 ML/MIN, and when the blood is upstream in front of the heparin tube, rapidly inject the first volume of heparin and determine the maintenance volume of heparin.
7. Puncture the endovascular vein and deflate. Turn off the blood pump as blood flows to the venous jug. Disinfect the orifice at the venous end of the blood circuit, exhaust air, and clamp the hemostat. Exhaust the air and connect the venous puncture needle orifice to the venous port of the blood circuit. Check that the entire circuit is clear and securely fastened.
8. Turn on the blood pump from small to between 200ML-300ML/MIN, press the start button, set the alarm limits for monitoring venous pressure and hydraulic pressure. Regulator whole dialyzer arterial end up;
9. Check the settings again, puncture site without blood seepage, fixation method is correct, no entanglement, the blood circuit is smooth, tighten each connection, check each hemostatic forceps to the tightest part. After the second person checks and confirms that there is no error, the dialysis starts;
10. Measure the patient's blood pressure and pulse without any abnormality, and register it on the dialysis record paper;
11. Monitor the blood pressure every hour during the process of dialysis, and report the abnormality to the doctor immediately, and deal with the symptomatic treatment at any time. The problem is solved in a timely manner. Ensure the smooth progress of dialysis and the accuracy of water removal.
Blood return operation procedure
I. The total water removal amount reaches the standard, the time has arrived then the target water removal amount prompts, no special treatment, you can return to the blood, press the peak sounding stop, ready, and then set the key, the heparin pump reset, to zero. Clamp the letter heparin tube, blood flow is adjusted to about 80ML-100/MIN, and blood return begins;
II. Turn off the blood pump, clamp the letter pump pre-tube, so that the bypass saline slowly flows into the arterial side, and the blood in the tube rinses out and then clamp the puncture needle tube. Open the pre-pump clamp, turn on the blood pump, the blood flow is about 100ML/NIN, use 0.9% saline to flush the arterial pot, the dialyzer, and the venous pot, flush the blood, and then clamp the venous puncture needle tube. The puncture point put a band-aid, paper roll compression, pull out the needle, fixed;
Three, press the bypass, drain key, drain the dialyzer liquid chamber liquid, disconnect the venous and arterial chain and reset. And dialysis key;
4. Remove the blood circuit and dialyzer, turn off the power switch;
5. Unplug the dialysate suction tube, insert it back into the A and B ports on the dialysis device. Start to flush and disinfect the dialysis unit automatically.
Hemodialysis Patient Nursing Routine
I. Vital signs are closely observed during dialysis, and T, PR and BP are measured hourly and monitored at any time in case of any special conditions and recorded.
Second, set the dialysis conditions (precipitation, dialysis time, water removal rate) strictly according to the doctor's orders, and checked by the second person.
Three, medication in dialysis strictly implement the system of three checks and seven checks.
Four, at any time to check the puncture site for blood seepage, blood leakage, timely treatment.
V. Understand the patient's weight change, contact with the doctor at any time to adjust the water. Disease changes, to ensure adequate dialysis.
Fifth, when low BP occurs in dialysis, take the position of head low and feet high, slow down the speed of water removal, and supplement 0.9% saline appropriately. Frequent low BP patients can adopt high sodium or take gradient high sodium dialysis.
VII. Patients with high BP on dialysis should pay attention to the complication of cerebral hemorrhage, and may adopt low-sodium dialysis or consider the increase in blood volume due to the increase in water removal.
VIII. Enhance the life care in dialysis.
Nine, strengthen health education, active health promotion, understanding of the patient's psychology, teaching patients to adjust their own intake, weight calculation and protection of internal fistula method.
Endocardial fistula care:
X. Introduce the knowledge of care of endocardial fistula to the patients and teach them to take care of and maintain the endocardial fistula.
1, the protection of the operating limb blood vessels to avoid repeated puncture to create the conditions for the internal fistula anastomosis.
2, the arterial - venous endovascular fistula anastomosis, the operating side of the limb swelling, pain, should be elevated operating limb, do not press the surgical site. Encourage the patient to move the limb, repeatedly make a fist, increase blood circulation.
3, closely observe the postoperative fistula situation can touch the intravascular pulsation, hear vascular murmur, found abnormal timely treatment. 2-4 weeks later, the endocardial fistula maturity can be used.
4, the fistula is limited to dialysis. Can not be used for blood or injection of drugs, and can not be inside the fistula side of the limb side of the blood pressure, (except rescue).
5, constantly changing puncture points, sequential replacement to protect the blood vessels.
6, to prevent the formation of hemangiomas, with the elasticity of the wrist guard compression of vascular rage.
7. Strictly perform aseptic operation during puncture, and move gently and swiftly.
8, back to blood after dialing a band-aid, the top of a roll of sterilized paper compression hemostasis, asked the patient to remove after 15 minutes, do not press too long and the formation of internal fistula thrombus.
9, compression paper roll tightness to touch the two sides of the blood vessel rotation is appropriate.
10, due to a variety of reasons caused by the internal fistula thrombus, should be extremely timely to the hospital for appropriate treatment.
V. External fistula care
1, strict aseptic operation, connecting the blood line and back to the blood are strictly completed under aseptic conditions.
2, aseptic bandage wrapping smooth external fistula tube, and will be partially exposed to do a day of monks to bang on the clock at any time to observe.
3, tell the patient to sleep not to pressure the fistula limb, smell the vascular murmur (whistling like the wind) for fluent.
4, if found in the fistula tube plasma ball separation layer, and can not hear the vascular murmur, depending on the coagulation blockage, should be dealt with immediately.
5, the occurrence of coagulation blockage should be in aseptic conditions with the catheter strangulation, remove the clot, slowly into the 5000 units of urokinase, 10-30 minutes after the withdrawal of the catheter, still can not be required to change the internal fistula. Reoperation, do not inject forcefully into the tube to prevent the blood clot is pressed into the blood circulation.
6, do not use dental pliers directly clip the external fistula. Can be padded with gauze to prevent clip broken, cut.
Temporary blood access operating procedures
A, direct puncture method
1, arterial puncture site: dorsalis pedis artery, radial artery (reserved for endocervical fistula limb), femoral artery, brachial artery.
2, puncture method:
1) Select the puncture site, the puncture point as the center of the ring disinfection, 5CM in diameter.
2) Select the 16G hemodialysis puncture needle, the mouth of the tube connected to the syringe, extract 1ML of air.
3) The right hand holds the puncture needle, the tip of the needle beveled upward, from the right side of the blood vessel into the skin, the left hand index and middle finger disinfection and gently press the arterial pulsation site.
4) When puncturing the artery, enter at an angle of 30-40 degrees, see the blood red and pulsating, and then advance the needle to a length of 2cm.
5) Quickly connect the line, HD to draw out the blood, to prevent the blood from spilling out along the wall of the tube causing hematoma.
3. Post-puncture precautions:
1) Insufficient blood flow in arterial puncture should be adjusted appropriately, and the wing of the needle should be fixed when the result is satisfactory.
2) Observe the puncture site closely for swelling.
3) After removing the needle, apply pressure until there is no bleeding.
II. Deep vein puncture
1. Site of puncture: direct puncture of the femoral vein.
2. Puncture method:
1) Choose the country of the blood vessel, the left hand index, middle and ring fingers feel the femoral artery pulsation, medial 0.5CM at the femoral vein.
2) Wear sterile gloves, 2.5% tincture of iodine, 75% alcohol deiodination, disinfection of the skin, with the puncture point as the middle ring disinfection area of 20 by 15 CM.
3) Take the 5ML injection shooter, pumping 2% procaine 2ML.
4) The left hand three fingers along the femoral artery pulsation of the strongest pressure.
5) Holding the needle in the right hand, the puncture site was injected with procaine for local anesthesia.
6) Remove the puncture cannula needle, connect the injector, and aspirate 2 ML of heparinized saline to ventilate.
7) The needle was held in the right hand, with the tip of the needle beveled upward, and was inserted at a 45-degree angle to the parapubic area at a point 0.5 CM medial to the femoral artery in a parallel direction.
8) The left hand fixes the direction of the needle, the right hand draws back the needle plug, the needle tip slowly withdraws in the original way, until the return of blood is seen, and the left hand is fixed.
9) Push the blood back into the blood vessel without negative force, suction smooth, repeated once to confirm in the femoral artery.
10) the left hand fixed trocar handle, the right hand will trocar core slowly pulled out, the left hand middle finger due to set the index finger, thumb holding the trocar slowly into, into the greater than 2/3 length of the filling, pull out the core, clamping the trocar handle hose.
11) Remove the needle handle rubber tip, connected to the arterial end of the HD line, for HD, fixed needle.
3. Precautions
1) Restriction of limb movement on the side of the puncture is not convenient for needle retention.
2) Observe whether there is bleeding or oozing of blood during HD.
3) Insufficient blood flow and confirmation that the needle is in the vessel can be adjusted by rotating the petiole in a direction parallel to the femoral artery.
4) blood back to pull out the needle, should be 8CM long, 4CM diameter gauze roll full compression hemostasis, 10-20 minutes without bleeding, can increase the bandage observation 1/2-1 hour, flat car back to the ward.
Three, indwelling catheter
1, part and time:
Generally for the internal jugular vein cannula, can also be used in the femoral vein, subclavian vein, the time of stay is generally 48-72 hours, can also be left a few weeks, a few months. Anti-infective tubes can be used for more than one year.
2, pre-dialysis treatment
1) Heparin saline is withdrawn from the catheter before taking over the route.
2) Strictly sterilize the mouth of the tubing during HD and soak the liver system cap in 75% alcohol.
3, post-dialysis treatment:
Hemodialysis (HD) operating procedures
Takeover procedures:
I. Review the dialysis conditions set before takeover, the AV end of the dialyzer, venous monitoring, heparin tubing and other parts of the connection is tight, the A, V vein pots exhaust tube with hemostatic clamps clamping, blood circuits, the dialyzer rinsed clean.
Second, connect the A tube: 75% alcohol to disinfect the mouth of the tube, release the liquid to flush the mouth of the tube of about 50ML, clamp the liquid into the tube, connect the A tube, connect and tighten again in order to prevent dislodgement, and lead the blood out.
Third, connect the V tube: V puncture, blood lead to the mouth of the tube, exhaust the puncture needle tube air, 75% alcohol disinfection of the V tube mouth, open the blood pump to discharge 250ML, clamped, padded with a square gauze, both hands hold the puncture needle tube head and the V tube head, pressurized exhaust, coupled to confirm that there is no air to open the hemostatic forceps, turn on the blood pump, dialysis treatment.
Puncture procedure:
I. Select the blood vessel, pay attention to the protection of blood vessels, with a length of 2CM divided into three points, in order to enter the needle, the next nudge.
Second, strict implementation of aseptic operating procedures, puncture arm under the aseptic treatment, 2.5% iodine cotton balls to disinfect the skin, centered on the puncture point, circular disinfection diameter of 5CM.
Third, the left thumb tense the skin, the right hand holding the needle wing, the tip of the needle beveled upward at 45 degrees, stabbing the skin, penetrate into the blood vessels, into the skin into the skin 2/3 length, after seeing the blood covered with aseptic cotton balls, fixed with adhesive tape
Four.
Four, the blood will be led to the mouth of the tube, connected to the blood line.
V. The A and V vein puncture needles will be managed smoothly, fixed with adhesive tape, and the blood circuit will be fixed again to avoid slipping off during treatment with hemostatic forceps clamps.