The blood pressure is too low during dialysis, and the blood flows slowly through the anastomosis, which is easy to cause thrombosis.
Ultrafiltration and excessive dehydration during dialysis aggravate hypovolemia, increase blood viscosity, promote thrombosis, and lead to internal fistula occlusion.
Nursing care of hypotension during dialysis
one
When acute hypotension occurs, stop ultrafiltration immediately or slow down ultrafiltration, slow down blood flow, let the patient lie flat (head down, feet up), and infuse normal saline or hypertonic sugar water (10%~40%), and then slowly resume ultrafiltration after vital signs are stable.
2
In order to prevent and control the decrease of effective blood volume, avoid excessive ultrafiltration rate, and make the weight gain during dialysis not exceed 5% of dry weight, it is the key to stabilize blood pressure to determine appropriate dry weight and ultrafiltration rate. If you gain too much weight in a single dialysis, you can increase the number of dialysis to remove excess water instead of removing water to dry weight in a single dialysis.
three
Patients with low temperature dialysis (35.5 and -36) can tolerate it. Hypothermic dialysis can stabilize blood pressure by increasing peripheral vascular resistance and reducing NO synthesis. Studies have shown that patients have good tolerance to the cooling of 1. In the process of dialysis, the ladder sodium curve model was selected. In this method, the sodium ion concentration is 150mmol/L at the beginning and 140mmol/L at the end, which can accelerate blood vessel refilling and maintain effective blood volume. Lowering the sodium concentration gradually during dialysis, maintaining the normal sodium concentration level at the end of dialysis and avoiding discomfort symptoms such as thirst during dialysis can improve hypotension.
four
Avoid eating a lot before or during dialysis, so as not to cause blood shunt and lower blood pressure. Antihypertensive drugs on the day of dialysis can be appropriately reduced or stopped before dialysis. Choose a dialyzer with good biocompatibility. If the patient responds to various dialysis membranes, pre-washing the dialyzer and dialysis pipeline with 0.9%NS500ml before dialysis, and then washing with 0.9%NS500ml after 15 minutes, which has a good preventive effect and basically won't cause membrane reaction again.
five
Closely observe the changes of the condition and find signs of hypotension in time: dizziness, cold sweat, yawning, abdominal pain, etc. And give corresponding treatment in time to prevent or reduce the occurrence of hypotension.
Nursing care of arteriovenous fistula
one
Low blood pressure in dialysis is easy to cause internal fistula occlusion, and dialysis nurses should attach great importance to the protection of internal fistula. Evaluate the internal fistula before puncture and feel the tremor of the internal fistula. Puncture technique should be skilled, and the action should be quick and accurate. Do not tie the pulse pressure belt too long and too tight to prevent thrombosis.
2
Establish standardized health education and improve the professional and technical level of medical staff. All patients should know the following knowledge: (1) compression channel bleeding; After hemodialysis, I feel tremor or auscultation of internal fistula every day; The arm pain and tremor are relieved or disappeared, and you can see a doctor in the shortest time; The best way to exercise forearm fistula; Avoid lifting heavy objects, measuring blood pressure, blood transfusion, and internal fistula limb pressure; Be able to report infection and no signs of tremor to medical staff in time.