Successful arteriovenous fistula is the guarantee of hemodialysis treatment for patients with end-stage renal failure. Thrombosis caused by various reasons often leads to embolism and internal fistula failure within 1 ~ 8 weeks after operation. Therefore, preventing early thrombosis after arteriovenous fistula surgery is the key to successful operation. Arteriovenous fistula was performed in 50 patients with end-stage renal failure. We gave psychological care and health education to patients, objectively introduced the knowledge about the occurrence, development and prognosis of diseases, educated patients to realize that internal fistula is the lifeline of patients with chronic renal failure, and the establishment and maintenance of internal fistula is very important, and taught patients to correctly care for internal fistula.
1 Preoperative education
1. 1 explain the purpose and importance of the operation to the patient, so as to obtain the patient's cooperation, measure the coagulation time, and conduct penicillin skin test and difocaine skin test.
1.2 protect the vein of the lateral limb, avoid intravenous injection or infusion, keep the skin on the stoma side clean, do not damage the skin, and prevent postoperative infection.
1.3 instruct patients to eat a low-fat diet and eat less animal viscera and greasy food.
2 postoperative care
(1) Anticoagulants such as dipyridamole and aspirin were used 3 ~ 5d days after operation of internal fistula, and low molecular weight heparin was given to prevent postoperative intravascular coagulation if necessary. At the same time, antibiotics 1 week were used to remove stitches.
(2) Local exercise can be carried out on the third day after operation to promote the maturity of fistula. Methods: Hold the rubber grip ring 3-4 times a day for 65,438+00 min each time, or by hand. Place a tourniquet or blood pressure cuff above the anastomosis, such as the upper arm, and gently pressurize the vein to moderately dilate, relaxing once every 15 ~ 20min, which can be repeated three times a day.
(3) 5 ~ 7 days after operation, keep the limbs on the operation side clean, avoid getting wet and prevent wound infection. If bleeding is found and the pain is unbearable, contact the doctor immediately and deal with it in time.
(4) Teach patients how to judge whether the internal fistula is unobstructed: Touch the non-operative vein of the operator, and if there is tremor or hear vascular murmur, it will prompt patency, otherwise, contact the doctor immediately and reconnect it in time.
(5) In the early postoperative period of internal fistula, we should try to wear loose underwear with cuffs, raise the limb on the surgical side, promote blood return, reduce limb swelling and avoid oppressing the affected limb. No tight sleeves, no watches, no blood pressure measurement, no load, no intravenous injection or internal fistula infusion.
(6) Measure blood pressure twice a day. When dizziness, hypotension, vomiting, nosebleed and other symptoms appear, report to the medical staff in time. Timely and appropriate application of erythropoietin can replenish blood volume and correct hypotension.
(7) After dialysis, the puncture point should be pressed for more than 5 ~ 10 min after needle drawing. The correct method is to press the upper and lower edges of the puncture point with the index finger and middle finger, and the arm can be slightly lifted to reduce the resistance of venous return and speed up hemostasis and pressurization, so as to prevent bleeding and feel tremor, and it is appropriate to hear vascular murmur [1].
Due to proper nursing measures, only 6 patients failed the operation, and the success rate reached 83%.
refer to
1 Mei Changlin, Ye Chaoyang, Zhao Xuezhi. Handbook of practical dialysis. Beijing: People's Health Publishing House, 2003,609-615.