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2013年1月13日星期日

Renal failure patients with hemodialysis access technology


Hemodialysis access is the lifeblood of the patients with renal failure. Continuously improve the quality of hemodialysis patients with renal failure can be long-term survival of hemodialysis access physicians hemodialysis access overall program to develop a system for the specific circumstances of the patient, to ensure the long-term dialysis patients needs.
In general, starting from the radial artery of patients with non-dominant hand - head venous fistula after successful if maintained properly, you can use 5-10 years. During this period most prone to the problem is long-term puncture caused a false aneurysm formation, thrombosis and vascular stenosis. Pseudoaneurysm and thrombosis of the need for timely surgical angioplasty or thrombus remove and save the path. Vascular stenosis may be using the latest high-pressure balloon balloon dilatation, improve path dysfunction.
If the radial artery - cephalic vein fistula failure, the purposes of the brachial artery - the cephalic vein of ostomy use more of such surgery in Europe. There is a slight difference in surgical approach based on the patient's specific circumstances, such as: retention of the cephalic vein of the forearm, later filling is good for dialysis; retain the upper arm cephalic vein and basilic vein, the two veins are used for dialysis. 3 months after surgery should be based on the extent of and puncture the difficulty of the upper arm cephalic vein or basilic vein filling, the purposes of the cephalic vein superficial surgery or basilic vein transposition surgery. In this manner has the advantage of low cost, drawback: short hemodialysis access, puncture inconvenient.
Greater use of artificial blood vessels ostomy surgery in the United States, after the failure of the radial artery - cephalic vein fistula. Artificial blood vessels for use specifically for puncture in the patient's forearm disk into a "U" loop, two consistent in the brachial artery and your vein or cephalic vein. The advantage of this way flow, hemodialysis access, easy to puncture, the disadvantage is the surgical trauma slightly higher cost.
Above pathways are finished using the other hand, patients can choose to repeat the above process. In the case of ostomy surgery are difficult to implement, can be semi-permanent dialysis tube. Semi-permanent dialysis tube using new materials can be long-term retention in the body, but its use has a certain period of time, rather than some patients can be mistaken for permanent use. Placement technology guarantee a semi-permanent dialysis tube critical of the use of time, two things: (1) subcutaneous tunnel is long enough to ensure that the in vitro part of the semi-permanent dialysis tube as far as possible in the subcutaneous tunnel semi-permanent dialysis tube partially exposed skin outside, may cause infection, and to increase the difficulty of care; (2) ensure that dialysis tube in the tunnel and intravascular discount long-term dialysis with high traffic. To guarantee this, the only semi-permanent dialysis tube implantation can be achieved under the surveillance of the X-ray machine (angiography). Discount under X-ray fluoroscopy, the catheter can be placed in the guide wire to correct curvature of, and adjust the dialysis tube in the superior vena cava to import right atrium at the best location. Otherwise, even with the experience and the naked eye can not guarantee that a semi-permanent dialysis tube formation in the skin and in vivo without fold, perfect arc, is bound to affect the flow of long-term use, resulting in the use of semi-permanent dialysis tube time is greatly reduced.

Note blood purification treatment


1. Establishment of vascular access: pediatric vascular fine cooperation difficult, blood purification key to success is to establish a good vascular access. Acute renal failure is appropriately selected chronic renal failure waiting to move arteriovenous fistula mature, required the establishment of a temporary vascular access, currently the main application of central venous catheter. Common femoral vein catheter, jugular vein, subclavian vein catheterization. Pediatric commonly neck, femoral vein catheter. Is the most important complications of central venous catheter infection was reported abroad m1 195 patients with temporary venous cannula average retention time of 35.7 d, the infection rate was 9.6 cases, 1,000 catheter days. Semi-permanent vascular access with a cuff of central venous catheter reported the the longest application in 19 cases of children 11 months (mean, 117 d), 10 cases of co-infection, six cases of catheter thrombosis. Permanent vascular access pediatric autologous subcutaneous move a venous anastomosis fistula is the preferred selection of our hospital cephalic vein and radial artery end side anastomosis, the success rate was 93%.
2. Pre-filled piping: pediatric physiological characteristics, light weight and absolute blood volume, blood purification have proper priming volume occupy dialysis tubing and dialyzer. Pipe commonly used isotonic saline, a small baby, anemia, heart and circulatory system function unstable prefilled application of albumin or blood pre-filled to prevent the incidence of hypotension.
3. Dialyzer and dialysis tubing choice: sJ 'JL blood volume the hesitant mVkg, dialyzers and piping volume should not exceed 0.8% of body weight, or 10% of the blood volume. Select dialysis tubing and dialyzer children. According to the weight choose dialysis <20 kg of 0.1 ~~ 0.4 m2; 20-30 kg, 0.4 - 0 .8 m2; 30-40 kg ,0.6-1 .0 Ⅱ 12;> 40 kg, 1 .0-1.2 odd dialyzer.
4. Anticoagulant therapy: the first dose heparin 25 to 50 u / l [g intravenous injection and continuous infusion of 5-15 U · l g ~ · h ~, to keep the clotting time of the test tube method in 30 to 45 alkali activated clotting time at 120 ~ 1808, subject to abnormal clotting or bleeding tendency, given low-dose heparin 2.5-5 u · kg a · h ~ thrombocytopenia or heparin-induced thrombocytopenia optional application of prostaglandins or recombinant hirudin (thrombin inhibitors), coagulation dysfunction, dialysis without heparin.
Primary disease, clinical status, the children blood purification select should be considered in children hospital equipment condition and kidney professional training. Peritoneal dialysis is a relatively simple, simple renal failure and technical conditions applicable to small babies are not allowed to do hemodialysis or continuous renal replacement therapy. Intermittent hemodialysis in the treatment of acute renal failure, hyperkalemia should be preferred. Continuous renal replacement therapy for critically ill children and provide a safe and effective renal replacement therapy. Blood Purification in pediatrics will have broad prospects for development. Parents of children If you have any questions you can make an appointment telephone consultation contact me.

How long after surgery fistula?


Autogenous fistula arteriovenous fistula waiting period "mature", ie vein dilation, the vein wall thickening can puncture hemodialysis, which normally takes 4-8 weeks after surgery. Artificial arteriovenous fistula theoretically do not have to wait after vascular "mature", can puncture immediately, but often local swelling after surgery, and can not find out the artificial blood vessels running yet healed, and artificial blood vessels and surrounding tissue, hematoma puncture prone and secondary infection, the impact of the use of the fistula, therefore, generally in January after use

There are several commonly used arteriovenous fistula surgery?


Generally divided into autogenous arteriovenous fistula and graft vessel arteriovenous fistula. Autologous arteriovenous fistula directly since the the shallow vein and artery anastomosis, hemodialysis, superficial vein puncture in clinical preferred forearm radial artery and cephalic vein anastomosis. When the patient's own not suitable shallow vein puncture or obese patients with superficial venous position is deep puncture is feasible to transplant arteriovenous fistula surgery. Is about to be buried in subcutaneous vascular graft section, both ends are connected to Autogenous vein hemodialysis puncture in the vascular graft can. The most common material is PTFE artificial blood vessels

Hemodialysis patients Guide


l Why establish arteriovenous fistula?
Hemodialysis, the body's blood need to quickly enter the dialyzer flow back into the body through the wash and then. Shallow vein easy to puncture, but due to the blood flow velocity is too slow, the blood flow is difficult to achieve the requirements of dialysis; arterial blood flow, and can meet the hemodialysis requirements, but the deeper parts of the puncture is difficult and not easy to be used repeatedly. Hence the need for surgery to connect the artery and superficial vein, called arteriovenous fistula surgery so shallow veins flow of arterial blood, the blood flow to the dialysis requirements. It is the "lifeline" of uremic patients need to take to protect.
l arteriovenous fistula surgery several?
Generally divided into autogenous arteriovenous fistula and graft vessel arteriovenous fistula. Autologous arteriovenous fistula directly since the the shallow vein and artery anastomosis, hemodialysis, superficial vein puncture in clinical preferred forearm radial artery and cephalic vein anastomosis. When the patient's own not suitable shallow vein puncture or obese patients with superficial venous position is deep puncture is feasible to transplant arteriovenous fistula surgery. Is about to be buried in subcutaneous vascular graft section, both ends are connected to Autogenous vein hemodialysis puncture in the vascular graft can. The most common material is PTFE artificial blood vessels.
l after surgery how to care for?
² daily with soap and water to prevent infection;
² elevation surgery limbs promote venous return, in order to reduce the degree of swelling;
² replace the puncture points each hemodialysis;
² surgery limbs try to wear loose-fitting underwear, do not wear tight ornaments;
² Do not sleep oppression surgery limbs;
² avoid hypotension;
² surgery limbs to avoid blood pressure, blood;
² Do not lift heavy objects;
² do some health fistula operation to promote fistula as soon as mature;
² learn to judge fistula patency, vein upcoming non-surgical side hand touch operated side palpable tremor or hear the vascular murmur prompted smooth. The daily check fistula is smooth.
l how to do the operation Kin fistula?
Day with the operative side hand pinch grip rubber fitness ball 3-4 times, every 10 minutes; hand, tourniquet or blood pressure Table cuff pressure gently to the top of the anastomotic vein moderate expansion until every 15-20 minutes to release the once a day, can be repeated three times. Hot compress or forearm immersion in hot water 2-3 times daily, every 15-20 minutes. The above methods may be used alone, may be mixed to use.
l blood pressure is maintained at how much is appropriate?
General requirements for systolic blood pressure remained at 130-150mmHg, diastolic blood pressure maintained at 80-90 mmHg, blood pressure is too low will lead to fistula clogging.
fistula can be used for a long time after surgery l?
Autogenous fistula arteriovenous fistula waiting period "mature", ie vein dilation, the vein wall thickening can puncture hemodialysis, which normally takes 4-8 weeks after surgery. Artificial arteriovenous fistula theoretically do not have to wait after vascular "mature", can puncture immediately, but often local swelling after surgery, and can not find out the artificial blood vessels running yet healed, and artificial blood vessels and surrounding tissue, hematoma puncture prone and secondary infection, the impact of the use of the fistula, therefore, generally in January after use.
l hemodialysis attention to what issues?
Select the correct puncture point, avoid anastomotic puncture, venipuncture should be left artery puncture site to reduce blood recirculation. Avoid puncture of fixed-point, so that the entire arterial veins good enough for equalization of uniform thickness, vascular avoid the fixed puncture or a small range puncture damage caused by the use of multi-vessel lumen. Correct haemostasis hemostasis arm slightly elevated, in order to reduce the resistance of the venous return, speed up to stop bleeding. Appropriate pressure to stop the bleeding efforts to not oozing and can be palpable tremor and hear the vascular murmur is appropriate. Good personal hygiene.
l may occur after complications?
Postoperative complications, including infection, thrombosis, intimal proliferation, pseudoaneurysm, limb remote ischemic heart failure. The high incidence of complications in the general transplant vascular arteriovenous fistula autogenous arteriovenous fistula.
l encountered situations that require immediate diagnosis and treatment?
² tremor or the murmur disappeared prompts fistula blockage;
² local swelling, chills, fever, wound the liquid oozing prompted infection.
l significance of vascular ultrasound.
Used before surgery to help choose the arteries, veins, detectors blood vessels without stenosis and occlusive lesions, improve the success rate of surgery. The postoperative monitoring fistula narrow, such as stenosis> 50%, early balloon dilatation or placement of endovascular stent method of early intervention to reduce the occurrence of thrombosis and improve the life of the fistula.

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