Sexual Health
Evidence-based nursing care of patients with internal fistula failure caused by hypotension during hemodialysis
Analysis of causes of internal fistula failure:
Low blood pressure during dialysis and slow blood flow through the anastomotic orifice can easily lead to thrombosis
Ultrafiltration and excessive dehydration during dialysis exacerbate low blood volume, increase blood viscosity, promote thrombosis, and cause internal fistula occlusion.
Nursing of hypotension during dialysis
1
In the event of acute hypotension, immediately stop or slow down ultrafiltration, slow down blood flow, place the patient flat (with head low and feet high), infuse physiological saline or hypertonic sugar water (10% to 40%), and slowly resume ultrafiltration until the vital signs stabilize.
2
Prevention and treatment of effective blood volume reduction, avoidance of excessive ultrafiltration rates, and weight gain during dialysis should not exceed 5% of dry weight. Determining an appropriate dry weight and appropriate ultrafiltration rate is the key to stabilizing blood pressure. If you gain too much weight during a single dialysis session, you can increase the number of dialysis sessions to remove excess water, rather than removing water to achieve dry weight during a single dialysis session.
3
In the process of low temperature sodium regulation dialysis, patients can choose a tolerable low temperature dialysis (35.5 ℃ - 36 ℃). Low temperature dialysis can stabilize blood pressure by increasing vascular peripheral resistance and reducing NO synthesis. Research has shown that patients have a good tolerance for a temperature decrease of 1 ℃. During the dialysis process, choose a stepped sodium curve mode for dialysis. This method starts with a sodium ion concentration of 150 mmol/L and ends with a concentration of 140 mmol/L, which can accelerate the vascular refilling speed and maintain effective blood volume. Gradually reducing sodium concentration during dialysis and maintaining a normal sodium concentration level at the end of dialysis can prevent discomfort such as thirst during dialysis and improve hypotension.
4
Avoid consuming large amounts of food before or during dialysis to avoid causing blood shunts and lowering blood pressure. The antihypertensive drugs on the day of dialysis can be appropriately reduced or discontinued before dialysis. Select a dialyzer with good biocompatibility. If the patient has reactions to various dialysis membranes, pre flush the dialyzer and dialysis pipeline with 0.9% NS500ml before dialysis, and then rinse with 0.9% NS500ml after 15 minutes of circulation. This has a good preventive effect, and membrane reactions basically do not occur again.
5
Closely observe the changes in the condition, promptly detect the signs of hypotension: dizziness, cold sweating, yawning, abdominal pain, etc., and promptly give corresponding treatment to prevent or reduce the occurrence of hypotension
Nursing care of arteriovenous fistula
1
Low blood pressure during dialysis can easily cause internal fistula occlusion, and the protection of internal fistula should be highly valued by dialysis nurses. Before puncture, evaluate the internal fistula and feel the tremor of the fistula. The puncture technique should be skilled, and the action should be rapid and accurate. The pulse band should be pressed to avoid being too long and tight to prevent thrombosis.
2
Establish standardized health education to improve the professional and technical level of medical personnel. All patients should understand the following knowledge: the compression of passage bleeding; After hemodialysis, internal fistula tremors or auscultation should be felt every day; If there is swelling and pain in the arm, and the tremor weakens or disappears, it can be seen in the shortest time; Use the best method to exercise forearm internal fistula; Avoid lifting heavy objects, measuring blood pressure, infusion, and pressure on the limb on the fistula side; Be able to report signs of infection and absence of tremors to medical personnel in a timely manner.