摘要
目的：探讨直接动静脉穿刺法建立血液透析通路的技巧及护理体会。方法：一共83例需要紧急或者临时血液透析患者选择直接动静脉穿刺建立透析通路。关键方法技巧采取：1）。首先把内瘘针与动脉血路管连接妥当；2）。触及穿刺部位动脉血管后以35度角进针皮下、在明显搏动处再以20度角刺入血管壁进血管；3）。再穿刺合适体表静脉、连接通路启动血泵进行透析。结果：其中53例直接穿刺桡动脉、36例穿刺足背动脉，各组总共穿刺3239例次。血流量200～250 ml/min，每次透析时间3-5小时；出血、血肿发生率低，处理后均恢复，无后遗症或严重并发症。结论：直接动脉穿刺建立血液透析通路必须有娴熟的血管穿刺技巧提高穿刺成功率，良好的血管通路维护护理、指导患者血管自护技巧相结合以延长血管通路使用时间。
Abstract
objective:To study the technique and nursing experience by the direct arteriovenous puncture method to establish hemodialysis access.Methods:A total of 83 patients in need of urgent or temporary hemodialysis were selected to establish direct arteriovenous puncture dialysis access. Key techniques were adopted: 1). Firstly, the internal fistula needle was connected to artery dialysis pipe; 2) To Pierce the needle into the blood vessel with 35 and 20 degree Angle under the skin and on the surface of artery; 3). Related vein was punctured and connected with path, then started the pump to blood dialysis.Results:53 cases of direct dorsalis pedis artery punctured, 36 cases of radial artery punctured, a total of 3239 case-times were pierced .The blood flow of 200 ~ 250 ml/min, dialysis time was 3-5 hours per each time; Lower incidence of bleeding, hematoma were rehabilitated without sequelae or severe complications.Conclusion:direct artery puncture as a hemodialysis pathway must be adept vascular puncture skils to improve the success rate of puncture. Combining a good nursing skils of vascular access with guiding patient’s blood vessels self nursing skils can prolong the life time of the vascular access.
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