1. 1 First, check the vascular maturity of internal fistula. It takes 3 ~ 4 weeks for the internal fistula to mature. The so-called maturity means that the vein is obviously dilated and the arterialized blood vessel wall is thickened, so it cannot be used for the first two weeks. Premature use can easily lead to vascular fibrosis, lumen stenosis and shortened service life.
1.2 Understand the mode of internal fistula, the anastomotic site and the direction of blood vessels before deciding the location and direction of puncture. The puncture point of artery is generally 3 ~ 4 cm at the anastomotic site, and it is decided whether to puncture along the blood flow direction or against the blood flow direction according to the blood vessel filling condition. The venous end should be punctured along the direction of blood flow. The distance between two puncture points should be 5 ~ 10 cm. Www.med66.com Medical Education Network
1.3 If the limb is edematous, the local blood vessels can be exposed by hand pressing; If the blood vessels are not dilated well, a tourniquet can be tied at the proximal end of the limb, and puncture can be performed after the blood vessels are filled. When the puncture needle is used for the first time, it should be loosened immediately after entering the blood vessel, and the puncture point should be lightly pressed with sterile gauze to prevent blood and hematoma.
1.4 The puncture needle is generally made of 16 stainless steel silicide puncture needle.
2 vascular puncture
2. 1 Expose the dilated vein of the patient, disinfect it with iodine and alcohol, puncture the artery 3 ~ 5 cm away from the anastomosis to draw blood, and then puncture the vein near the heart along the blood flow direction to make the blood enter the body.
2.2 The included angle between the puncture needle and the skin is 15 degrees, and it is required that the inclined plane of the needle pierce the skin and immediately pierce the blood vessel. The subcutaneous tunnel of the needle is very short, accounting for about 1/3 of the needle, and the rest of the needle penetrates the blood vessel.
2.3 The blood vessel puncture sequence is to puncture the proximal end of the blood vessel first, and then puncture the arterial end. Because the local blood vessel must be pressurized after the arterial puncture fails, the blood vessel near the heart end cannot be filled, and it is very difficult to puncture the blood vessel again. Www.med66.com Medical Education Network
2.4 If a puncture fails and no blood vessel is punctured, it can be punctured again at the original puncture point. If it is punctured, it should be pulled out immediately and pressurized to stop bleeding. Avoid the repeated advance and retreat of the puncture needle, otherwise it will easily lead to blood seepage in the eye of the needle, so the operator is required to be skilled in operation and make full preparations for puncture.
2.5 In order to prolong the service life of blood vessels, blood vessels can be punctured alternately or repeatedly in the original needle eye. The success rate of fixed-point puncture is high and the puncture pain is light. For patients who are thin, tired and have poor skin elasticity, it is prudent to use fixed-point puncture, because less subcutaneous tissue will cause blood seepage in the eye of the needle.
2.6 There is a significant relationship between the therapeutic effect of hemodialysis and blood flow. The blood flow is generally required to be 150ml/min. If you can't reach it, you must find the reason. The most common reasons are improper puncture position, poor direction of needle tip bevel or insufficient blood volume of patients. If the blood flow is insufficient due to the poor expansion of the blood vessel itself, a small gauze ball can be used to compress the blood vessel between the two puncture points to increase the blood flow.
Nursing care of arteriovenous fistula after treatment
3. 1 Due to the high pressure in arterialized blood vessels, if the needle is not properly handled after dialysis, the hematoma will affect the life of the next dialysis puncture and internal fistula. After the puncture needle is pulled out, press a 2cm×3cm gauze ball 15 ~ 20 min at the eye of the needle, and tie the skin on both sides to the middle with adhesive tape to stop bleeding. Then wrap gauze strips or bandages on the gauze ball and tie a slipknot. Loosen the long gauze strip or bandage properly after 30 minutes, and take out the small gauze ball as appropriate after 12h.
3.2 For hemodialysis patients, vascular access is equivalent to their lifeline, so it is extremely important. In order to prevent skin infection and vascular inflammation and ensure smooth blood flow, it is necessary to avoid intravenous infusion and blood pressure measurement at the stoma site, and it is not suitable for strenuous activities at this site.