龙虎28app

血液净化科

DEPARTMENT OF ENT

当前位置: 龙虎28app 科室设置内科血液净化科科室动态详细

血液透析患者自体动静脉内瘘术的家庭护理

时间:2012-05-08       来源:龙虎28app

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患者明白理解造瘘的目的、意义以及该手术意义,消除焦虑不安、紧张惧怕的心理。

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动静脉内瘘形成后,嘱患者将内瘘侧肢体抬高至水平以上30°,以利静脉回流,减少内瘘侧手臂的肿胀。
术后24h内密切观察内瘘通畅与否及全身情况。注意心率、心律、呼吸是否改变,是否有胸闷、心悸,如有变化应及时向医生汇报,及时处理。

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教会患者自行判定内瘘是否通畅,每日触摸内瘘静脉处有无震颤,如扪及震颤则表示内瘘通畅,反之则应马上通知医生进行处理。


龙虎28app 术后1周即可指导患者进行早期功能锻炼,以促进内瘘早期成熟,每日用内瘘侧手臂捏橡皮健身球3次~4次,每次持续10min~15min,或用止血带压住内瘘侧手臂的上臂,使静脉适度扩张充盈,2次/d~3次/d,5min/次~10min/次,局部肿胀者可用热毛巾热敷内瘘侧手臂。

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内瘘的成熟早晚取决于患者血管自身条件,手术情况及术后患者的配合情况。一般当静脉呈动脉化,内瘘直径增粗,能保证成功的穿刺,提供足够的血流量时才算成熟,成熟时间一般至少需要1个月,最好在成形术后6周后再使用。
龙虎28app 提高穿刺技术,力争一次穿刺成功;避免过早使用内瘘,新建内瘘的穿刺最好由有经验的护士进行。止血时要注重按压的力度,不轻不重,以不出血为准,并且必须以指压;当患者有时,应根据病情调整肝素用量;避免反复在同一部位进行穿刺,以防发生动脉瘤。

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血栓形成
防治及护理: 避免过早使用内瘘,一般内瘘成熟至少需要1个月,最好在内瘘成形术后3个月~4个月后再使用;根据患者情况,指导患者以拇指及中指指腹压迫穿刺点,止血时要注重按压的力度,弹力绷带包扎不宜过紧;切忌定点穿刺;提高穿刺成功率;假如早期血栓形成,及时通知医生。
必须让患者了解内瘘对其生命的重要性,使患者在主观上重视并积极配合;保持内瘘侧皮肤清洁,每次透析前必须用肥皂水将造瘘侧手臂彻底清洗干净;透析结束当日穿刺部位避免接触到水,并用无菌敷料覆盖4h以上,以防。

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