Hemodialysis blood lines to the introduction of dialysis patients, the use of semi-permeable membrane on both sides of the solute concentration difference, after penetration, diffusion and ultrafiltration, to remove metabolites and toxic substances, correct water and electrolyte balance disorder purposes.
The methods:
1 Preparation of arteriovenous access and types of dialysis prior to the establishment of arteriovenous access, the introduction of arterial-side blood dialyzer, after dialysis the role of blood purification. And then purified by the venous blood vivo transplantation. arteriovenous reserved intubation. Generally used in the dorsal pedal artery and saphenous vein medial malleolus intubation; can be used to expand ductal Seldinger puncture femoral vein. Apply to acute drug poisoning or acute renal failure were the emergency dialysis. vein fistula. Can use the radial artery and cephalic vein with the line, with two silicone rubber tubes were inserted into the vein of the heart end of the line connecting the outer skin to form a shunt in vitro. Apply to acute and chronic renal failure who require dialysis for a long time. vein fistula. Can use the radial artery and accompanying veins as side to side or end to side anastomosis; can screw with titanium wheel (pore size 2.0 ~ 2.5mm) line of anastomosis. Match two weeks later, you can in the Department for puncture vein arterialization for hemodialysis. Applicable to long-term dialysis are. subclavian vein catheterization. The double-lumen catheter into the subclavian vein, the blood side of the hole by the jacket tube aspiration, flows through the dialyzer, then lost by the inner tube back to the body.
2, dialysis type standard flat-plate dialyzers. Dialysis area 1.0m2, due to large volume, easy Louxue, leak. At present, many switch to fixed (multilayer) small flat device, an area of 1.1 ~ 1.8m2, small size, has been commercialized. hollow fiber dialyzers. Small size, ultrafiltration and dialysis efficacy, is the most commonly used.
3. The application process takes dialysis heparin anticoagulation. Method depends on whether anticoagulation in patients with bleeding tendency may be. Optional: systemic heparin method, the conventional method. 5 minutes before dialysis, to the heparin 0.5 ~ 0.8mg/kg, intravenously; dialysis an additional hour after the beginning of heparin 10mg; dialysis discontinuation of heparin before the end of 1 hour. local (in vitro) method of heparin. Heparin with heparin pump to 0.25mg / min continuous infusion at a rate of arterial pipelines, while intravenous protamine pipeline to 0.25mg / min rate of infusion to neutralize heparin. After 3 hours of dialysis intravenous protamine 30 ~ 50mg, to prevent heparin rebound. edge of heparin method. The first heparin dose of 0.5 ~ 0.7mg/kg, the future supply of heparin per hour, 5 ~ 7mg, to keep the blood dialyzer clotting time of 30 minutes, 10 minutes before the end of dialysis discontinuation of heparin.
4. Dialysate composition: use in accordance with condition No. or dialysis.
on dialysate formula: sodium chloride per liter, with 6.6g, potassium chloride 0.3g, calcium chloride 0.185g, magnesium chloride 0.1g, Sodium 2.5g, glucose 2.2g, osmolality 314mosm / L.
on dialysis prescription: including sodium chloride per liter, 6.0g, potassium chloride 0.3g, calcium chloride 0.185g, magnesium chloride 0.1g, sodium acetate 4.48g, glucose 2.2g, osmotic pressure 300mosm / L.
5. Dialysis care in the course of each dialysis, patients should be recorded blood pressure, heart rate, breathing and body temperature. Monitoring of dialysate flow rate, temperature, negative pressure, catheter blood flow, watch for Louxue, the phenomenon of hemolysis and coagulation, prevent massive hemorrhage caused by dialysis catheter dislodged. I am China Crafts Suppliers writer, reports some information about mold making silicone rubber , concrete brick mold.
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