扩张动静脉内瘘局部狭窄的穿刺技巧及护理对策

Puncture kills and associated nursing maneuvers in the dilatation procedures of internal arteriovenous fistula stenosis

目的通过良好的穿刺技巧和有效的护理干预使狭窄的动静脉内瘘逐渐扩张,延长内瘘的使用寿命。方法通过对15例动静脉内瘘狭窄的血透患者(血流量<150 mL/min,1个月以上)采取不同的穿刺技巧和护理对策,使狭窄的内瘘逐渐扩张。结果 9例狭窄的内瘘得以扩张,血流量达250 mL/min左右,再次使用达2年以上,2例吻合口狭窄者血流量达200mL/min左右,使用不到1年闭塞。结论良好的穿刺技巧及切实有效的护理干预,可挽救濒临闭塞的内瘘,延长动静脉内瘘的使用寿命,提高患者的生存质量。

Objective To increase the service life of internal arteriovenous （AV） fistula via gradually dilating the stenosis lesion with the implementation of fine puncture skills and effective nursing interventions. Methods Fifteen hemodialysis patients who had AV fistula stenoses （under the condition that the regional blood flow was less than 150 mL/min and the situation lasted for a period of one month or longer） were given various bid to gradually dilate the stenotic lesions. Results punctures and different nursing maneuvers in a Of 15 studied AV fistula stenoses patients, nine of them were dilated successfully. The regional blood flow therefore improved to 250 mL/min or so, and the service life of the AV fistula was extended to over two years. Another two patients had a problem of anastomosis stenoses with a blood flow up to 200 mL/min. The fistula was blocked one year after being used. Conclusion Good puncture skills together with the practical and effective nursing interventions are defined to be useful in saving the AV fistulas which are in danger of being blocked and increasing their service life, and therefore improving the life quality of patients.