48例钝针扣眼穿刺法在血液透析患者动静脉内瘘中的实施与效果分析

Implement and effect analysis of buttonhole puncture to arteriovenous fistulas in 48 hemodialysis patients

目的探讨对自体动静脉内瘘的钝针扣眼穿刺法实施方法与效果分析,为临床提供指导和借鉴。方法回顾在哈尔滨医科大学附属第二医院应用扣眼穿刺法穿刺动静脉内瘘的48例透析患者,总结隧道形成、钝针穿刺的方法及技巧,分析在穿刺过程中疑难问题的处理方法。结果 48例患者中,有43例患者通过扣眼穿刺法使用钝针穿刺;有2例患者内瘘栓塞,在对侧肢体质量新行动静脉内瘘手术后,改为绳梯穿刺法;有3例患者发生感染,其中1例感染症状消失后改为绳梯穿刺法;2例患者假隧道形成,改为绳梯穿刺法。结论扣眼穿刺法的要点主要包括隧道形成、锐针穿刺更换为钝针穿刺时机、钝针穿刺方法、去痂方法。如以往已形成假性动脉瘤的患者应用扣眼穿刺法时,需避开瘤体建立隧道。钝针穿刺中断使用,如需重新启用,需用锐针沿原隧道穿刺几次后再改为钝针。当穿刺部位发生感染时,不得在感染部位穿刺,需每日3次碘伏消毒感染部位,当感染症状消失后可继续使用;当发生钝针穿刺困难时,勿盲目进针,需分析穿刺困难原因后,再行钝针穿刺;一旦发生皮下血肿,停止血肿部位穿刺,更换穿刺点;发生渗血时,及时分析渗血原因并进行干预。

Objective To explore the procedure and the effect of blunt needle puncture to autogenous arteriovenous fistulas in order to provide a guidance for clinical practice. Methods We retrospectively sum- marized 48 hernodialysis patients treated with buttonhole puncture to arteriovenous fistulas for blood access, and analyzed the tunnel formation, the technique of blunt needle puncture and the management of obstacles during puncture. Results Blood access was successfully performed in 43 of the 48 patients using buttonhole puncture method of blunt needles. Two of them had embolisms in fistulas and underwent another arteriove- nous fistula surgery in the contralateral limb. Ladder puncture was then used. Infections occurred in 3 pa- tients; the symptoms disappeared after the change to ladder puncture in one cases, and pseudo-tunnel forma- tion was found in 2 cases and ladder puncture was then used. Conclusion The critical techniques for button- hole puncture include tunnel formation, the time for the replacement of sharp needle puncture to blunt needles puncture, procedures for blunt needle puncture, and taking off the scars. In patients with pseudo-aneurysm on fistulas, buttonhole puncture should be carefully manipulated to establish a tunnel far from the pseudo-aneu- rysm. When blunt needle puncture is interrupted and has to be reused, the original tunnel should be punctured several times with a sharp needle and then a blunt needle is used for the puncture. When infection occurs at the puncture site, local treatment with iodophor is used 3 times daily and this site can be used until the infec- tion disappears completely. When obstacles happen during blunt needle puncture, the puncture must be stopped to explore the causes before continuing the manipulation. When hematoma forms, the puncture site must be changed. When bleeding at the puncture site occurs, intervention and investigation of the bleeding cause must be immediately conducted.