ACUSEAL人工血管内瘘在血液透析患者中早期穿刺及护理

目的探索和总结ACUSEAL人工血管动静脉内瘘的早期穿刺使用方法及临床护理要点。方法收集分析2018年10月以来收治的5例患者临床资料,5例患者的穿刺部位均在上臂(肱动脉及上臂静脉)。观察术后前臂肿胀等情况,根据患者治疗需要及前臂肿胀情况决定行人工血管内瘘穿刺的时间,探讨临床护理要点。结果5例患者ACUSEAL人工血管动静脉内瘘均一次性建立成功。术后上臂均未见重度以上肿胀,本组2例患者最早在术后24h开始穿刺使用。其余3例在术后3~5d开始穿刺。结论ACUSEAL人工血管动静脉内瘘给多次失败的血液透析通路和不良的血管解剖结构患者提供了一种较好的治疗选择,ACUSEAL人工血管动静脉内瘘建立后24h内即可穿刺使用,避免了使用中心静脉导管及其后续的并发症,可较为明显提高患者的安全性和医护人员的工作效率。

Objective To explore and summarize the early application methods and key clinical nursing points of ACUSEAL internal arteriovenous fistula.Methods Clinical data of 5 patients admitted to our center since November 2018 were collected and analyzed.All 5 patients had puncture sites at the upper arm(brachial artery and upper arm vein).The postoperative swelling of forearm was observed.The time of puncture of artificial vascular internal fistula was determined according to the treatment needs of patients and the swelling of forearm.The key points of clinical nursing were discussed.Results ACUSEAL arteriovenous fistula was one-time successfully established in 5 cases.No moderate or severe upper arm swelling was observed after the operation,and the puncture was applied as early as 24 hours after the operation in the 2 patients in this group.The other 3 patients received puncture 3~5 days after operation.Conclusion ACUSEAL artificial blood vessel internal arteriovenous fistula provides a very good treatment option to patients with multiple failures of hemodialysis pathway or with poor vascular anatomical structure.ACUSEAL artificial blood vessel internal arteriovenous fistula can be punctured within 24 hours after setup,avoiding the use of central venous catheter and its subsequent complication,which will improve the safety of patients and medical staff's working efficiency.