Q:What is vascular access? A:Vascular access refers to the pathway that leads the patient’s blood out of the body into tubing and dialyzers and back into the body. Q:What are the common vascular accesses? A:1. Temporary vascular access: direct arterial puncture, internal jugular vein indwelling catheter, subclavian vein indwelling catheter, femoral vein indwelling catheter. 2.Semi-permanent vascular access: deep vein indwelling catheter with polyester sleeve. 3.Permanent vascular access: autologous arteriovenous endovascular fistula, transplant vascular endovascular fistula. Q:什么情况下需要建立临时性血管通路 A:1.急性肾衰需要紧急血析 2.慢性肾衰患者内瘘未成熟或未建立血管通路前出现各种危生命的 complication，如高血钾症.急性左心衰竭.严重酸毒，需要紧急血液析。 3.Malfunction of arteriovenous endovascular fistula, thrombosis, insufficient flow, infection. 4.Other diseases need hemodialysis treatment. 5.Peritoneal dialysis patients with emergency complications need hemodialysis treatment. Q:How to prevent indwelling catheter dislodgement? What should be done once it comes out? A:The indwelling catheter of abdominal vein should not be exercised too much, and the person who puts the catheter in the internal jugular vein or subclavian vein should not exercise strenuously, try to wear a placket, and avoid pulling out the catheter when taking off the pants, once the catheter is dislodged, the person should use sand bag, salt bag or hand pressure to stop the bleeding, and consult the doctor at once. Q:Why is there blood seepage from the indwelling catheter after dialysis? How to deal with it? A:Due to the application of anticoagulants during hemodialysis and the fact that most of the platelets of hemodialysis patients are lower than normal, it is easy for the indwelling catheter to bleed after dialysis. If it occurs, the indwelling catheter can be gently pressed or cold compresses can be used to apply acupressure for 20~30 minutes, and the catheter can be removed to stop bleeding if necessary. Q:What are the reasons for insufficient blood flow of indwelling catheter? How to deal with it? A:Long time of use, patient’s hypercoagulable state, insufficient heparin dosage, twisted pipeline and other reasons can lead to thrombosis in the catheter. Urokinase can be used to dissolve the tethering method, with urokinase 50~150,000 units plus saline 3~5ml injected into the indwelling catheter, retained for 15~20min, back to extract the dissolved fibrin or blood clot. If one time is not effective, it can be repeated, if repeated lysis of tethering is ineffective, then the catheter will be removed. Q:What are the symptoms of indwelling catheter infection? How should it be treated? A:The blood in the catheter should be collected for bacterial culture, and sensitive antibiotics should be selected for treatment. Depending on the symptoms of the infection, oral, static or antibiotic catheterization treatment can be selected. Q:What should I pay attention to during catheterization? A:1, good personal hygiene, keep the local dry, clean; 2, should not shower within a month, after a month of showering can be indwelling catheter and skin outlet sealed with a dressing, so as to avoid infection after wetting; 3, such as puncture place appears red, swelling, heat, pain phenomenon, should immediately consult a doctor; 4, change the medication every two to three days; 5, do not go to the public places, or go to the public places; 6, femoral vein cannulae are prohibited from 900 bending, the internal jugular vein cannulae can be localized with a collar, and the local collar can be used as a collar, and the local collar can be used for the internal jugular vein cannula. Internal jugular vein cannulation can be beautified and fixed with necktie or silk scarf. Q:What is arteriovenous fistula? A:It refers to the vascular access established by subcutaneous anastomosis of arteries and veins, including direct arteriovenous endovascular fistula and graft vascular arteriovenous endovascular fistula. The former is made by direct anastomosis of the arterial and venous blood vessels, and the latter is made by inserting a section of transplanted or artificial blood vessels between the arteries and veins. Q:When is it appropriate to create an autologous arteriovenous fistula? A:An autologous arteriovenous fistula should be performed when the endogenous creatinine clearance (Ccr) is less than 25 ml/min /1.73 m2. Q:When can an arteriovenous endovascular fistula be used? A:The maturation period of an arteriovenous fistula is at least 1 month and preferably 3-4 months. Q:How do I perform functional exercises after arteriovenous fistula surgery? A:One week after surgery, if there is no complication such as bleeding, infection, etc., you can start to hold the palm of the hand exercise, the second week after surgery, the endocardial fistula side of the arm to pinch the rubber gym ring 3-4 times a day, each time lasts for 10-15 min. one month after surgery, such as the endocardial fistula vasculature is poorly filled, you can use a tourniquet to press the endocardial fistula side of the arm of the arm of the upper arm, so that the venous moderate expansion of the filling, 2-3 times per day, every day, 5 ~ 10 min. Q:How to maintain the arteriovenous endovascular fistula? A:Correct and good daily care is an important part of the long-term use of arteriovenous endovascular fistula. During the dialysis period, it should be noted that: 1. Before each dialysis, wash the arm on the fistula side with soap and water. 2. 2, the end of dialysis on the day of the puncture site to avoid contact with water, and cover with a sterile dressing for more than 4 hours. 3, fistula side arm can not measure blood pressure, infusion, blood draw, etc.. 4, 3~4 times a day into the self-judgment of the arteriovenous fistula is smooth. 5, the fistula side of the arm can not be pressurized. 6, non-dialysis day appropriate activity fistula side arm. 7, to avoid fistula side arm trauma, it is best to often wear wrist guards. Q:How to determine whether the arteriovenous fistula is open? A:Touch the surgical anastomosis, such as touching the tremor means smooth; or stethoscope auscultation, can hear the vascular murmur means smooth. If the tremor, murmur disappears, and there is tenderness or pain at the fistula, you should come to the hospital in time.