An internal fistula is a vascular channel created by surgically anastomosing an artery directly to a vein. It is the lifeline of their long-term hemodialysis patients. Establishing and maintaining a good vascular access is the basic condition to ensure smooth continuous hemodialysis treatment, both to ensure adequate dialysis blood flow and dialysis effect and to enable long-term use so that uremic patients can survive with effective dialysis for a long time. This is why the perioperative care of arteriovenous endovascular fistula and the use of endovascular fistula is very important. 1. Preoperatively, the patient understands the importance of fistula, the method and how it is performed. Cooperate during the operation and avoid stress. Avoid doing arteriovenous puncture and blood pressure measurement in the arm where the fistula is prepared. Keep the skin on the fistula side clean and do not damage the skin to prevent postoperative infection. Start fist clenching exercise 2 weeks before surgery to promote vascular filling. 2.Postoperative Avoid pressure on the operated side of the limb after surgery to ensure smooth blood flow and reduce edema, and patients should keep the operated side of the limb padded when lying down. If standing or sitting, the arm should be bent and raised to the chest, and the wound condition and vascular pulsation should be closely observed. Keep the operated side of the limb dry, do not apply too much dressing to the wound, do not apply too much pressure, so that you can feel the endovascular tremor or hear the vascular sound, avoid infusion or blood sampling on the side of the fistula, avoid external pressure: such as blood pressure measurement, lifting heavy objects, wearing too tight hand ornaments, etc. Loose cuffed underwear should be worn as much as possible. Elevate the limb on the operated side to promote blood flow and prevent thrombosis. The method of determining whether the endovascular fistula is patent: i.e., touch the vein on the operated side with the hand on the non-operated side, and if tremor is felt or a vascular murmur is heard, it is indicated to be patent; otherwise, the surgeon should be contacted immediately for timely recanalization. Postoperatively, promote maturation of the endovascular fistula as soon as possible. Maturation of the endovascular fistula is defined as the dilatation of the endovascular vein and hypertrophy of the vein wall by the impact of arterial blood, which usually takes 6-8 weeks after surgery. If the wound does not bleed and heals well after 1-2 weeks after surgery, do the “fistula exercise”: squeeze and hold the rubber exercise ball 3-4 times a day for 10 minutes each time with the operated hand; also use a tourniquet or blood pressure gauge cuff to gently apply pressure above the anastomosis until the vein is moderately dilated. This can be repeated 3 times a day by releasing every 10-15 minutes, and can be done by applying heat or dipping the forearm into hot water 2-3 times a day for 5-10 minutes each time. The above methods can be used alone or in combination, all of which help the internal fistula to mature. During the use of the endovascular fistula, the correct method of hemostasis is used, mainly by compression hemostasis. If the pressure in the arterialized vessels is too high, a piece of gauze about 2*50px in size will be pressed at the eye of the needle for 15-30 minutes after the needle is removed at the end of dialysis, and then an elastic bandage will be wrapped around it with appropriate tightness so that there is no blood leakage and tremors can be felt and vascular murmurs heard, and the gauze will be removed after 2-3 hours as appropriate. The correct use of antihypertensive drugs to avoid blood pressure dropping too fast and too low; constipation, the application of laxatives to avoid diarrhea caused by dehydration or dialysis dehydration (should not exceed 4-5% of body weight), because blood pressure is too low can slow down blood flow, blood viscosity increased, accelerating thrombosis, resulting in the closure of the internal fistula. Patients should protect their fistulas by keeping their arms clean before dialysis, avoiding contact with water on the day of the dialysis puncture site to prevent infection, regularly testing whether the fistula is open, and not putting pressure on the limb on the side of the fistula, lifting heavy objects, etc. to prevent occlusion. |Dialysis