I. Renal puncture biopsy
Renal puncture biopsy is the gold standard for the diagnosis of chronic kidney disease and has an irreplaceable and important role in the clinical work of kidney disease. Its significance is: to clarify the pathology of kidney disease and make the final diagnosis in combination with clinical; to formulate a scientific treatment plan to avoid detours or delays; and to judge the prognosis of patients. It is widely carried out at home and abroad, and is a commonly used test in the diagnosis of kidney diseases.
Patient precautions.
1, preoperative exercise bed prone position deep inspiration after holding the breath for about 25 seconds, the purpose is to not move the abdomen during the operation to keep the kidney from moving, so that the puncture is completed successfully; preoperative exercise bed urination and defecation, the purpose is to avoid or reduce postoperative bleeding.
2. During the operation, you must obey the doctor’s command and cooperate with the successful completion of the puncture.
3, after the operation must rest in bed for 24 hours, do not force activities, bed urination and defecation, the waist can not actively force, can be turned with the help of family members, other parts of the body other than the waist can move independently, appropriate more water and pay attention to observe the color of urine and urine volume and other changes, the purpose is to prevent bleeding, prevent clots blocking the urinary tract, timely detection of bleeding phenomenon and timely and effective treatment.
Autologous arteriovenous endovascular fistuloplasty
Autologous arteriovenous endovascular fistuloplasty refers to the endovascular anastomosis of the arteries and veins in the limbs of patients with uremia who are ready for hemodialysis, and the radial artery-cephalic vein endovascular fistula in the forearm and wrist is most commonly used. The arteriovenous endovascular fistula is primarily a vascular access for long-term hemodialysis treatment, as it takes at least 1 month or more for the endovascular fistula to mature, and it is more desirable to start using it after 2-3 months, so it is necessary to operate earlier before starting hemodialysis. Arterio-venous endovascular fistula is the lifeline of hemodialysis patients, please protect it carefully!
Post-operative patient precautions.
1. Keep the operated limb clean for one week after surgery, especially to keep it dry, do not remove the dressing at will to prevent wound infection, contact the doctor promptly if there is significant blood seepage, and the dressing should not be too tight.
2. Keep the operated limb properly elevated in the early postoperative period.
3. Postoperative limb should be kept warm, do not immerse in cold water, do not bear weight, do not compress the operated limb, especially do not lie on the side of the operated limb during sleep, do not wear items such as watches or jewelry, do not bend the operated limb for a long time, do not measure the blood pressure of the operated limb, do not give fluids or draw blood.
4, after surgery should wear cuffs loose clothes, the cuff of the operated limb for transformation, the dorsal side of the inner fistula installed a zipper, convenient for later puncture.
5, a week after surgery wound without significant blood leakage, infection, good healing, you can start to exercise the surgical limb: such as surgical limb hand squeeze gripper, etc.
6.Learn to judge whether the internal fistula is open or not, it is recommended to touch the wound with the finger of non-operative limb once a day in the morning and once a day in the evening, you can touch the tremor or put the operative limb on the opposite side of the ear, you can hear the “whirring” wind-like murmur, which indicates openness, otherwise you must contact the doctor immediately.
Hemodialysis central venous line placement
Hemodialysis central venous placement is clinically divided into two types. One is temporary placement, which is mainly used for emergency hemodialysis patients; the other is long-term placement, which is mainly because the patient’s limb vascular condition is not good enough to perform arteriovenous endovascular fistuloplasty. Regardless of the type of placement, the patient should be well taken care of after surgery.
Postoperative patient precautions.
1, pay attention to observe whether the catheter suture is loose or dislodged, if it is loose or dislodged promptly inform the health care provider.
2. Do not place the catheter in the lateral position for a long time to avoid compression of the catheter.
3, try to wear cardigan clothes to prevent pulling the catheter in and out of clothing.
4, pay attention to body hygiene, keep the placement port clean and dry, temporary catheter can wipe body, avoid bathing caused by infection, long-term catheter recommended to use the bath protection bag.
5.Femoral vein intubation bedside angle should be less than 40 degrees, can walk on the floor for a short distance, try to avoid long time sitting or wheelchair.
6. Temporary placement of the internal jugular vein is generally reserved for about one month, and femoral vein placement is generally reserved for about one week, and it is recommended to remove it after the time.