Vascular access is the lifeline of hemodialysis patients, and it is very important to do a good job of protecting the lifeline of dialysis patients! I. Commonly used surgical methods of arteriovenous endovascular fistula.
Autologous arteriovenous endovascular fistula: mainly in the extremities, the commonly used anastomosis method for the upper extremities is end-to-end anastomosis or end-to-side anastomosis between the flexural artery and the cephalic vein, while the lower extremities are anastomosed between the posterior tibial artery and the saphenous vein.
Human cadaveric artery bypass arteriovenous internal phlegm: human cadaveric artery comes from fresh cadaver without infectious disease and atherosclerosis, and the anastomosis method is to anastomose the radial artery stump with the cephalic vein, noble vein and median elbow vein in the upper extremity, and to anastomose the brachial artery with median elbow vein mostly by straight bridge or U-shaped bypass, and the diameter of the anastomosis is 0.4-1.2 cm, and to anastomose the femoral artery with the saphenous vein in the lower extremity by U-shaped bypass end-lateral anastomosis. Polytetrafluoroethylene (PTFE) artificial vessel bypass: 6-8 mm in diameter and 30-50 cm in length is used. A U-shaped bypass is performed between the brachial artery and the elbow vein or the femoral artery and the saphenous vein.
I. Precautions for autologous arteriovenous fistulae.
1. 24 hours after surgery, you can try to start doing ball gripping exercises (holding and pressing a rubber ball with one hand to grip it tightly for 5 seconds and then relaxing it for 5 seconds for 1 time). It is recommended to do 300-500 times a day and can be done in rounds. This will increase the blood flow to the fistula and help it to mature and expand; 2. Wait 1-4 weeks after surgery for the fistula to fully mature before puncturing it.
Touch the fistula with your hand daily to check for “thrill” or use a stethoscope to check for “bruit” sounds. If these two symptoms diminish or disappear, seek immediate medical attention, as the sooner the obstruction is treated, the better.
4. Avoid injury to the arm on the side of the arteriovenous fistula (e.g. injections, blood draws, blood pressure measurements) or compression (wearing a watch, bracelet, pillow, etc.) that could affect the circulation of the fistula and cause an embolism.
5. After dialysis, the fistula wound should be kept dry to avoid infection. The gauze should be wrapped for 24 hours and removed after the puncture wound has healed, and a moderate amount of warm water should be applied to the arm of the fistula to promote blood circulation.
If the fistula is not large enough, do exercises such as holding a ball, lifting a dumbbell, holding a handle, or making a fist.
7. If the fistula is excessively enlarged, use an elastic sheath to apply moderate pressure to prevent cardiac discomfort due to excessive blood flow.
8. If the arm is swollen due to needle leakage, ice packs can be applied within 24 hours after dialysis (10-15 minutes per hour) to stop the bleeding and pain; and hot packs can be applied after 24 hours after dialysis to reduce the swelling.
9. Clothing should avoid tight cuffs (e.g., when rolling up sleeves) to prevent compression of the fistula. It is recommended that the sleeve on the side of the fistula limb can be equipped with a zipper.
10. Control the amount of water you drink and do not increase your body weight by more than 5% of your dry weight between dialysis sessions to prevent a drop in blood pressure during dialysis, which could lead to fistula embolism.
11. Avoid smoking.
12, Pay attention to the warmth of the limb at the fistula to prevent the blood flow from slowing down due to excessive cold, which may cause fistula embolism.
13, after the daily hot compress, you can make a circular massage from the anastomosis in the direction of the blood vessels (not too hard), vascular function is not good r, the force can be increased.
14.Maintain good personal hygiene habits and wash the skin outside the fistula with antibacterial soap before each dialysis.
15, avoid skin injuries, use iodine volts to wipe the skin when there is a break.
16.If the fistula is red, swollen or painful, it may be a symptom of infection and should be treated immediately by a physician, not by self medication.
17.If you accidentally cut your hand and it bleeds a lot, you should use clean gauze to compress the wound directly to stop the bleeding and seek medical attention immediately.
Second, transplantation of arteriovenous fistula (artificial blood vessels) precautions.
1, transplantation fistula is usually used in poor vascular conditions, is the use of artificial blood vessels as a bridge between arteries and veins. It can be used two weeks after surgery when the swelling is gone.
2. If edema is present, the arm should be elevated (above the heart). If the swelling is very serious, you can wrap it with elastic bandage to reduce the swelling.
3.Since the artificial blood vessel does not need to mature and become thicker, you may not do ball gripping exercise.