In hemodialysis patients, pruritus is a common and intolerable symptom with an incidence of 60%-90%. With the prolongation of dialysis time, the symptoms gradually worsen, making patients anxious and painful all day long, which seriously affects the quality of life of patients.
I. Electrolyte metabolism disorder leads to itchy skin
Patients with chronic renal failure are most commonly affected by secondary hyperparathyroidism due to reduced phosphorus excretion, repeatedly elevated blood phosphorus levels, and decreased blood ionized calcium levels, which stimulates PTH (parathyroid hormone) secretion. Studies have shown that secondary hyperparathyroidism can cause pruritus, and its increase can cause hypercalcemia, skin calcification and stimulation of histamine release from skin mast cells, thus elevated PTH is considered an important causative factor.
Countermeasures.
1, limit the intake of phosphorus in the diet, it is recommended that the phosphorus level should preferably be less than 600-l200mg/d, avoid soy-based foods and animal offal.
2. Apply active vitamin D for calcium supplementation. Adjust dialysis fluid to proper calcium concentration to prevent hypercalcemia.
3.Change the way of scratching. Pat gently with hands and cut nails regularly. Pay special attention to maintain the integrity of the skin of the arm on the side of the arteriovenous endovascular fistula so as not to cause endovascular infection. In case of local infection, avoid puncture and use Bactrim antibiotic ointment as prescribed by the doctor.
Itchy skin due to nitrogen metabolite retention
Nitrogen metabolite retention stimulates the skin and makes the sebaceous glands and sweat glands atrophy, causing itching due to different degrees of dryness and flaking of the skin. The skin looks like ichthyosis, and the itchy skin is unbearable and often scratched or even broken without relief. The main causes of nitrogen metabolic retention are: inadequate dialysis, the choice of low-flux dialyzers also multiple consecutive reuse, etc.
Countermeasures.
1, reduce the number of reuse of low flux dialyzer, increase the number of dialysis (3 times/w), conditions allow, can use medium flux dialyzer (ultrafiltration coefficient 15-30mL/mmHg・h・m2) for dialysis.
2.Dialysis process, closely observe whether the operation of dialysis machine is normal, try to achieve early detection, early prevention, early treatment.
3.The nursing operation should be standardized, and attention should be paid to the aseptic operation when performing treatment to ensure the safety during dialysis treatment.
4, guide patients to use cold water, ice towel wet compresses to reduce itching, and apply external skin lubricant and use cheese soap when the skin is dry.
Third, allergic reactions lead to itchy skin
Allergic reactions occur mainly because heparin, softening hemodialysis tubing access plasticizers and sterilizing dialyzer and blood circuit ethylene oxide can stimulate the proliferation of mast cells in the spleen, bone marrow and skin of dialysis patients, leading to increased histamine concentration in the blood and inducing itchy skin.
Countermeasures.
1.Treatment with antihistamines is relieved.
2. Encourage and comfort the patient to reduce the patient’s tension.
3.Select a dialyzer with good biocompatibility to reduce the allergic reaction caused by ethylene oxide.
4, Before dialysis, you can choose saline to fully pre-flush the reusable dialyzer and tubing, and do the residual disinfectant detection when you get on the machine to ensure the safety of dialysis treatment.
5.The itching caused by such allergic reactions is mostly accompanied by rash. Patients are instructed to avoid scratching hard and causing skin breakage, and some cool medicated oil can be used for external application to reduce the symptoms.
Health tips.
1, psychological care: patients due to itchy skin and scratching leads to defects in self-image. Make the patient very anxious. As the symptoms worsen day by day, affecting the quality of sleep at night, you can take sedatives under the guidance of a doctor. To avoid excessive emotional anxiety. As the treatment cost of HP combined with HD increases compared with the implementation of HD treatment alone, it will bring certain psychological pressure to patients, resulting in low compliance of dialysis patients receiving HP combined with HD treatment, so health guidance should be done to improve patient compliance with treatment. Ensure that the treatment is carried out smoothly.
2. Instruct patients to wear cotton and loose underwear in their daily life. Bathing water should not be too hot, generally use 40 ℃ warm water bathing is appropriate. Avoid the use of alkaline soap and body wash.
3, in order to avoid itching caused by dry skin, local moisturizing lubricant can be applied, and at the same time do a good job of personal hygiene, diligent bathing and changing clothes. It is not advisable to drink alcohol and eat less stimulating food.
4. Properly instruct patients to take phosphorus binding agents, regularly draw blood to check the indicators, strengthen the education of nutritional intake, improve patient compliance with treatment, and delay the occurrence of long-term complications.