Hemodialysis vascular access is the lifeline for dialysis patients. With an aging population, an increase in the number of patients with diabetic nephropathy, and an increase in the duration of dialysis, more and more patients are starting to use artificial endovascular fistulas for dialysis. Artificial vascular arteriovenous endovascular fistula is more complex than autologous arteriovenous endovascular fistula puncture, now some of the puncture, care points are listed below, we will also publish related series of specialist articles in the future, hope to provide some help for you. 1. Timing of puncture: Because of the large surgical trauma and damage to subcutaneous tissues, the limbs have different degrees of swelling after surgery. Although the literature reports that puncture dialysis can be performed 2-4 weeks after surgery, we observed that generally the swelling can be completely subsided only 6-8 weeks after surgery, the new inner and outer membranes are gradually formed, and the outline of artificial blood vessels becomes clear. Premature use is prone to graft vessel compression, anastomotic stenosis, bleeding, infection and thrombosis, so it is generally preferable to puncture the artificial vessel 6-8 weeks postoperatively. If the artificial vascular pathway is dysfunctional, after surgical intervention and recanalization, the wound is free of bleeding and swelling and can be used on the first day after surgery. 2.Puncture site: the distance between the arterial and venous puncture points is >3cm from the anastomosis, and the distance between the two points is >5cm. It is not suitable to puncture in the turning, curved and folded parts of the vessel; take a step or spiral type irregular puncture, and each puncture site is 0.6-1.2cm from the last needle. 3.Puncture direction: for the artificial blood vessel with short puncture range, the arterial puncture is in the direction of reverse blood flow, which can reduce the recirculation rate. For the artificial blood vessel with long puncture range, the arterial puncture needle can be in the direction of downward or counter-flow. The puncture in the direction of downward flow makes the blood flow have little influence on the live valve that may exist after the needle is removed, which is conducive to the healing of the vascular needle eye. 4.Puncture method: before puncture, feel the shape and depth of the blood vessel, puncture without tourniquet. Strictly implement the principle of aseptic operation, disinfect the skin of the puncture area spirally from inward to outward with the puncture point as the center, the disinfection range is more than 10 cm in diameter, disinfection twice. The needle tip is beveled upward, enter the needle at an angle of 40°-45°, touch the artificial blood vessel when piercing the skin with a sense of pause, and feel a sense of falling after entering the artificial blood vessel, reduce the angle between the puncture needle and the skin to 20°-30° after seeing the return blood, continue to advance inside the blood vessel until the needle is fully fed, then rotate the needle 180° so that the needle is beveled downward, fix the puncture needle to a proper and comfortable position. The puncture needle should be fixed to a proper and comfortable position to prevent ectopic or dislodged needle. For patients with deeper artificial vessel implantation or obese patients, when the edge of the vessel cannot be clearly touched, the artificial vessel can be pinched up so that it is higher than the skin, which is helpful to improve the success rate of puncture. A stepped or spiral approach to the needle should be adopted so that the puncture is not fixed in any area of the entire vascular access. 5. Needle extraction and hemostasis: When extracting the needle, make sure that the needle tip is beveled downward, compress the puncture point with sterile cotton balls, and stop the bleeding with finger pressure for 15-20 min after needle extraction, with the compression point at the artificial vessel entry point, and pay attention not to add pressure during needle extraction, but add pressure after needle extraction to avoid cutting the vessel with the bevel of the puncture needle. The compression time should not be too long, and the force should be moderate, so that the proximal artificial vessel tremor can be palpated or the vascular murmur can be heard on auscultation. Too much pressure can easily cause blood flow blockage, too little pressure can easily cause bleeding, and too long compression time can easily lead to thrombosis. Figure 1 The arterial and venous puncture points are >3cm away from the anastomosis, and should not be punctured in vascular turns, arcs and folds. 6. Daily care: Observe blood pressure changes during dialysis treatment, if blood pressure is below 100/60mmHg, deal with it in time to prevent prolonged hypotension from slowing blood flow and causing thrombosis. If you find that the patient’s fistula limb is swollen or the venous return pressure is increased, you should be alert to the stenosis of the proximal end of the fistula vessel and promptly inform the doctor.
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