Analysis Of The Effects Of Targeted Care For Vascular Blockade In Critically Ill Patients With CRRT

Objective:Vascular access is the lifeline of critically ill patients, and is the premise of continuous renal replacement therapy CRRT (continous renal replacement therapy). Smooth of the vascular access relates to CRRT efficacy and the survival time of patients. Currently, CRRT therapy were widely used in critically ill patients, however, CRRT treatments usually had to be interrupted because of vascular access blockade, the blockade reason sometimes related to inappropriate care of filters and pipes by nurse. At home and abroad, there are some reports on CRRT care for ICU (Intensive Care Unit), but most of them are literatures review. Therefore, study of targeted care for the vascular smooth in critically ill patients treated with CRRT have become our urgent problems. In this randomized controlled trial, we intervened several factors linked with poor vascular access including patient's own factors, disease severity, age factors and factors of medical personnel by targeted care in CRRT. And we want to investigate whether the targeted care in CRRT would be helpful in maintaining the smooth of vascular access and reducing the economic burden of patients.Methods:Critically ill patients accepted CRRT treatment in the second hospital of Jilin University from July,2009 to December,2010 were selected to our study, their disease severity were evaluated by APACHEII scoring system. 60 patients were randomly divided into control group (usual care group) and intervention group (targeted care group). Control group patients were given usual care by general specialist, the intervention group patients accepted targeted intensive care on the basis of routine care:(1) add a nurse (member of the research team). (2) Sedation were given for the patients with irritability, pain, discomfort and poor psychological situation, according to "ICU treatment guidelines for sedation analgesia" (2006). (3) femoral vein anatomy and physiology based on location and physically placed supine nursing intervention. (4) Place the catheter by ultrasound-guided puncture and the tube length was longer than the control group 1cm. (5) Give special care for old patients according to their own characteristics. (6) Strengthen the pipeline flushing in hypercholesterolemic patients because the lipid was easy to plug the pipeline. Closely monitored arterial pressure, venous pressure, transmembrane pressure, filter pressure and other parameters from early CRRT treatment, and adjusted the ultrafiltration rate and ultrafiltration volume based on the patient's blood pressure, central venous pressure and water and sodium retention.Collected patient's age, sex, blood coagulation, blood lipids situation, pipe length (cm), APACHEII score and so on. All patients were treated on a continuous ECG monitoring and recorded their data:â‘ record the number of filters used in 24h per person and every filter use time, compare vascular access patency rate and the filter cost of the two groups.â‘¡record arterial pressure, venous pressure, transmembrane pressure, filter pressure, observe the filter and vascular access smooth between the two groups.â‘¢record body temperature, heart rate, respiration, blood pressure, Na+, K+, creatinine and other indicators in 24h, compare the treatment effects between two groups.Finally, all data were analyzed statistically.Results:1, Vascular access patency rate:Using only one filter(manufactured by the French Campbell Prisma M100 Pre set) within 24h is considered as the standard for vascular access smooth. Compare vascular access patency rate of the two groups. The results showed that patency rates in the intervention group are 56.67%(17/30), the control group's patency rates are 19.35%(6/31). There are significant difference between the two groups (x2=9.04, P=0.0026).2, The filter usage:The two groups'total filter usage time in 24h was no significant different (P>0.05). But the average number of filters used were significantly different (P<0.05); the average time for each filter using were different significantly (P<0.05); average cost of filter consumption was significantly different (P<0.05). Show that in the intervention group, the average filter usage time of every person is longer, the filter used number is lesser, and treatment costs reduced.3, CRRT machine monitoring indicators:In the two groups, arterial pressure, venous pressure, transmembrane pressure were different significantly (P<0.05), showing that the function of vascular access in the intervention group are better than the control group. Filter voltage was not significant difference (P>0.05).4, Physiological and biochemical monitoring indicators:The intervention group and control group of patients'24h body temperature, respiratory rates changes were significantly different (P<0.05); heart rates, blood pressures were no significant different (P>0.05). Comparing creatinine change between the two groups, we found creatinine changes in 24h were not significantly different (P>0.05). Comparison of ACT values showed in 24h ACT values changes not significantly between the two groups (P>0.05).Conclusition:The incidence of poor vascular access in CRRT treatment were related to patients'own reasons and the technology of nursing.1, Awareness of risk factors for patients and improving nursing techniques in CRRT can increase the patency rates of vascular access of critically ill patients. 2, Targeted care in CRRT can effectively maintain the smooth of vascular access, extend the filter's use time, reduce the number of filters-used, which can ensure continuity of treatment and can reduce the financial burden of patients.3, Maintain vascular access smooth in CRRT in critically ill patients may improve the effect of CRRT treatment.