Investigation On The Vascular Access Using And Complication Among Hemodialysis Patients In A Tertiary Teaching Hospital

ObjectiveTo investigate of hemodialysis patients with vascular access (main:central venous catheter and arteriovenous fistula),to analyze hemodialysis patients general information in the process of dialysis vascular access situation, complications and related influencing factors on hemodialysis vascular access complications, prevention and control measures, in order to improve the quality of dialysis,reduce complications, nursing staff rich business knowledge, to alleviate the patient economy burden, improve the quality of life of patientsMethodInvestigation of a hospital blood purifying room in2009January-2012year in July during blood purification (mainly blood dialysis) in treatment of200cases. The investigation content:general situation (age, gender, diagnosis),blood dialysis treatment times, frequency, the vascular access, complications, blood routine, biochemical, infections disease test results and test index. The survey instrument:Hospital Information System (HIS)electronic medical records, the hemodialysis room monitoring records, the new formulation in a hemodialysis patient target detection registration form. Data collection and input the collected "hemodialysis patient target detection registration form" data encoding, using EXCEL for tada entry, data statistics and analysis.Results1. On January1,2009-31July2012survey during hemodialysis patients a total of200cases, with women72people (36%),128male (64%). Age<25years of age14(7%),25-55years,136(68%),>50years55(25%). Agricultural registered permanent residence 166people (83%), town worker34(17%).2.200cases of hemodialysis patients diagnosis constitution:acute renal failure (ARF)20cases, accounting for10%; Chronic renal failure (CRF) in180cases, accounting for90%.3.200cases of dialysis patients dialysis age:death (30cases):dialysis age the shortest2days (give up treatment), the longest7years and two months, mean1year2months, median1year7months; Transferred hospital (n=92):dialysis age the shortest2days, the longest2year6months, with a median of3months, an average of6months; Cure (12cases):dialysis age18-65days, the average35days. Renal transplantation success (5cases): dialysis age the shortest3months, the longest12months, average8months; Maintenance hemodialysis (n=61):dialysis age the shortest7days, the longest for11years, with a median of1year1months, an average of1year8months.4.200cases of hemodialysis vascular access in a patient using:survey of patients with vascular access are:cannulation of femoral vein, internal jugular vein catheterization, autogenous arteriovenous fistula for hemodialysis vascular access is the main way, very few patients take arteriovenous direct puncture. The details are as follows:the femoral vein catheterization in155cases (78%); the internal jugular vein catheterization in46cases (23%); direct puncture in12cases (6%); internal arteriovenous fistula in89cases (45%).5. In200patients without Anticoagulants dialysis (commonly known as anticoagulants heparin free hemodialysis) in161cases:815analysis of the causes of the day (or femoral vein catheterization of internal jugular vein indwelling catheter, chest or abdominal effusion puncture drainage tube, peritoneal dialysis catheter) in138cases (86%), dialysis153times (19%); internal fistula operation in37cases (27%), dialysis45times (6%); menstrual period in34patients (21%), dialysis98times (12%); the body has inner and outer bleeding (hemorrhage, fundus hemorrhage, hemoptysis, abdominal subcutaneous hematoma, bleeding hemorrhoids, bladder, low platelets, etc.) in13cases (8%), dialysis519times (63%).6. In200patients with vascular access complications, femoral venous catheterization in155cases (78%):bleeding complications (peritubular blood oozing) in3cases (2%), infection in11cases (7%), hemodynamic instability (adherent phenomenon, tube position undesirable) in102cases (66%), pipe blockage (thrombosis, fibrin sheath) in7patients (5%), and canal in3cases (2%), a two catheter in17patients (11%). Internal jugular vein catheterization in46cases (23%):bleeding complications (peritubular blood oozing) in2cases (4%), infection in3cases (7%), hemodynamic instability (catheter placement adverse, adherent phenomenon) in26cases (57%), pipe blockage (thrombosis or fibrin sheath formation) of urokinase thrombolysis in7cases (15%), a two catheter in2patients (4%).Direct puncture in12cases (6%) complications:puncture failure in5cases (42%)38, hemodynamic insufficiency7cases (58%)46, false aneurysm in5patients (42%).Internal arteriovenous fistula in89cases (45%) complications:operation failed in3cases (3%), operation successful fistula in86cases (97%), wherein:hemorrhage (bleeding, hematoma)(14%),12cases of heart failure in8cases (9%),6cases of thrombosis (7%) vascular stenosis (insufficiency) in5cases (9%), hemangioma, arteriovenous aneurysm, pseudoaneurysm in9cases (10%), false aneurysm repair in2cases (2%), swelling of the hand syndrome in3cases (3%), arteriovenous fistula occlusion reconstruction in2patients (2%), arteriovenous fistula occlusion deactivated in2cases (2%)Conclusion1Patients undergoing hemodialysis increases year by year, recent years have seen a surge in the survey,200cases of hemodialysis patients and the ratio of128:72=1.8:1, male than female.2Average dialysis age short, inadequate dialysis phenomenon is serious.3There are still many problems with vascular access, there are still have direct puncture phenomenon, deep vein indwelling tube indwelling time is too long, the high rate of increase in complications, operation time of AVF slants generally late, long-term users had a false aneurysm and thrombosis fistula occlusion such complications occur, the fistula closed phenomenon, to be the patient, clinical medical and nursing staff efforts.4No anticoagulant hemodialysis is develop, well to avoid, reduce bleeding, bleeding patients. But no anticoagulant hemodialysis problems:dialysis time shorten of0.5-1h, Dialysis efficiency to reduce, dialyzer and extracorporeal circulation pipeline coagulation (blood clotting problems patients lost, blockage of the line required replacement)...