Atoyerɛnkyɛm Ho Ahosiesie a Wɔyɛ Ma Wɔn a Wɔde Insulin Pɔmpɛ Di Dwuma ne Ayarefo a Wɔyɛ Dialysis: Nsaano Syringe a Wɔdannan ne Potassium Aduan¶

Sɛ ahum, nsuyiri, wuram ogya a wɔde fi hɔ, anaasɛ anyinam ahoɔden nhama a ɛhwe ase nna pii tu a, ankorankoro a wɔte asikreyare a egyina insulin so anaasɛ asaabo mu yare a ɛba awiei no hyia nipadua mu nneɛma a ɛsakra ntɛm ara a ɛde wɔn nkwa to asiane mu wɔ nnɔnhwerew 12 kosi 72 ntam. Sɛ insulin pɔmpɛ bi mu paapae, batere no ahoɔden hwere, anaasɛ infusion sets a ɛyɛ ne de no sa bere a wɔretu no a, mogya mu glucose kɔ soro ma ɛyɛ owuyare asikreyare a ɛma obi nya ketoacidosis wɔ nnɔnhwerew 4 kosi 8 mu gye sɛ ɔyarefo no betumi adan ntɛm ara akɔ nsa a wɔde twitwiw syringe mu denam nhyehyɛe a wɔadi kan abu ho akontaa a wɔde bɛboa no so. Bere koro no ara mu no, sɛ akwan a nsu ayiri afa so anaasɛ anyinam ahoɔden a ɛtwam no to mmeae a wɔyɛ mogya mu nhwehwɛmu a wɔde ayarefo a wɔda abɔnten nna abien anaa abiɛsa a, ayarefo a wɔwɔ asaabo a wɔde asaabo yɛ no hyia koma a ɛyɛ komm esiane mogya mu potassium a ɛrekɔ soro nti anaasɛ nsu a ɛboro so nti a wɔbɛmene wɔn mu gye sɛ wɔde nnafua 3 adidi a egye ntɛmpɛ a ɛyɛ katee a wɔde di dwuma wɔ adwene mu no mu ntɛm ara. Ansa na ntɛmpɛ bi bɛba no, fa metabolic go-bag a wɔatu ho ama sie wo... nnuru a ɛma ɔhyew te, kyere sɛnea wobedi ho dwuma no gu wo tirim dialysis fistula ne hyperkalemia ntɛmpɛ, na fa wo mpɔtam hɔ sie nɔma ahorow a egye ntɛmpɛ (911 wɔ United States ne Canada, 112 wɔ Europa Aman Nkabom no nyinaa mu, 999 wɔ United Kingdom) wɔ krataa a nsu ntumi nkɔ mu so.

Yɛ eyi mprempren¶

1. Print na laminate wo mprempren Insulin Pump Basal ne Bolus Settings Card nnɛ. Bue wo insulin pump anaa automated insulin delivery (AID) smartphone app mprempren ara na kyerɛw wo nnɔnhwerew 24 basal rate profile pɔtee (units per hour for every time block), wo da biara da basal insulin dodow nyinaa, wo insulin-to-carbohydrate ratios (ICR), wo insulin sensitivity anaa correction factor (ISF), ne wo insulin a ɛyɛ adwuma a wɔde si wɔn ani so. Fa teyp biako a wɔayɛ no laminated no gu wo asikreyare kɔ bag mu na fa nea ɛto so abien sie wo sika kotoku mu.
2. Fa basal insulin a ɛyɛ adwuma bere tenten, U-100 insulin syringes, ne pen needles sie wo ntɛmpɛ kit no mu. Insulin pɔmpɛ bi wɔ insulin a ɛyɛ adwuma ntɛmntɛm (te sɛ lispro, aspart, anaa glulisine) nkutoo. Bisa wo endocrinologist sɛ ɔmma wo nnuru a wɔde bɛboa wo ama basal insulin pens anaa vials a ɛyɛ adwuma bere tenten (te sɛ insulin glargine anaa insulin degludec), anyɛ yiye koraa no U-100 insulin syringes 30 a ɛnyɛ ɔyare mmoawa (0.3 mL anaasɛ 0.5 mL tumi), ne penne nnade a ɛyɛ milimita 4 anaa milimita 5 sɛnea ɛbɛyɛ a wubetumi adan akɔ Multiple Daily Injections (MDI) so bere a pɔmpɛ bi abubu anaasɛ ahoɔden a ɛyera no.
3. Fa mogya mu glucose mita a wɔde di dwuma wɔ amanne kwan so, sɔhwɛ nhama 100, ketone nhama, ne glucagon a wɔasiesie sɛ wode bedi dwuma hyehyɛ mu. Continuous glucose monitor (CGM) sensor ahorow no di nkogu bere a transmitters ahoɔden sa, telefon ahorow wuwu, anaasɛ ade a wɔde nkata so no pepae wɔ nsuyiri nsu anaa fifiri mu no. Bere nyinaa fa atetesɛm nsateaa glucometer a sika-nkwaboaa batere a aka, mogya anaa nsu ketone sɔhwɛ nhama, anom anaa auto-injector glucagon, ne gram 300 a ɛyɛ adwuma ntɛmntɛm glucose tablets anaa gels hyehyɛ mu bere nyinaa.
4. Wɔ ayarefo a wɔyɛ mogya mu nhwehwɛmu: Fa wo Hemodialysis "Run Sheet" ne Vascular Access Bleed Kit a wɔatintim no gu kotoku a nsu ntumi nkɔ mu. Bisa wo dialysis ayaresabea ɔyarehwɛfo no ma ɔmma wo ayaresa krataa a wɔayɛ no foforo a ɛkyerɛ wo target dry weight, dialyzer filter model, mogya pɔmpɛ flow rate, dialysate potassium ne calcium bath concentrations, ne heparin dose a wɔde ma. Fa krataa yi fa Plastic toa nkataso a ɛho tew 3 nkyɛn, a ɛnyɛ ɔyare mmoawa 10 x 10 centimeter (4 x 4 inch) gauze pads, ne venous catheter clamp.
5. Yɛ Nnafua 3 Aduan Adaka a wɔatu ho ama a Potassium Nni Mu, Sodium Nni Mu, Nsuo Anohyeto. Fa plastic tub a ɛyɛ soronko a wɔakyerɛw so sɛ "Dialysis 3-Day Disaster Diet Only" a wɔde nnuan a ɛwɔ shelf-stable, a potassium kakraa bi nnim (krackers a nkyene nnim, aburow fitaa nkotoku, applesauce cups, pears a wɔde ahyɛ toa mu) ahyɛ mu ma sie anaasɛ peaches a ɛwɔ nsuo mu a wote mu ansa na woadi, aburow aburow a wɔayam, ne nkesua fitaa a ɛwɔ shelf-stable anaa tuna a sodium kakraa bi na wɔhohoro mu) ne susudua kuruwa ketewaa bi a wode bɛto nsu a wobɛnom nyinaa ano ma ayɛ 500 kosi 700 mililita (nsu ounces 16 kosi 24) wɔ nnɔnhwerew 24 biara mu.
6. Bisa wo nephrologist fa asiane bi a wɔde asie a ɛwɔ potassium-binding packets a wɔnom wɔ ano ho. Sɛ wo nsa ka maintenance hemodialysis a, bisa w’asaabo ho oduruyɛfo sɛ ɛsɛ sɛ wode nnɛyi potassium a wɔde kyekyere yafunu mu anom (te sɛ sodium zirconium cyclosilicate anaa patiromer) a wɔakyerɛw ho akwankyerɛ a ɛkyerɛ bere a ɛsɛ sɛ wode ma ntɛm so nnafua 3 kɔ anaa sɛ wubefi ase anom sɛ wo dialysis ayaresabea no to mu bere a asiane bi a wɔabɔ ho dawuru asi no a.

Gyinaesi dua: Insulin pɔmpɛ a entumi nyɛ adwuma anaasɛ dialysis ayaresabea a wɔto mu bere a asiane bi asi¶

Fa saa triage flowchart yi di dwuma bere a anyinam ahoɔden atɔ, wɔretu, anaa ahum a emu yɛ den asiw asikreyare ketoacidosis, asikreyare a ɛkɔ fam kɛse, koma a ɛyɛ den kɛse, ne ahurututu mu edema a ɛyɛ hyew ano.

flowchart TD
    Start["Atoyerɛnkyɛm a Ɛba: Tumi a Ɛtɔ, Tumi a Wɔtu, anaa Ayaresabea a Wɔto mu"] --> PatientType{"Aduruyɛ mu ahotoso bɛn na ɛfa ho?"}

    PatientType -->|"Insulin Pɔmpɛ / CGM Ɔdefo"| PumpCheck{"So insulin pɔmpɛ no nni dɛm, ɛwɔ ahoɔden, na wɔde spare sets ahyɛ mu?"}
    PumpCheck -->|"Yiw, adwuma a wɔyɛ no sɛnea ɛsɛ"| PumpConserve["1. Plug rechargeable pɔmpɛ mu portable tumi bank wɔ 50% charge; 2. Bɔ insulin nsuhina ho ban wɔ kotoku a nsu na ɛyɛ adwuma (15C kosi 30C) mu; 3. Ration CGM screen nhwehwɛmu; fa nsateaa mita ne glucose tabs sie nipadua no so"]
    PumpCheck -->|"Dabi: Pɔmpɛ no mu apaapae, ayɛ nsu, batere a awu, anaasɛ infusion sets awie"| PumpFail["DAN KƆ MANUAL INJECTION (MDI) PROTOCOL Ntɛm ara:; 1. Yi pɔmpɛ cannula fi honam ani na amma adwene atu afra; 2. Twe Pump-to-Syringe Conversion Card a wɔakyerɛw no fi go-bag mu; 3. So Wowɔ Basal Insulin a Ɛyɛ Adwuma Bere Tenten (Glargine / Degludec)?"]

    PumpFail -->|"Yiw, nya Basal Insulin"| GiveBasal["Fa kyerɛwdua anaa U-100 syringe so fa nnɔnhwerew 24 Long-Acting Basal dodow a wɔakyerɛw ama no gu mu; + Fa Rapid-Acting insulin gu mu ansa na woadi na ama woateɛteɛ glucose a ɛkɔ soro"]
    PumpFail -->|"Basal Insulin biara nni hɔ a ɛwɔ hɔ"| RapidBridge["EMERGENCY RAPID-ACTING BRIDGE:; Fa Rapid-Acting insulin a wɔabu akontaa sɛ ɛyɛ Basal equivalent a wɔabu akontaa sɛ ɛyɛ nnɔnhwerew 3 kosi 4; via U-100 syringe nnɔnhwerew 3 kosi 4 biara awia ne anadwo + sɔ ketones hwɛ"]

    PatientType -->|"Hemodialysis anaa Peritoneal Dialysis Ɔyarefo"| DialCheck{"So wobue wo ayaresabea a wɔde dialysis a wɔde kɔ ayaresabea no ano anaasɛ wotumi kɔ hɔ?"}
    DialCheck -->|"Ayaresabea a Wɔato Mu Anaasɛ Nsu Ayiri Ayɛ Akwan"| DialDiet["YƐ ADWUMA 3-DAY EMERGENCY REENAL SURVIVAL PROTOCOL:; 1. Fi ase di Nnafua 3 Aduan a Potassium nnim (<1,500 mg/da) a ɛyɛ katee ntɛm ara; 2. Siw nsu a wɔnom NYINAA ano hye ma ɛnyɛ 500 kosi 700 mL (16 kosi 24 oz) nnɔnhwerew 24 biara; 3. Frɛ ayaresabea atoyerɛnkyɛm hotline / KCER na hwehwɛ open backup unit; 4. Fa potassium binder a wɔakyerɛw ama wo ntɛm ara sɛ nephrologist kyerɛ wo a"]
    DialDiet --> RedFlags{"Nan a ɛyɛ mmerɛw, anofafa a ɛyɛ yaw, ɛbɔ a ɛyɛ brɛoo, anaasɛ mframa a ɛrehuruhuruw biara?"}
    RedFlags -->|"Yiw"| CallEMS["FRE 911 / 112 / 999 Ntɛm ara:; Fa ‘Dialysis Ɔyarefo a Wosusuw sɛ Hyperkalemia anaa Pulmonary Edema’ no to gua; Tra bolt tẽẽ wɔ digrii 90 a wo nan sɛn fam"]
    RedFlags -->|"Dabi"| MonitorWeight["Kari da biara (to mfaso no ano hye ma 0.5-1.0 kg/da) na tu kɔ ayaresabea dan a wɔabue mu"]

Ɔfã 1: Insulin pɔmpɛ ne CGM asiane ho ahosiesie (The Pump-Failure Survival Kit) .¶

Nnipa a wɔwɔ asikreyare a ɛto so 1 no mu bɛboro fã ne pii a wɔwɔ asikreyare a ɛto so abien a egyina insulin so no de wɔn ho to insulin a wɔde ma a ɛkɔ so wɔ honam ani (CSII) so denam pɔmpɛ a wɔde nhama a wɔakyekyere anaasɛ pɔmpɛ a wɔde ntama a ɛnyɛ nhama, a wɔde abɔ Glucose a ɛkɔ so (CGM) ho wɔ Automated Insulin Delivery (AID) afrafra closed-loop nhyehyɛe mu. Bere a saa mfiri yi ma da biara da tumidi soronko no, ɛde huammɔdi biako pɛ anan a ɛyɛ mmerɛw ba bere a asiane bi asi:

1. Electronic ne Battery Dependency: Nnɛyi tubed pumps ne patch-pump controllers dodow no ara yɛ adwuma wɔ mu rechargeable lithium-ion batteries (anaasɛ specialty lithium AA batteries) a ewu wɔ nnafua 2 kosi 5 mu a enni grid ahoɔden.
2. Proprietary Infusion Hardware: Worentumi ntwe insulin mfi pɔmpɛ a wɔde ahyɛ mu ma a ɛyɛ wo dea mu anaasɛ wode bɛhyɛ wo nipadua mu gye sɛ wowɔ standard U-100 insulin syringes (anaasɛ pen needles a wɔde yɛ insulin pen). Sɛ wo plastic infusion set a etwa to no kinks wɔ belt buckle so bere a wode kar a wɔde yi nkurɔfo fi mu rehyɛ mu a, wo pɔmpɛ no bɛyɛ plastic a mfaso nni so.
3. Absence of Subcutaneous Basal Depot: Esiane sɛ pɔmpɛ ahorow no de insulin analogs a ɛyɛ adwuma ntɛmntɛm (insulin lispro, insulin aspart, anaa insulin glulisine) a ɛkɔ soro wɔ simma 60 kosi 90 mu na ɛsɛe wɔ nnɔnhwerew 3 kosi 5 mu nkutoo na ɛhyɛ mu nti, sɛ wogyae pɔmpɛ a wɔde ma no a, ɛma nipadua no nya insulin a ɛwɔ akyi no zero wɔ nnɔnhwerew 2 kosi 3 mu.
4. Cloud ne Smartphone Lockout: Nnipa pii a wɔde di dwuma no de wɔn basal rates, carb ratios, ne sensitivity factors sie wɔn pump no menu anaa cloud portal mu nkutoo. Sɛ pɔmpɛ bi screen bubu anaasɛ telefon batere wu a, ɔyarefo no anaa oduruyɛfo a ɔwɔ baabi a wɔhwɛ ntɛmpɛ mu biara nnim insulin a ɔyarefo no hia da biara da.

Anamɔn biara: Woresiesie wo Pɔmpɛ-kɔ-Syringe Nsakrae Kaad a Wɔakyerɛw no¶

Ɛsɛ sɛ obiara a ɔde insulin pɔmpɛ di dwuma no ne ne endocrinologist anaa Certified Diabetes Care and Education Specialist (CDCES) tra ase pɛnkoro afe biara de hyehyɛ honam fam, nsuo ntumi nkɔ mu Emergency Pump Failure Conversion Card. Mma nsusuw insulin dodow a wɔde ma wɔ ɔhaw bi mu ho da. Ɛsɛ sɛ wo kaad no kyerɛw nɔma asia yi pefee:

Sɛnea wɔdannan fi insulin pɔmpɛ a adi nkogu so kɔ nsa a wɔde twitwiw nipadua mu so (Nsɛm Abien) .¶

Sɛ wo pɔmpɛ no di huammɔ, kɔ nsuyiri nsu mu, anaasɛ infusion sets sa a, honam fam bue na yi pɔmpɛ infusion cannula dedaw no anaasɛ patch pod no ntɛm ara sɛnea ɛbɛyɛ a wubegye adi sɛ insulin biara a wonhwɛ kwan ntu nkɔ mu, afei di tebea a ɛne wo nneɛma hyia no akyi:

Tebea A: Wowɔ Basal Insulin a Ɛyɛ Adwuma Bere Tenten (Glargine, Detemir, anaa Degludec) NE Insulin a Ɛyɛ Adwuma Ntɛmntɛm¶

Eyi ne ɔkwan a ahobammɔ wom sen biara, a ɛyɛ sika kɔkɔɔ a wɔde boa atoyerɛnkyɛm a Amerika Asikreyare Fekuw (ADA), Asikreyare UK, ne Asikreyare Atoyerɛnkyɛm Ho Mmuae Nkabom (DDRC) kamfo kyerɛ: 1. Fa pen anaa U-100 syringe so fa Long-Acting Basal Insulin a wɔakyerɛw ama wo no ma: Hwɛ wo nsakrae krataa a woakyerɛw no mu hwɛ sɛ wo duruyɛfo adi kan abu ho akontaa pɛnkoro da biara (anaasɛ mprenu da biara) basal dose no. Esiane sɛ basal insulin a ɛyɛ adwuma kyɛ no gye ** nnɔnhwerew 2 kosi 4** ansa na ayɛ nea edi mũ wɔ aduru a edi kan koraa a wode bɛhyɛ wo mu no akyi nti, ebia nsakrae nhyehyɛe a woakyerɛw no bɛkyerɛ wo sɛ fa nnɔnhwerew 1 kosi 2 a ɛyɛ adwuma ntɛmntɛm a ɛka bom no dodow ketewaa bi ma wɔ bere pɔtee a wobɛtwa pɔmpɛ no mu sɛ wo mogya mu asikre akɔ soro dedaw a. 2. Tew basal insulin so 10% kosi 20% sɛ woreyɛ atoyerɛnkyɛm adwuma a emu yɛ duru anaasɛ woreyɛ aduan a wɔde ma a: Sɛ wode anhwea nkotoku, nantew akyirikyiri kɔ fie, anaasɛ wudi nnuan nketenkete a egye ntɛmpɛ a, ɛma insulin ho nkate kɔ soro kɛse. Di kan ka "Atoyerɛnkyɛm Dwumadie Basal Reduction" (ɛtaa yɛ 80% wɔ normal basal) ho asɛm wɔ wo krataa a woakyerɛw so. 3. Ma Rapid-Acting Insulin ansa na woadidi na woayɛ nteɛso a glucose pii wom: Fa wo ICR ne ISF formulas a woakyerɛw no di dwuma denam kyerɛwdua a ɛyɛ adwuma ntɛmntɛm anaa U-100 syringe a wɔtwe fi wo pɔmpɛ a ɛyɛ adwuma ntɛmntɛm no mu. Anyɛ yiye koraa no, twɛn ** nnɔnhwerew 3 kosi 4 wɔ nteɛso dodow ntam** na woakwati "insulin stacking" (wɔde nteɛso dodow a ɛto so abien bɛhyɛ mu ansa na tuo a atwam a ɛyɛ adwuma ntɛmntɛm no awie adwuma, a ɛma asikre a ɛba fam a ɛkyɛ kɛse ba).

Nsɛm tebea B: Wo pɔmpɛ no bubui na wowɔ wo vial/cartridge a Rapid-Acting Insulin (No Long-Acting Basal Insulin) NKUTOO .¶

Sɛ wode wo pɔmpɛ ne ne toa a insulin a ɛyɛ adwuma ntɛmntɛm (lispro, aspart, anaa glulisine) nkutoo na etu fii hɔ na wunni basal insulin a ɛyɛ adwuma bere tenten a: 1. Wubetumi atwe insulin a ɛyɛ adwuma ntɛmntɛm afi ahwehwɛ toa mu tẽẽ, plastic pɔmpɛ akorae, anaa mpo rɔba septum a ɛwɔ insulin pen a wɔtow gu ano no denam U-100 insulin syringe a wɔtaa de di dwuma so. 2. Mfa insulin a ɛyɛ adwuma ntɛmntɛm mfa nnɔnhwerew 24 basal dose a edi mũ nhyɛ mu da: Sɛ wode insulin a ɛyɛ adwuma ntɛmntɛm 20+ units gu mu prɛko pɛ a, ɛbɛma asikre a ɛwɔ nipadua mu no akɔ fam a edi awu wɔ simma 90 mu. 3. Di 3-to-4-Hour Rapid-Acting Micro-Basal Schedule akyi: Esiane sɛ insulin a ɛyɛ adwuma ntɛmntɛm di nnɔnhwerew 3 kosi 4 pɛ wɔ honam ani nti, ɛsɛ sɛ wode alarm si hɔ na wode dɔnhwerew 3 anaa nnɔnhwerew 4 fã bi gu wo basal dose no mu nnɔnhwerew 3 kosi 4 biara, nnɔnhwerew 24 da biara (a nea ɛka ho ne sɛ wobɛsɔre mprenu anadwo), ne aduan ne nteɛso dodow a wɔde ma, kosi sɛ wubedu nnurutɔnbea anaa baabi a wɔhwɛ ntɛm a insulin a ɛyɛ adwuma bere tenten wom. - Nhwɛsoɔ a ɛfiri wo kaad a woakyerɛw mu: Sɛ wo pɔmpɛ no taa infuse a 0.8 units/hour anadwo biako, nnɔnhwerew 4 nsaanodwuma ntɛmntɛm bridge dose yɛ \(0.8 \times 4 = 3.2\text{ units}\) (rounded down conservatively sɛnea wo duruyɛfo akwankyerɛ ma 3 units wɔ U-100 syringe so) a wɔde gu mu nnɔnhwerew 4 biara.

Nnafua 14 Asikreyare & CGM Atoyerɛnkyɛm Go-Bag Nhwehwɛmu Nhoma¶

Fa saa nneɛma yi gu bag a nsu ntumi nkɔ mu a wɔde sie w’anim pon nkyɛn mu:

• Laminated Written Pump-to-MDI Conversion Card ne nnuru a wɔnom nyinaa a wɔde ma nnafua 14.
• Rapid-Acting Insulin + Long-Acting Basal Insulin Backup a wɔde asie wɔ frigye mu kotoku a ɛnyɛ den sɛ wobɛfa mu, ne nsu-activated evaporative cooling wallet a ɛma insulin kɔ so tra \(15 degrees\text{C ne }30 degrees C\) (\(59 degrees\text{F kosi }86 degrees F\)) ntam kosi nnafua 28 a anyinam ahoɔden nni mu anaasɛ nsukyenee. Hwɛ insulin ne nnuru a wɔbɛma ayɛ nea ahobammɔ wom bere a anyinam ahoɔden atwa no.
• U-100 insulin syringe a ɛnyɛ ɔyare mmoawa 30 kosi 50 (0.3 mL anaasɛ 0.5 mL size) NA amansan nyinaa 4 mm pen needles 30.
• 5 kosi 7 spare pump infusion sets, reservoirs, anaa adhesive pods, ne honam ani akwanside popa ne aduruyɛ tape.
• 2 kosi 3 spare CGM sensors ne transmitter cable, ne 20,000 mAh USB power bank a charging cable a wo pump ne receiver hwehwɛ (ne spare lithium AA batteries sɛ ɛfata a).
• Amammerɛ Fingerstick Mogya Glucose Mita, afiri a wɔde bɔ lancing, batere a wɔde sika ayɛ (CR2032), ne sɔhwɛ nhama 100 wɔ wɔn ahina a wɔakata so no mu.
• Mogya Beta-Ketone Test Strips anaa Urine Ketone Strips de hwɛ sɛ Asikreyare Ketoacidosis ntɛm bere biara a glucose boro \(13.9\text{ mmol/L}\) (\(250\text{ mg/dL}\)) anaa bere a ɔyare.
• Glucagon Rescue Kits abien a ne bere atwam (nasal spray anaa nsuo auto-injector) ne 300+ grams a ɛyɛ adwuma ntɛmntɛm carbohydrates (glucose tablets, glucose gel packets, anaa ɛwo packets).
• Portable Travel Sharps Container (anaasɛ toa a wɔde hohoro nneɛma ho a ɛwɔ ɔfasuo a ɛyɛ den a wɔakyerɛw so sɛ "BIOHAZARD SHARPS").

--- .

Ɔfã 2: Hemodialysis ne peritoneal dialysis asiane ho ahosiesie¶

Ayarefo a wɔwɔ Asaabo Yare a Enni sabea a Ɛto so 5 (End-Stage Renal Disease, anaa ESRD) a wɔde wɔn ho to in-center hemodialysis, home hemodialysis, anaa da biara da peritoneal dialysis (PD) so mprɛnsa dapɛn biara no ka nnipa a wɔyɛ mmerɛw wɔ aduruyɛ mu wɔ abɔde mu asiane biara mu no ho. Nnɔnhwerew 4 mogya mu nhwehwɛmu biako pɛ no hwehwɛ sɛ wɔde nsu a ɛho tew yiye a wɔde reverse-osmosis ayɛ ho adwuma bɛyɛ lita 120 kosi 160 (galɔn 32 kosi 42) ne anyinam ahoɔden a ɛkɔ so wɔ afã abiɛsa. Sɛ ahum, asasewosow, awɔw bere mu nwini, anaa nsuyiri ma nkurow akɛse mu nsu nhyɛso anaa anyinam ahoɔden adwumayɛbea nketewa gu a, ayaresabea ahorow a wɔhwɛ ayarefo a wɔda abɔnten wɔ ɔmantam bi mu nyinaa betumi atoto bere koro mu nnɔnhwerew 48 kosi 96.

Mmara 1: Fa "Early Surge" Pre-Disaster Dialysis Nhyiam no¶

Bere biara a wɔhyɛ nkɔm sɛ ahum, ahum kɛse, anaa nsuyiri kɛse bi bɛba nnɔnhwerew 48 kosi 72 ansa na wɔadi kan ayɛ no, wɔn a wɔde dialysis ma wɔ ayaresabea no de "Early Dialysis Surge Schedules" (wɔyɛ adwuma bere tenten a wɔde nnɔnhwerew 24 yɛ adwuma de dialyze ɔyarefo biara ansa na ahum no aba asase so). - Nhuw dialysis a wɔyɛ ansa na ahum no aba da na woaboaboa nneɛma ano anaasɛ wobɛtu akɔ baabiara a wɔmmɔ wo amanneɛ: Sɛ woyɛ dialyz ansa na ahum no atu pɛɛ a, ɛma wunya nnɔnhwerew 48 kosi 72 metabolic buffer a ɛho tew a potassium sua na nsu a ɛboro so nni mu. - Sɛ wotu kɔ kuro foforɔ mu a, fa wo Printed Hemodialysis Run Sheet: "Ahɔho" dialysis beaeɛ anaa ayaresabea ntɛmpɛ dwumadibea biara a ɛwɔ wo tu a wobɛtu no hia wo pɛpɛɛpɛ Target Dry Weight (kilograms/pounds), vascular access type, heparin anticoagulation protocol, ne dialysate potassium concentration (\(1\text{K}, 2\text{K},\text{ anaa }3\text{K}\)) de dialyze wo ntɛm ara a ɛremma arrhythmias anaa hypotension mma.

Mmara 2: Tow Nnafua 3 Emergency Low-Potassium, Low-Fluid Renal Diet no mu bere a asiane bi asi no¶

Sɛ asasewosow a ɛba mpofirim, nsuyiri a ɛba ntɛmntɛm, anaasɛ anyinam ahoɔden siw wo kwan mma wuntumi nkɔ dialysis a, nea wode bɛhyɛ w’anom wɔ nnɔnhwerew 72 a edi hɔ no mu no na ɛkyerɛ sɛ wubenya nkwa. Sɛ wɔamfa asaabo mu nsu ankɔ mu a, nneɛma abien kunkum ayarefo a wɔantumi annye wɔn asaabo no ntɛmntɛm: 1. Adidi mu Potassium (K+): Ɛma mogya mu potassium boro \(6.0\text{ kosi }7.0\text{ mmol/L}\), na ɛma nan a ɛforo kɔ soro no yɛ mmerɛw na ɛma koma no gyaw mpofirim a edi awu (ventricular fibrillation anaa asystole). 2. Nsu ne Sodium (Na+): Nsu mililita biara a wobɛnom no tra wo mogya ntini mu tẽẽ, na ɛma mogya mmoroso kɔ soro kodu ɔhaw dodow na ɛma nsu (acute flash pulmonary edema) hyɛ w’ahurututu mu.

Di Asaabo Community Emergency Response (KCER), National Kidney Foundation (NKF), ne CDC 3-Day Emergency Renal Diet a ɛyɛ aban de no akyi katee kosi sɛ wobɛsan akɔ dialysis afiri so:

Mmara titiriw a wɔde ma Ayarefo a Wɔyɛ Asikreyare Dialysis (Tebea Abien no Abien a Wɔbom Di Dwuma) .¶

Ayarefo a wɔyɛ wɔn dialysis no mu bɛyɛ 40% kosi 50% nso wɔ asikreyare. Wɔ asiane bi mu no, su ahorow abien a wɔahyɛ da ayɛ no bɔ abira wɔ ɔkwan a ɛyɛ hu so: 1. MFA Orange Juice, Bananas, Chocolate, anaa Milk nni dwuma mfa nsa asikre a ɛba mogya mu (hypoglycemia) sɛ woreyɛ dialysis a: \(240\text{ mL}\) (\(8\text{ oz}\)) kuruwa biako a wɔde akutu nsu gu mu no, ɛkame ayɛ sɛ potassium \(500\text{ mg}\) ka nsu kuruwa a ɛyɛ ma. Mmom no, sa asikre a ɛba fam ( .<3.9 mmol/L anaasɛ <70 mg/dL) a wɔde glucose aduru a ɛho tew, glucose gel nsukorade, asikre a ɛyɛ den ahwiesa, ɛwo, anaa pon so asikre a wɔapete wɔ nsu tablespoon 1 mu nkutoo, a potassium zero ne nsuo a ɛnyɛ hwee wom. 2. Kwati Hard-Candy/Sugar Calorie Boosters a wɔakyerɛw wɔ adwene mu aduan a ɛnyɛ asikreyare a wɔtaa di mu no mu gye sɛ wode nsiyɛ reyɛ asikre a ɛba mogya mu yare anaasɛ wode insulin akata carbohydrates no so. Mmom no, fa ngodua ngo, canola ngo, bɔta a nkyene nnim, anaa cream cheese a nkyene nnim di dwuma wɔ krak a sodium nnim ne aburow fitaa so na ama woanya calories a ɛyɛ den a woremma mogya mu glucose anaa mogya mu potassium nkɔ soro.

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Ɔfã 3: Wo ntini a ɛkɔ ne ofie peritoneal dialysis nhyehyɛe a wobɛbɔ ho ban wɔ ɔhaw bi mu¶

1. Abasa AV Fistula / Graft ne Central Catheter Ntɛmntɛm Kit¶

Sɛnea wɔaka ho asɛm kɔ akyiri wɔ yɛn dialysis fistula mogya ne dialysis mmoa a edi kan akwankyerɛ nhoma a wɔantumi, ɛsɛ sɛ ɔyarefo biara a wɔreyɛ no mogya mu nhwehwɛmu no de ade a ɛbɔ ho ban wɔ ɔkwan a wɔfa so kɔ hɔ no kyekyere ne go-bag ho: - Pinpoint Bleed Control Supplies: Pack 3 tew plastic twitwa-off toa nkataso, sterile 10 x 10 cm (4 x 4 in) gauze squares, ne gauze pad a ɛma mogya tu. Sɛ fistula needle scab pae bere a wɔretu no a, mfa mpopaho kɛse a wɔde guare nkyekyere wo nsa no ho da; mia nsateaa biako anaa plastic toa a ɛho tew kyɛw tẽẽ wɔ tokuru a wɔde kyerɛ biribi no so simma 15 kosi 20 a ɛkɔ so bere a woma basa no so kɔ soro sen koma no na wofrɛ adwumayɛfo a wɔhwɛ ntɛmpɛ so no. - High-Visibility "NO BP / NO IV / DIALYSIS ACCESS ARM" Medical Alert Wristband: Bere a basabasayɛ wɔ dabere mu triage anaa ogye no, hyɛ aduruyɛ kɔkɔbɔ ahama kɔkɔɔ a ɛhyerɛn wɔ wo fistula basa so sɛnea ɛbɛyɛ a nnuruyɛfo a wɔboa nkurɔfo mfa mogya mmoroso cuff nhyɛ mu da anaasɛ wɔmfa IV nhama nhyɛ wo oprehyɛn nkwa nhama mu. - Central Venous Catheter (Permcath) Clamp ne Nsuo Ntumi Ntama Ntama: Sɛ wofa koko anaa kɔn mu catheter so dialyze a, fa smooth-jawed plastic vascular clamp, nsuo ntumi nkɔ transparent dressings (Tegaderm), ne kyɛw a ɛnyɛ sterile. Mma nsuyiri nsu anaa tap mu nsu a wɔannoa no nka baabi a catheter no fi mu da; sɛ catheter tubing no mu paapae anaasɛ cap bi hwe ase a, clamp anaa kink tube no ntɛm ara wɔ break ne wo koko ntam na da wo benkum so a wo ti akɔ fam na amma mframa embolism a edi awu.

2. Ofie Peritoneal Dialysis (PD) Bere a anyinam ahoɔden atwa¶

Ayarefo a wɔde automated cycler machine (APD / CCPD) di dwuma anadwo wɔ fie no betumi anya nkwa bere a anyinam ahoɔden atwa nna pii sɛ wodi kan siesie wɔn ho a: - Fa Manual Twin-Bag CAPD Supplies (Y-sets ne drain bags) nnafua 7 kɔsi 14 sie: Sɛ anyinam ahoɔden di huammɔ na wo automated night cycler no gyae adwumayɛ a, dane ntɛm ara kɔ manual gravity exchanges (Continuous Ambulatory Peritoneal Dialysis, anaa CAPD). Fa solution bag no sɛn wo mmati so na fa drainage bag no to fam petee sɛnea ɛbɛyɛ a gravity no bɛtwe nsu no na ahyɛ wo yafunu mu ma a anyinam ahoɔden nni mu. - Sɛnea wobɛma PD solution bags ayɛ hyew dwoodwoo a anyinam ahoɔden anaa microwave nni mu: Mfa PD nsu a ɛyɛ nwini te sɛ nsukyenee nhyɛ mu da, na mma PD bag mu hyew wɔ microwave mu da anaasɛ fa plastic ports no hyɛ nsu fĩ mu (a ɛde peritonitis a edi awu ba). Mmom no, fa akyi kotoku a ɛyɛ dry a wɔatoto mu no kyekyere mpopaho a ɛyɛ dry a ɛho tew ka nnuru a wɔde yɛ nsa hyew anaa nsu a ɛyɛ hyew nkotoku ho (ma nsu nyinaa ntra hyɛn gyinabea ahorow no ho), anaasɛ fa kotoku no to wo nipadua so wɔ ntama ase kosi sɛ ebedu nipadua no hyew ho (\(37 degrees C / 98.6 degrees F\)). - Waterless Hand Antisepsis: Sɛ tap nsuo wɔ boil-water notice ase anaasɛ wɔato mu a, fa 60% kɔsi 80% nsa-based hand rub hohoro wo nsa simma 60, hyɛ oprehyɛn anim akatasoɔ, na dum fans ansa na wode wo PD transfer set no abɔ mu.

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Mpɔtam hɔ ntɛmpɛ nɔma ne adwumakuw no nhyehyɛe ahorow¶

Wɔ ɔmantam mu asiane bi mu no, dialysis networks ne asikreyare nkabom ahorow de telefon a wɔde frɛ nkurɔfo a wɔatu wɔn ho ama a wontua hwee a wɔde hwehwɛ nneɛma mu no yɛ adwuma de fa ayarefo a wɔatu afi wɔn afie mu no kɔ ayaresabea ahorow a wobue, insulin a wɔde sie ntɛm ara, ne nnuruyɛbea ahorow:

• Amerika:
• Aduruyɛ mu Ntɛmntɛm: Frɛ 911.
• Kidney Community Emergency Response (KCER) Hotline: Frɛ 1-866-901-3773 na hwehwɛ ayaresabea ahorow a wɔabue mu a wɔde dialysis yɛ a wɔde bɛboa.
• Ɔman Asaabo Fapem (NKF) Mmoa Ntrɛwmu: Frɛ 1-855-NKF-CARES (1-855-653-2273) (DaVita Ntɛmntɛm Hotline: 1-800-400-8331; Fresenius Atoyerɛnkyɛm Ntrɛwmu: 1-800-626-1297).
• Asikreyare Atoyerɛnkyɛm Ho Mmuae Kuw (DDRC) & ADA: Frɛ 1-800-ASIKARE (1-800-342-2383) anaa hwɛ Akwahosan Ho Nsiesiei (RxOpen.org) ma nnurutɔnbea ahorow a wɔabue.
• Canada:
• Nneɛma a Ɛho Hia Ntɛmntɛm: Frɛ 911. Di wo mantam adwene mu nkitahodi (Kidney Foundation of Canada: 1-800-361-7494) ne Asikreyare Canada (1-800-BANTING) di nkitaho.
• Aman Nkabom:
• Nneɛma a Ɛho Hia Ntɛmntɛm: Frɛ 999 (anaa 112), anaa NHS 111 ma insulin a wɔkyerɛw ma ntɛm anaa renal unit nhyehyɛe. Di kan kyerɛw wo din wɔ wo nnwumakuw a wɔde nneɛma di dwuma no Priority Services Register (PSR) so na woanya anyinam ahoɔden ne nsu a wode bɛkɔ akɔma wo a wɔde di kan.
• Europa Aman Nkabom:
• Nneɛma a Ɛho Hia Ntɛmntɛm: Frɛ 112. Fa European Renal Association (ERA) asiane krataa ne wo European Health Insurance Card (EHIC) ka wo dialysis run krataa a wɔatintim no ho.
• Australia ne New Zealand:
• Nneɛma a Ɛho Hia Ntɛmntɛm: Frɛ 000 wɔ Australia anaa 111 wɔ New Zealand. Di nkitaho ne Kidney Health Australia (1800 454 363) anaa Kidney Health New Zealand (0800 543 639), na kyerɛw wo din sɛ Asetra mu Mmoa Adetɔfo wɔ wo anyinam ahoɔden ne nsuo adwumayɛbea.
• India ne Asia-Pacific:
• Nneɛma a Ɛho Hia: Frɛ 112 wɔ India, 119 wɔ Japan, 995 wɔ Singapore, anaa 999 wɔ Malaysia ne Hong Kong. Fa wo dialysis aduru a wɔakyerɛw, nea efii Hepatitis B, Hepatitis C, ne HIV lab mu aba nnansa yi, ne insulin nhyehyɛe no honam fam mfonini sie.

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Nsɛm a wɔtaa bisa¶

Dɛn nti na obi a ɔde insulin pɔmpɛ di dwuma ntumi ntwɛn nnɔnhwerew 12 kosi 24 kɛkɛ ansa na anyinam ahoɔden anaa pɔmpɛ a wɔde besi ananmu aba?¶

Insulin pɔmpɛ de insulin a ɛyɛ adwuma ntɛmntɛm nkutoo na ɛhyɛ mu, na eyi fi mogya no mu wɔ nnɔnhwerew 3 kosi 5 ntam. Esiane sɛ basal insulin a ɛyɛ adwuma bere tenten biara nni hɔ a wɔkora so wɔ honam ani nti, sɛ wogyae pɔmpɛ a wɔde ma no a, ɛma insulin ho yɛ na koraa wɔ nnɔnhwerew 2 kosi 3 mu. Sɛ wonni insulin a ɛwɔ akyi a, mmerɛbo no hwie glucose ne acidic ketones gu mogya no mu, na ɛkanyan Asikreyare Ketoacidosis (DKA) a ɛde nkwa to asiane mu wɔ nnɔnhwerew 4 kosi 8 mu. Ɛsɛ sɛ obiara a ɔde pɔmpɛ di dwuma no kura basal insulin a ɛyɛ adwuma bere tenten, U-100 syringes, ne nsakrae krataa a wɔakyerɛw na ama watumi ayɛ nsakrae ntɛm ara bere a pɔmpɛ bi adi huammɔ no.

So metumi de U-100 syringe a wɔtaa de di dwuma atwe insulin afi insulin kyerɛwdua anaa pɔmpɛ a wɔde tow gu mu sɛ kyerɛwdua anaa pɔmpɛ no bubu a?¶

Yiw, sɛ insulin a ɛwɔ kyerɛwdua anaa afiri no mu no yɛ U-100 dodow a wɔahyɛ da ayɛ (100 units wɔ mililita biara mu) a. Sɛ insulin kyerɛwdua bi siw anaasɛ pɔmpɛ bi bubu na wunni kyerɛwdua nnade anaa infusion set biara a, fa nsa srasra rɔba septum a ɛwɔ U-100 pen anaa cartridge no ano no, fa U-100 insulin syringe needle a wɔtaa de di dwuma no hyɛ membrane no mu, na twe wo unit dose no pɛpɛɛpɛ. Mma ntwe insulin a wɔahyɛ no den (U-200, U-300, anaa U-500) nkɔ U-100 syringe mu da a oduruyɛfo mfa akwankyerɛ mma sɛ wɔbɛsakra no.

Dɛn nti na nnuru a wɔde si nkyene ananmu a wɔde potassium ayɛ (te sɛ NoSalt anaa Lite Salt) kunkum ayarefo a wɔyɛ wɔn dialysis bere a asiane bi asi no?¶

Nneɛma pii a wɔde si "sodium a ɛba fam" a wɔtɔn no ananmu de potassium chloride kronkron si sodium chloride ananmu. Potassium chloride nkyene a wɔde si ananmu teaspoon biako mu no, potassium miligram 2,500 kosi 2,800 na ɛkame ayɛ sɛ ɛboro asiane dodow a ɛyɛ miligram 1,500 da biara da nyinaa mmɔho abien ma ɔyarefo a wɔde anuric hemodialysis di dwuma no. Sɛ obi di potassium nkyene ananmu bere a wɔakyɛ wɔ dialysis mu a, ebetumi ama serum potassium akɔ soro aboro 6.5 mmol/L wɔ nnɔnhwerew biako mu na ama koma no agyae mpofirim.

Ɔkwan bɛn so na ɛsɛ sɛ obi a ɔwɔ asikreyare ne n’asaabo a entumi nyɛ adwuma yiye wɔ dialysis mu no sa asikre a ɛba fam wɔ mogya mu (hypoglycemia)?¶

Mfa akutu nsu, banana, nufusu, anaa chocolate nni dwuma da mfa nsa asikre a ɛba fam sɛ woreyɛ dialysis a, efisɛ potassium ne nsu a ɛyɛ hu ahyɛ akutu nsu ne banana mu ma. Mmom no, di "Mmara a ɛwɔ 15" no akyi denam carbohydrate a ɛho tew a potassium nnim a ɛyɛ adwuma ntɛmntɛm gram 15 so: we glucose aduru a ɛho tew 3 kosi 4, pia glucose gel tube 1, mene ɛwo anaa asikre a ɛwɔ pon so tablespoon 1, anaa nufu asikre a ɛyɛ den a ɛyɛ ahwiesa, afei san hwɛ wo mogya mu glucose mu wɔ simma 15 mu.

Nwoma bɛn na ayaresabea ahorow a wɔyɛ ahɔho a wɔde wɔn ho hyɛ mu no hwehwɛ ansa na wɔasa ɔyarefo a wɔatu no yare no yare?¶

Ntɛmntɛm backup dialysis mmeae hia wo Hemodialysis Ayaresa Krataa ("Run Sheet") a wɔatintim a ɛkyerɛkyerɛ wo botae dry weight, dialyzer nhwɛso, mogya ne dialysate flow rates, potassium ne calcium aguare dodow, heparin dodow, mprempren nnuru list, ne nnansa yi Hepatitis B, Hepatitis C, ne HIV lab lab aba. Sɛ wode laminated copy sie wo go-bag mu a, ɛmma triage nkyɛ.

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Akwankyerɛ ahorow a ɛfa ho¶

• Insulin ne nnuru a ɛma ɔhyew te a wɔbɛma ayɛ nea ahobammɔ wom bere a anyinam ahoɔden atwa
• Dialysis fistula mogya (bottle-cap protocol) ne dialysis hyperkalemia ntɛmpɛ a wɔantumi
• Asikreyare ketoacidosis (DKA) ne hyperosmolar hyperglycemic tebea
• Ahosiesie a wɔyɛ ntɛm ma nnipa a wɔadi dɛm ne ayaresa ahiade

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Fibea ne aban akwankyerɛ¶

• Kidney Community Emergency Response (KCER) & Centers for Disease Control and Prevention (CDC, United States): Ahosiesie ma Ntɛmntɛm: Akwankyerɛ ma Nnipa wɔ Dialysis ho (CMS Pub. No. 10150, 3-Day Emergency Renal Diet and Run Sheet Protocol).
• Ɔman Asaabo Fapem (NKF, United States) & UK Asaabo Fekuw (UKKA): Nhyehyɛe a wɔyɛ ma tebea horow a egye ntɛmpɛ: Asaabo mu yare a enni sabea ne Hemodialysis Access Control.
• Asikreyare Atoyerɛnkyɛm Ho Mmuae Kuw (DDRC), Amerika Asikreyare Fekuw (ADA), & Endocrine Society: Asikreyare Atoyerɛnkyɛm Ho Ahosiesie Ho Ɔyarefo Nhyehyɛe ne Nsakrae Fi Insulin Pɔmpɛ so Kɔ Daa Nnuru Pii (MDI).
• United States Aduan ne Nnuru Dwumadibea (FDA): Insulin Pɔmpɛ ne Glucose Monitor a Ɛkɔ So Ahobammɔ Wɔ Atoyerɛnkyɛm Bere Mu.
• Amanaman Ntam Fekuo a ɛhwɛ Peritoneal Dialysis so (ISPD): ISPD Akwankyerɛ a ɛfa Peritoneal Dialysis Nyarewa a Wɔsiw ano ne Atoyerɛnkyɛm Nsesa ho.