Jinin Fistula Dialysis (Tsarin Kwalba-Cap) da Abubuwan Gaggawa na Dialysis da aka rasa.¶

Ga mutumin da ke karɓar hemodialysis na kulawa don gazawar koda (Ƙarshen-Stage Renal Disease, ko ESRD), ** arteriovenous (AV) fistula, AV graft, ko tsakiyar venous dialysis catheter ** shine rayuwar su ta jiki, amma kuma babban matsi ne na jijiyoyin bugun jini wanda zai iya haifar da bugun jini mai saurin mutuwa a cikin ƙasa da mintuna 5. fita. Wani balagagge AV fistula kai tsaye yana haɗa jijiya zuwa wata jijiya a hannu, yana ɗauke da \(600\rubutu zuwa }2,000\rubutu{mililita}\) A lokaci guda, bacewar ko da daya ko biyu zaman hemodialysis (lokacin guguwa, rashin wutar lantarki, ko rashin lafiya) yana haifar da kisa cikin sauri guda biyu: ** hyperkalemia mai barazana ga rayuwa (mai guba na jini mai guba) wanda zai iya dakatar da zuciya ba tare da gargadi ba, da ** matsanancin uremic fluid (flash pulmonary edema)** wanda ke mamaye huhu. Taimakon farko yana buƙatar gwaninta Matsayin yatsa ɗaya / kwalabe-kwalba (kada a taɓa nannade babban tawul mai girma a kusa da yoyon fitsari), kare hannun dialysis daga cuffs ɗin jini ko yawon shakatawa, da sanin raunin hyperkalemia da wuri kafin kama bugun zuciya.

Yi wannan yanzu¶

1. Don ciwon yoyon fitsari na AV na jini: Danna yatsa DAYA ko hular roba mai tsabta kai tsaye a kan ramin da aka nuna nan da nan. Kada a bata dakika 10 neman bandeji. Sanya babban yatsan yatsan yatsa ko madaidaici (ko ƙaramin gauze murabba'i / hular kwalban filastik) ** kai tsaye a saman ainihin ramin huɗar allura ko ulser** inda jini ke tsirowa. Aiwatar da ƙarfi, mai da hankali ƙasa, isa kawai don dakatar da zubar da jini yayin da har yanzu kuna jin girgizar ƙarar jini ("mai ban sha'awa") na jini yana gudana ta fistula ƙarƙashin yatsan ku, kuma riƙe shi ci gaba ba tare da leƙon minti 15 zuwa 20 ba**.
2. Kira lambar gaggawa ta gida nan da nan akan lasifika kuma ɗaga hannu sama da matakin zuciya. Kira lamba 911 a Amurka da Kanada, 112 a cikin Tarayyar Turai, 999 a Burtaniya, ko duba duka. lambobin gaggawa. A sa majiyyaci kwana bayansa a kasa ko gado (don kada su suma su cire hannunsu daga yatsan ka) sannan su rike hannun na jini* ya daukaka sama da matakin zuciyarsa**. Ko da madaidaicin zubar jini ya tsaya bayan mintuna 15 a gida, ** duk wani busa-busa na bayan-dialysis ko fashewar scab dole ne a kimanta shi a cikin Sashen Gaggawa**, kamar yadda bangon anerysm na bakin ciki (pseudoaneurysm) zai iya fashewa da mutuwa yayin barci bayan 'yan sa'o'i.
3. Kada a shafa yawon shakatawa sai dai idan majiyyaci yana mutuwa sakamakon zubar jini da ba a iya sarrafa shi ba kuma matsa lamba kai tsaye ya kasa cikawa. Duk da haka, "Rayuwa ta zo gaban gagarawa ko yoyon fitsari": idan ciwon yoyon fitsari ya fashe a fili kuma matsa lamba ba zai iya sarrafa zubar jini na jini mai barazana ga rayuwa ba. gigice, shafa yawon shakatawa na iska ** sama (kusanci zuwa)* yoyon fitsari a kafada don ceton ran majiyyaci (duba zub da jini).
4. **Domin katsewa ko kuma wanda ba a rufe ba (Permcath / Vas-Cath a ƙirji ko wuyansa): Maƙale bututun kuma kwantar da mara lafiya a gefen hagun nan da nan.
5. Nan da nan ** tsunkule bututun catheter tare da yatsun hannunka** (ko ƙwace matsin filastik a kan catheter a rufe, ko ninka/kink ɗin bututun da kyau cikin rabi).
6. Kwanta mara lafiya ** lebur a gefen hagunsu tare da karkatar da kansu kadan ƙasa ** (** Matsayin Durant's / hagu na gefen Trendelenburg ***) don kama duk wani kumfa na iska lafiya a cikin madaidaicin atrium daga huhu, kuma kira 911/112/999.
7. Don majinyacin dialysis da aka rasa tare da raunin ƙafar ƙafa kwatsam, ƙumburi, jinkirin bugun jini, ko alamun ƙirji: Kira 911 / 112/999 don "Hyperkalemia da ake zargi." Lokacin da potassium ya tashi sama da \(6.5 rubutu zuwa } 7.0\rubu {mmol/L}\) ($ mEq/L$) bayan rashin lafiyar tsokar wutar lantarki. Kada a bar mara lafiya ya ci ko ya sha wani abu, kuma ya nemi likitocin gaggawa tare da ** 12-lead ECG da calcium gluconate / calcium chloride**.
8. **Ga majinyacin dialysis da aka rasa yana haki don iskar da ruwa mai yawa: Zauna su tsaye a 90 digiri tare da kafafu suna rawaya. Zaune tsaye tare da rataye kafafun ruwa mai yawa a cikin ƙafafu nesa da huhu yayin da motar asibiti ta garzaya da su zuwa ga aikin haemodialysis na gaggawa.

Bishiyar yanke hukunci na rikicin gaggawa da dialysis¶

Yi amfani da wannan taswirar hanyar asibiti don ba da amsa ga duk wani gaggawar samun jijiyar jini ko rikicin rayuwa a cikin majinyacin hemodialysis ko peritoneal dialysis.

flowchart TD
    Start["Gaggawa a cikin Marasa lafiyan Diyalysis (Hemodialysis AV Fistula, Graft, Catheter, <br/> ko Zama da aka rasa)"] --> CrisisType{"Menene gaggawa ta farko a yanzu?"}

    CrisisType -->|"1. Zubar da jini daga Hannu AV Fistula ko Graft"| FistulaBleed["HANYAR HANYAR CIWON JINI:<br/>1. Latsa YATSA DAYA ko KULLA kai tsaye a kan rami mai ma'ana <br/> (KADA ku taɓa tawul ɗin wanka mai girma a hannu) <br/>2. Kwanciya mara lafiya lebur; daga hannu sama sama da matakin zuciya<br/>3. Kira 911 / 112 / 999 akan lasifikar murya<br/>4. Riƙe matsi mara karye 15-20 mins (BABU KYAU)<br/>5. Je zuwa ER don duban Tiyatar Jijiyoyin Jini koda jinin ya tsaya"]

    CrisisType -->|"2. Buɗewa, Fasasshiya, Ko Ƙirji/Katatar Wuya Mai Jini"| CathEmerg["GAGGAWA TA TSAKIYA: <br/>(Hadarin Ciwon Jiki da Jini)<br/>1. Matsa filastik zamewar matsi KO kink/ tsunkule bututu tam<br/> (Make tsakanin tsaga/budewar ƙarshen da kirjin mara lafiya) <br/>2. Rufe cibiya tare da bakararre gauze; KADA a yi amfani da almakashi kusa da bututu <br/>3. Kwanta haƙuri a gefen hagu tare da ƙasa da kai idan iska ta tsotse a cikin<br/>4. Kira 911/112/999 Nan take"]

    CrisisType -->|"3. An rasa Dialysis + Ƙafafu masu nauyi/Rauni, <br/> Lebe/Yatsu masu Tingling, Slow/Pulse mara daidaituwa"| HyperK["HYPERKALEMIA MAI BARAZANAR RAYUWA (Babban Potassium):<br/>1. Kira 911 / 112 / 999: Bayyana 'Masu fama da Ciwon Jiki tare da Hyperkalemia'<br/>2. Nemi motar asibiti ta ALS don 12-Lead ECG + IV Calcium Ceto<br/>3. Madaidaicin NPO (Abinci / ruwan 'ya'yan itace Zero); Ɗauki Binder Resin Gaggawa KAWAI<br/> idan a farke kuma an ba da izini a sarari a Tsarin Ayyukan Bala'i"]

    CrisisType -->|"4. An rasa Dialysis + Gas ɗin iska,<br/>Tari mai ruwan hoda, Ba za a iya Kwanta ba"| FluidOverload["FLASH EDEMA (Matsalar Ruwan Ruwa): <br/>1. Kira 911 / 112 / 999 Nan da nan<br/>2. Zauna majiyyaci BOLT KYAU (digiri 90) da ƙafafu suna rawa ƙasa<br/>3. Gudanar da iskar oxygen / sublingual nitroglycerin idan an umarce shi"]

    CrisisType -->|"5. Zazzabi/Ciwon Ciki + Jan Katheter KO <br/>Jakar Ciwon Ciki"| DialSepsis["CATHETER SEPSIS KO PD PERITONITIS: <br/> Sashen Gaggawa YANZU don Al'adun Ruwan Jini/PD da kuma Magungunan rigakafi na Ciki ko Intraperitoneal na gaggawa"]

Sashe na 1: Dakatar da AV Fistula mai Barazana Rayuwa ko Jini (Pinpoint Finger & Bottle-Cap Protocol)¶

Me yasa Fistulas Dintal ke zubar da jini da tashin hankali (kuma me yasa Scabs masu sheki ke zama bama-bamai na lokaci)¶

A lokacin hemodialysis sau uku a mako, manyan-bore \(14\ rubutu-zuwa 16\rubutu{-gauge}\) ana saka allura a cikin fistula na majiyyaci ** arteriovenous (AV) fistula** (jini na asali wanda aka dinka kai tsaye zuwa jijiya a cikin wuyan hannu ko babba hannu) ko ** AVthe filastik haɗe da majiyyaci artery da PT. ana ba da sinadarin heparin* don haka jininsu baya toshewa a cikin injin dialysis.

Nau'i biyu na zubar da jini na yoyon fitsari na faruwa a wajen asibitin: 1. Sake Jin Jini na Farko Bayan-Dialysis (Hoto na Farko 1 zuwa 6 Gida): Bayan barin cibiyar dialysis, filogin platelet ɗin da ke rufe ɗaya daga cikin ramukan huda allura guda biyu ya ɓace lokacin da majiyyaci ya ɗaga kayan abinci, ya lanƙwasa hannu, tari, ko bazata ya ci karo da tef ɗin a cikin jini har yanzu. 2. Late Spontaneous Aneurysm / Pseudoaneurysm Rupture (The "Shiny Black Scab" Gaggawa): Sama da watanni ko shekaru na maimaita buƙata a wuri guda, bangon fistula ko daskarewa na iya shimfiɗawa zuwa cikin ɓarna ** anerysm ko pseudoaneurysm ***. Idan fatar da ke saman wannan kumburin ta zama tabbatu-bakar-bariya, matsewa, mai sheki, ta baci, ja, ko kuma ta samu bakar baki (eschar) mai duhu wanda ba ya warkewa har tsawon makonni, bangon jijiya na jijiya yana gushewa ta fata. Idan wannan baƙar fata ta faɗo a cikin shawa ko kuma ta fashe yayin barci, ginshiƙi mai matsa lamba na jets na jini a cikin ɗakin.

Mataki-mataki: Hanyar Finger-Finger da Bottle-Cap¶

Bi ƙa'idar samun damar zubar jini na hukuma ta ** National Kidney Foundation (NKF)**, Kidney Care UK / UK Kidney Association, da Vascular Access Society:

1. Bayar da Daidaitaccen Ramin (Tare da Tawul ɗin Jini Masu Jiki):
2. Ba za ku iya dakatar da jirgin sama mai ɗaukar nauyi ba idan kuna latsawa a makance akan tulin rigar masana'anta. Dubi fatar yoyon fitsari kai tsaye don nemo ainihin \(1\ rubutu- zuwa }3\rubu{-millimeter}\) inda jini ke fita.
3. ** Aiwatar da Matsa Matsi da Yatsa DAYA, Babban Yatsan Yatsa, ko Tsaftace Rigar kwalbar Filastik:**
4. Zaɓi A (Yatsa / Babban Yatsan Yatsa): Ninka ƙaramin gauze mara kyau guda ɗaya (ko amfani da babban yatsan yatsan yatsa mara kyau idan babu gauze ɗin da yake isa gareshi) sannan danna ** tsaye ƙasa kai tsaye saman ramin nuna alama **.
5. Zaɓi na B (Tsaftataccen Filastik Bottle-Cap Technique): Yawancin rukunin dialysis suna ba wa marasa lafiya ƙwararriyar Fistula Clamp ko koyar da Tsaftataccen Tsarin kwalban kwalban (ta amfani da madaidaicin madaidaicin murɗa daga kwalban ruwa ko soda, ko gaggawa * HemCon / Celox* pad hemostatic):
   • Danna madaidaicin hular kwalban kai tsaye akan ƙaramin gauze pad akan wurin huda yana mai da hankali sosai, matsa lamba iri ɗaya a kusa da zoben \(2\rubu{-centimeter}\) na lahani ba tare da murkushe duk faɗin hannu ba, kuma yana rage gajiyar yatsa yayin jiran mintuna 15 don motar asibiti.
   • (Lura: Koyaushe zauna tare da majiyyaci kuma ka riƙe hular kwalbar ko yatsa a hankali a wurin da hannu; kar a taɓa maƙarƙashiyar hular kusa da kewayen hannu sannan ka tafi, saboda zubar jini na iya bi ta gefe a ƙarƙashin fata zuwa wani babban hematoma idan hular ta zame daga tsakiya.)
6. ** Kaddamar da Matsi naka ("Dakatar da Jini, Ci gaba da Farin Ciki"):**
7. Danna sosai cewa jinin sifili yana fita daga ƙarƙashin yatsan ka.
8. Idan za ta yiwu, danna sosai don rufe ramin da ke saman bangon yoyon fitsari ba tare da rufe bangon ƙasa gaba ɗaya ba: da kyau har yanzu kuna jin motsin motsin motsi (** abin burgewa ***) ƙarƙashin yatsanku. Amma idan jini yaci gaba da fita sai a dage sosai har sai duk jinin ya tsaya,domin dakatar da zubar jini yana zuwa farko.
9. Ka Sanya Mara lafiya Lebur A Bayansu Ka Daga Hannu:
10. Ka sa majiyyaci ya kwanta a ƙasa ko kujera nan da nan. Rashin saurin jini yana haifar da suma kwatsam (vasovagal ko syncope hemorrhagic); idan majiyyaci yana tsaye a wurin wankan wanka lokacin da suka suma, za su ƙwace hannunsu daga hannunka kuma su buga kai.
11. Ɗaga hannun dialysis ** sama da matakin zuciya *** don rage venous da matsi na hydrostatic a cikin fistula.
12. ** Rike Matsi mara karye na tsawon mintuna 15 zuwa 20 (Kada Ka Kallo da wuri):**
13. Dubi agogo. Rike yatsan ka a wuri na akalla ** 15 zuwa 20 mintuna masu ci gaba ** har sai ma'aikatan lafiya sun zo kuma su dauki nauyin.
14. Kimanin Asibitin Tilas Koda Jini Ya Tsaya Gaba Daya:
15. Kar a taɓa soke motar asibiti ko zama a gida bayan zubar jini na yoyon fitsari kwatsam ya tsaya. Idan pseudoaneurysm mai sirara ko kamuwa da cuta ya haifar da zubar jini, gudan jini mai rauni da aka samu a ƙarƙashin yatsanka akai-akai yana sake busa bayan sa'o'i 2 tare da zubar da jini mai mutuwa. Dole ne likitan tiyata na jijiyoyin jini ya kimanta samun dama nan da nan don bitar aikin tiyata, sanya stent-graft, ko ligation.

Alamomin faɗakarwa na Rupwar Fistula mai zuwa (Lokacin da za a je wurin ER Kafin Ya Zuba jini)¶

Duba dialysis AV fistula ko graft kowace rana. Jeka Sashen Gaggawa ko kuma a kira Likitan Likitan Ruwan Jiki a wannan rana (kafin ya fashe) idan ka ga daya daga cikin wadannan guda biyar "Tsarin Jajayen Tutoci":

"Dokoki Uku Ba Su Taba" Don Kare Hannun Samun Damagarin Diya¶

Don kiyaye yoyon fitsari daga tarwatsewa ko toshewa yayin kowane yanayi na likita ko taimakon farko: - KADA KA Ɗauki karatun hawan jini a hannu tare da yunƙurin AV ko ƙugiya (kuma kar a taɓa ɗaukar BP akan hannu inda aka shirya yoyon fitsari na gaba). - KADA KA ƊAN JININ jini ko fara layin intravenous (IV) a cikin hannun dama na dialysis. - KADA KA ƙyale ɗorawa, rigunan hannu na roba, jakunkuna, jakunkuna, kayan abinci, ko barci tare da ɗaga kai akan wannan hannu.

Sashe na 2: Gaggawa na Gaggawa na Dialysis: Hyperkalemia da ƙoshin huhu na huhu¶

Lafiyayyan koda tana tace ** lita 150 zuwa 180 na jini a kullum**, tana fitar da abinci mai yawa potassium (\(K^+\)), ruwa, sodium, acid,* da uremic poisons*. Marasa lafiyan hemodialysis wanda ke yin fitsari kadan ko babu (anuric) ya dogara kacokan akan zaman sa'o'i 4 da zasu yi na wankin fitsari sau uku a mako (Litinin/Laraba/Juma'a ko Talata/Alhamis/Asabar). Lokacin da majiyyaci ya ɓace ko da ** zaman guda ɗaya ko biyu na dialysis ** (ko kuma yayin doguwar tazarar sa'o'i 72 na ƙarshen mako tsakanin Juma'a/Asabar da Litinin/Talata), lamurra guda biyu masu barazanar rayuwa suna tasowa cikin sauri:

1. Hyperkalemia mai Barazana Rayuwa (Babban Potassium na Jini, “Mai Tsayawa Zuciya Silent”)¶

Potassium na jini na al'ada yana kulle sosai tsakanin \(3.5\rubutu{ da }5.0\rubutu{ mmol/L}\) (\(mEq/L\)). Lokacin da potassium ya haura sama da ** $ 6.0 rubutu zuwa } 6.5 rubutu mmol/L}$** bayan zaman dialysis da aka rasa (ko bayan cin abinci mai girma-potassium, raunin nama, zubar da jini na gastrointestinal, ko ɗaukar ACE inhibitors / spironolactone / NSAIDs), yana lalata wutar lantarki mai hutawa na ƙwayoyin tsoka da ƙwayoyin tsoka na zuciya (**).

** Me yasa Hyperkalemia Yayi Haɗari:** Ba kamar yawancin cututtuka ba, ** hyperkalemia na iya haifar da kamawar zuciya na kwatsam (sine-wave ventricular fibrillation ko asystole) ba tare da gargadin farko ba**, ko kuma yana iya kwaikwayi gaggawar jijiya kamar ciwon Guillain-Barre: - Alamomin Gargaɗi na Farko Neuromuscular (Yawanci Ba a Rasa): - ** Tingling ko "pins da allura" (paresthesias)** kewaye da lebe, harshe, hannaye, da ƙafafu. - Rauni mai nauyi na hawan ƙafa da sauri (Hyperkalemic Flaccid Paralysis): Mara lafiya ba zato ba tsammani ya ji ƙafafu "an yi su da gubar," ba za su iya tashi daga kujera ko gado ba, kuma rauni yana hawa zuwa gangar jikin da hannaye. - Tsananin tashin zuciya, amai, ko ciwon ciki. - Alamomin Gargadin Zuciya: - Rashin jinkirin zuciya kwatsam (bradycardia), tsallake bugun zuciya, bugun zuciya, amai, ko suma. - Akan ECG ** 12-lead na ma'aikatan lafiya, haɓakar potassium yana haifar da ci gaba mai mahimmanci: ** tsayi, tent "T-waves"** $\madaidaicin $ lallausan / raƙuman P-waves da tsawan lokaci PR tazara $ madaidaiciyar tazara $ ** faɗaɗa hadaddun QRS** $ madaidaiciyar madaidaiciyar madaidaiciyar madaidaiciyar madaidaiciyar madaidaiciyar madaidaiciyar madaidaiciyar hanya"

Yadda Ma'aikatan Lafiya da Asibitoci ke Ceci Marasa lafiya Mai Haɓakawa cikin Mintuna: Lokacin da kuka gaya wa mai aikawa 911/112/999 "Majinyacin dialysis wanda ya rasa magani tare da raunin ƙafa da ake zargi da hyperkalemia," ma'aikatan lafiya da likitocin gaggawa suna aiwatar da tsarin ceton rayuwa mai matakai uku: 1. Tabbatar da tsokar zuciya a cikin mintuna 1 zuwa 3: Intravenous ** Calcium Gluconate (\(10\%\), \(10\text{ to }30\text{ mL}\))** ko ** Calcium Chloride** baya rage potassium a cikin jini, amma* nan take yana kare tsokar zuciya a cikin dakika 6. 2. Shift Potassium Ciki Kwayoyin Cikin Minti 15 zuwa 30: Ciki ** Insulin na yau da kullun (\(10\rubutu{raka'a}\)) wanda aka haɗa tare da dextrose na ciki (glucose), babban adadin nebulized ** albuterol (salbutamol, $10 \rubutu, \(10 ** rubutu* zuwa 20\) intravenous) bicarbonate *** (idan acidic) yana fitar da potassium daga cikin jini ya koma cikin kwayoyin jikin dan lokaci. 3. ** Cire Potassium Din-din-din daga Jiki:** Abubuwan haɗin potassium na gastrointestinal na baka (** sodium zirconium cyclosilicate [Lokelma], patiromer [Veltassa], ko sodium polystyrene sulfonate [Kayexalate]**) da ** gaggawar hemodialysis *** (maganin tabbatacce).

2. Maɗaukakin Ruwa mai Mutuwa (Flash Pulmonary Edema) da Uremic Pericarditis¶

Ba tare da fitowar fitsarin koda ba, kowane kofi na ruwa, miya, kankara, ko 'ya'yan itace da majinyacin dialysis ke cinyewa yana tsayawa kai tsaye a cikin jini da kyallen jikinsu. Bayan an rasa maganin dialysis na 1 zuwa 2, lita 3 zuwa 6 na ruwa mai yawa zai iya komawa cikin huhu (** m cardiogenic/volume pulmonary edema*) da kuma kewayen zuciya (uremic pericarditis / cardiac tamponade): - Alamomin Filashin huhu: - Matsananciyar ƙarancin numfashi wanda ke sa ya zama ** rashin yiwuwar kwanciya kwance akan gado (orthopnea). - Haki don iska, huci ("asthma na zuciya"), gurgujewa ko sautin numfashi, da tarin ruwan hoda, sputum mai kumfa. - Ƙunƙarar kumburi ( edema**) a cikin idon sawu, ƙafafu, ƙasan baya, da kewayen idanu, haɗe tare da hawan jini yakan wuce \(180/110\rubutu{mmHg}\). - ** Alamomin Uremic Pericarditis:** - Kaifi, ciwon ƙirji a bayan ƙashin ƙirji wanda yana yin muni yayin kwanciya a bayansa kuma yana inganta lokacin zaune da jingina gaba. - ** Matsayin Taimakon Farko na Gaggawa don Kiwanyar Ruwa:** - Zauna majinyacin a tsaye a kusurwar digiri 90 tare da kafafu biyu suna rataye a gefen gado ko kujera. Gravity yana riƙe da kusan \(500\text{ zuwa }800\text{ milliliters}\) na jini mai jijiyoyi a cikin ƙananan ƙafafu maimakon barinsa ya shiga cikin cunkoson huhu. - Kada ka ɗaga ƙafafu na majinyacin dialysis mai ɗauke da ruwa, kuma ka riƙe duk abin ruwa na baka yayin jiran motar asibiti.

Rayuwar Bala'i: "Ranana 3-Rana na Potassium, Abincin Gaggawa Mai Ƙuntatawar Ruwa"¶

A lokacin guguwa, ambaliya, blizzards, ko baƙar wutar lantarki lokacin da aka rufe asibitocin dialysis na ɗan lokaci na tsawon sa'o'i 48 zuwa 72, bin ** National Kidney Foundation (NKF) da Cibiyoyin Kula da Cututtuka (CDC) "Ranana 3 na Ciwon Gaggawa na Renal"** yana riƙe da potassium da ruwan huhu a cikin matakan rayuwa har sai an dawo da matakan dialysis.

Abubuwan gaggawa na musamman a cikin marasa lafiya na Peritoneal Dialysis (PD): Jakar Girgiza Peritonitis¶

Marasa lafiyan da ke yin Peritoneal Dialysis (PD) a gida ta amfani da catheter mai laushi na silicone a cikin cikin su (** Tenckhoff catheter**) suna fuskantar wani yanayi na musamman da ake kira PD Peritonitis: - Yadda ake gane shi nan da nan: Duba cikin buhun magudanar ruwa na filastik bayan kowane musayar. A al'ada, magudanar ruwan dialysis na peritoneal (** datti*) yana kama da kyan gani kamar kodadde rawaya (ya kamata ku iya karanta buga jarida a fili ta cikin cikakkiyar jaka). Idan ruwan da ya zube ya yi kama da gajimare, madara, hamma ko ruwan hoda, KO kuma idan majiyyaci ya kamu da ciwon ciki, taushi, tashin zuciya, ko zazzabi, sai a dauka Acute Bacterial Peritonitis. - Mataki na Gaggawa: 1. Ajiye jakar magudanar ruwa (kulle ta ku tafi da ita asibiti ko asibitin PD don ma'aikatan jinya su iya zana ruwa kai tsaye daga jakar don ƙididdigar ƙwayoyin cuta da al'adun ƙwayoyin cuta). 2. Kira likitan ku na awa 24 na Peritoneal Dialysis Nurse / Kiran Nephrologist ko ku je Sashen Gaggawa nan da nan don intrapereritoneal (IP) ko maganin rigakafi na jijiya. 3. ** Idan PD catheter da gangan ya yanke ko saitin canja wuri ya rabu da tsabta ko cikin datti:** Nan da nan danna farar filastik **Beta-Clamp ** (ko tsunkule / kink mai laushi mai laushi mai laushi tsakanin hutu da fata na ciki), rufe ƙarshen budewa tare da gauze maras kyau, ** kada ku zubar da ruwa a cikin bututun buɗaɗɗen buɗaɗɗen PD don gaggawa naúrar. adaftar / canja wuri-saitin canji da prophylactic maganin rigakafi.

Madaidaicin rubutun sadarwa na 911/112/999 da Triage na Asibiti¶

• Don AV Fistula ko Jini:

  • "Ina buƙatar motar gaggawa ta gaggawa a [Adireshin Daidaita]. Mara lafiya mai ciwon hemodialysis ne wanda hannunsa AV [fistula / graft] ya fashe kuma yana zubar da jini sosai. Ina riƙe da matsi mai yatsa kai tsaye a kan wurin allura, sun kwantar da majiyyaci, kuma sun ɗaga hannu sama da zuciya. Muna buƙatar ci gaba na tallafin rayuwa zuwa asibiti tare da jijiyoyin jini. "*

• Don Majinyacin Dialysis da aka rasa wanda ake zargin Hyperkalemia ko Ruwan Ruwa:

  *"Ina buƙatar motar asibiti ta gaggawa a [Adireshin Daidai] don majinyacin hemodialysis wanda zaman sa na ƙarshe ya kasance [X] kwanakin da suka gabata a ranar [Ranar] [Ya / She] yanzu yana da [ƙananan rauni na ƙafa da tingling / jinkirin bugun jini / matsanancin ƙarancin numfashi kuma ba zai iya kwance ba]. 12-gubar ECG da ba da sinadarin calcium gluconate a cikin jijiya kai tsaye."

Lissafin jeri na jeka na gaggawa na majiyyaci¶

• ** Kwafi na sabon takaddar Maganin Hemodialysis ɗinku ("Run Sheet"):** Yana Nuna ** Busassun Nauyinku (nauyin manufa)**, girman tace dializer, adadin jinin jini, dialysate potassium bath maida hankali, da maganin heparin don haka kowane asibiti na gaggawa zai iya yi muku dilyse lafiya.
• ** 2 zuwa 3 tsaftataccen kwalban kwalban filastik, bakararre $ 4 times4$ gauze pads, da kushin hemostatic na kasuwanci (ChitoGauze / Celox)** a cikin aljihunka ko jaka a kowane lokaci.
• Matsi mai santsi mai santsi mai laushi (catheter clamp) idan kana da kirji ko wuyan Permcath, ko farar Beta-Clamp idan kana kan Peritoneal Dialysis.
• ** Samar da gaggawa na kwanaki 3 na fakitin dauri mai raguwar potassium da aka tsara** (sodium zirconium cyclosilicate [Lokelma] ko patiromer [Veltassa]) da masu ɗaure phosphate.

Tambayoyin da ake yawan yi¶

Me yasa sanya tawul a kusa da fistula na dialysis na jini yana sa marasa lafiya su zubar da jini har ya mutu?¶

Fistula ta arteriovenous (AV) tana ɗaukar jinin jijiya a ƙarƙashin matsin lamba a 600 zuwa 2,000 milliliters a minti daya ta wani ɗan ƙaramin rami mai tsawon milimita 1 zuwa 2 a cikin fata. Kunna tawul mai kauri mai kauri a hannu yana ɓoye wurin zubar jini daga gani kuma yana watsa matsa lamba a raunata a kan faffadan wuri maimakon rufe ƙaramin rami. A cikin minti 3 zuwa 5, majiyyaci na iya rasa rabin adadin jininsu a cikin tawul kuma ya sami kamawar zuciya. Koyaushe kalli raunin kai tsaye kuma danna kan yatsa DAYA, babban yatsa, ko hular kwalbar filastik mai tsabta kai tsaye a kan ainihin ramin na tsawon mintuna 15 zuwa 20 masu ci gaba.

Idan fistula na dialysis na jini ya daina zubar jini bayan mintuna 15 na matsawar yatsa a gida, me yasa har yanzu ina bukatar zuwa dakin gaggawa?¶

Zubar da jini na kwatsam daga ƙwanƙolin ƙwanƙwasa ƙwanƙwasa ko ƙwanƙwasa a wajen asibiti ana yawan haifar da shi ta hanyar ɓata lokaci da yashewar bangon jijiya mai tushe ko kamuwa da cuta ta jirgin ruwa. Ko da gudan jini na wucin gadi ya rufe ramin da ke ƙarƙashin yatsan ku, matsananciyar jijiya a cikin fistula akai-akai yana busa wanda ke toshewa bayan ƴan sa'o'i, sau da yawa yayin da majiyyaci ke barci a gado. Kowane jini na yoyon fitsari na gida dole ne a duba shi nan da nan a cikin sashin gaggawa ta wurin ƙwararren jijiyoyi.

Ta yaya zan iya sanin idan mutumin da ya rasa lokacin aikin dialysis yana da haɗari mai girma potassium (hyperkalemia)?¶

Hawan jini na potassium yana lalata wutar lantarki na jijiyoyi da tsokoki kafin ya dakatar da zuciya. Kula da rauni mai nauyi kwatsam a kafafu biyu (wahala ta tashi ko tafiya), tausasawa ko tawassuli a kusa da lebe, harshe, hannaye, ko ƙafafu, tashin zuciya mara fa'ida, ko bugun jini ba zato ba tsammani ko ba daidai ba. Domin hyperkalemia na iya haifar da kama bugun zuciya kwatsam a kowane lokaci, kira 911/112/999 nan da nan don haka ma'aikatan lafiya za su iya yin ECG kuma su ba da calcium mai garkuwar zuciya.

Menene zan yi idan baƙar fata scab ya fito a kan kumburi akan fistula na dialysis?¶

Baƙar fata scab (eschar), fata mai laushi-baƙi mai sheki, ja, ko ƙananan digon jini da ke fitowa a kusa da tsohuwar ƙumburi akan ƙumburi na AV fistula ko dasa alama ce ta gargaɗin tiyata nan da nan na fashewar bala'i mai zuwa. KAR KA Ɗauki, ɓata, ko wanke ɓangarorin da kyau, kar ka bar kowa ya saka allurar dialysis ta ko kusa da wannan saunin, ajiye hular kwalba mai tsabta da gauze a hannunka, kuma kai tsaye zuwa sashin gaggawa ko likitan likitan ku na jini a rana guda don a iya gyara bango kafin ya fashe.

An duba tushe¶

• ** Gidauniyar Koda ta Kasa (NKF, Amurka): *** * KDOQI Jagoran Ayyukan Clinical don Samun Dama: Sabuntawar 2019* (Lok et al., * American Journal of Kidney Diseases , Gudanar da gaggawa na AV fistula / graft hemorrhage, pseudoaneurysms, da kwalabe-cap / PinpointFench tare da fasaha na gaggawa na mutane) Ciwon koda.
• Kungiyar Koda ta Burtaniya (UKKA), Ƙungiyar Vascular Society of Great Britain and Ireland (VSGBI), da Ƙungiyar Radiology ta Burtaniya (BSIR): Hanyoyin Barazana Mai Barazana Daga Jijiyoyin Jijiyoyin Jijiyoyin Jijiyoyin Jijiyoyin Jiki: Bottle-Cap / Nuni Matsi Matsi na Tsaron Tsaro da Ka'idodin Asibitoci.
• European Resuscitation Council (ERC) and American Heart Association (AHA): Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care: Electrolyte Abnormalities and Life-Threatening Hyperkalemia in Dialysis Patients.
• ** Ƙungiyar Ƙasa ta Duniya don Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararru na 2022 (Li et al., * Peritoneal Dialysis International *).
• Cibiyoyin Kula da Cututtuka da Rigakafin Cututtuka (CDC, Amurka) & Amsar Gaggawar Gaggawa ta Al'umma (KCER): Shirye-shiryen Gaggawa da Abinci na Bala'in Renal na Kwana 3 ga Marasa lafiya Hemodialysis.

Jagora masu alaƙa¶

• Tsananin sarrafa zubar jini, tattara raunuka, da yawon shakatawa
• Mummunan rauni na koda, rhabdomyolysis, da duhun fitsari
• Sepsis da Septic shock ganewa da amsa gaggawa
• Ganewar girgiza da sarrafa agajin farko
• Ciwon zuciya na zuciya (CPR) da jagorar AED