Ọbara ọgbụgba Fistula Dialysis (Protocol-Cap Protocol) yana Mberede Dialysis Agbagharaghị.¶

Maka onye na-anata hemodialysis na-arụzi maka ọdịda akụrụ (Ọgwụgwụ-Stage Renal Disease, ma ọ bụ ESRD), ha ** arteriovenous (AV) fistula, AV graft, ma ọ bụ etiti venous dialysis catheter ** bụ ndụ anụ ahụ ha, mana ọ bụkwa eriri akwara dị elu nke nwere ike ịkpata igbu egbu egbu egbu n'ime ihe na-erughị nkeji ise. pụọ. Fistula AV tozuru oke na-ejikọ akwara akwara na akwara dị n'ogwe aka, na-ebu \(600\text{ga }2,000\text{ milliliters}\) (\(0.6\text{ to }2.0\text{liters}\)) nke ọbara akwara kwa otu nkeji, nke karịrị otu ụzọ n'ụzọ atọ nke mmepụta ahụ dum. N'otu oge ahụ, na-efunahụ ọbụna otu ma ọ bụ abụọ hemodialysis sessions (n'oge oké ifufe, ike ọkụ, ma ọ bụ ọrịa) na-akpalite abụọ ngwa ngwa na-egbu mmadụ: ** hyperkalemia na-eyi ndụ egwu (ọbara na-egbu egbu potassium)** nke nwere ike ịkwụsị obi na-enweghị ịdọ aka ná ntị, na ** nnukwu uremic fluid overload (flash pulmonary edema)** nke na-ekpuchi ngụgụ. Enyemaka mbụ na-achọ ịmụta Pinpoint One-Finger/Bottle-Cap Pressure (anaghị eji akwa akwa akwa akwa gburugburu fistula na-agba ọbara), na-echebe ogwe aka dialysis site na mkpị ọbara mgbali elu ma ọ bụ njem nlegharị anya, na ịmara adịghị ike hyperkalemia n'oge tupu ejide obi obi.

Mee nke a ugbu a¶

1. N'ihi na AV fistula ma ọ bụ aka na-agba ọbara: Pịa otu mkpịsị aka ma ọ bụ okpu karama rọba dị ọcha ozugbo na oghere pinpoint ozugbo. Akwụsịla sekọnd 10 na-achọ bandeeji. Tinye isi mkpịsị aka gị ma ọ bụ mkpịsị aka aka gị (ma ọ bụ obere gauze square / plastic karama dị ọcha) ** kpọmkwem n'elu oghere ntụ ntụ ma ọ bụ ọnya ** ebe ọbara na-agbapụta. Tinye nrụgide siri ike, gbado anya ala, zuru oke iji kwụsị ọbara ọgbụgba ka ị ka na-enwe mmetụta mkpọtụ ("ihe na-atọ ụtọ") nke ọbara na-erute fistula n'okpuru mkpịsị aka gị, ma jide ya n'ihu n'eleghị anya maka nkeji 15 ruo 20 **.
2. Kpọọ nọmba mberede mpaghara gị ozugbo na igwe okwu ma welie ogwe aka n'elu ọkwa obi. Kpọọ 911 na United States na Canada, 112 gafee European Union, 999 na United Kingdom, ma ọ bụ hụ ha niile. nọmba mberede. Mee ka onye ọrịa ** dinara ala n'azụ ya *** n'ala ma ọ bụ akwa (ka ha ghara ịda mbà ma wepụ ogwe aka ha na mkpịsị aka gị) ma jide ogwe aka ọbara ọgbụgba ** ka ọ dị elu karịa ọkwa nke obi ha**. Ọbụlagodi na ọbara ọgbụgba na-akwụsị mgbe nkeji iri na ise gachara n'ụlọ, ** a ga-enyocha ihe ọ bụla gbasara dialysis ma ọ bụ scab rupture na Ngalaba Mberede , dịka mgbidi akwara gbajiri agbaji ( pseudoaneurysm**) nwere ike ịgbawa n'oge ụra awa ole na ole ka e mesịrị.
3. Etinyela njem nlegharị anya ọ gwụla ma onye ọrịa na-anwụ n'ihi ọbara ọgbụgba na-enweghị nchịkwa yana nrụgide nrụnye kpọmkwem adaala kpamkpam. Itinye ihe nlegharị anya ma ọ bụ ọbara mgbali elu n'ebe a na-enweta dialysis na-akpụkọta ogwe aka wee mebie usoro ịwa ahụ onye ọrịa. Otú ọ dị, "Ndụ na-abịa n'ihu akụkụ aka ma ọ bụ fistula": ma ọ bụrụ na fistula aneurysm mebiri emebi na-agbawa nke ọma ma ọ bụrụ na nrụgide dị nro enweghị ike ijikwa ọbara ọgbụgba akwara na-eyi ndụ egwu. ujo, tinye ihe nlegharị anya windlass ** n'elu (nke dị nso)** fistula n'akụkụ ubu iji zọpụta ndụ onye ọrịa (lee. ọbara ọgbụgba).
4. ** Maka oghere Central Venous Dialysis Catheter (Permcath / Vas-Cath na igbe ma ọ bụ n'olu): Kpọchie tube ahụ ma dina onye ọrịa n'akụkụ aka ekpe ozugbo.*
5. Ngwa ngwa ** jiri mkpịsị aka gị tụchie tubing catheter (ma ọ bụ kụchie tubing plastik na catheter ahụ, ma ọ bụ mpịaji/tinye tubing ahụ nke ọma na ọkara).
6. Dina onye ọrịa ** larịị n'akụkụ aka ekpe ya na isi ha gbadara ntakịrị ala ** (** Durant's / ekpe mpụta Trendelenburg ọnọdụ ***) ka ọnyà ikuku ọ bụla n'enweghị nsogbu na atrium aka nri pụọ na ngụgụ, wee kpọọ 911/112/999.
7. Maka onye ọrịa dialysis na-efunahụ ya nwere adịghị ike ụkwụ mberede, ọgbụgbọ, ọzịza na-adịghị ngwa, ma ọ bụ mgbaàmà obi: Kpọọ 911/112/999 maka "Hyperkalemia a na-enyo enyo." Mgbe potassium gbagoro n'elu \(6.5 ederede {mmol/L}\) ($ mEq/L$) mgbe ọ na-efunahụ akwara nsi nke akwara obi na akwara akwara. Ekwela ka onye ọrịa rie ma ọ bụ ṅụọ ihe ọ bụla, rịọkwa ndị na-ahụ maka ahụike ozugbo nwere ** 12-lead ECG na calcium gluconate / calcium chloride**.
8. **Maka onye ọrịa dialysis furu efu na-eku ume maka ikuku nwere oke mmiri: Nọdụ ala ka ha kwụ ọtọ na ogo 90 ka ụkwụ na-adaba ala. Ịnọdụ ala kwụ ọtọ na ụkwụ gbadoro ụkwụ na ọdọ mmiri karịrị akarị n'ụkwụ pụọ na ngụgụ ebe ụgbọ ihe mberede na-ebuga ha na hemodialysis mberede.

Osisi mkpebi nsogbu mberede na dialysis¶

Jiri eserese ụlọ ọgwụ a iji zaghachi ihe mberede ịnweta vaskụla ma ọ bụ nsogbu metabolic ọ bụla na hemodialysis ma ọ bụ onye ọrịa dialysis peritoneal.

flowchart TD
    Start["Ihe mberede na onye ọrịa dialysis<br/>(Hemodialysis AV Fistula, Graft, Catheter,<br/>ma ọ bụ Oge Dialysis Agbagharaghị)"] --> CrisisType{"Kedu ihe bụ isi ihe mberede ugbu a?"}

    CrisisType -->|"1. Ọbara site na Arm AV Fistula ma ọ bụ aka aka"| FistulaBleed["PROTOCOL OKWU HEMODIALYSIS ACCESS HEMORRHAGE:<br/>1. Pịa OTU mkpịsị aka ma ọ bụ okpu karama ozugbo na oghere pinpoint<br/> (AKWỤKWỌ KWESỊRỊ akwa akwa nhicha bath buru ibu n'ogwe aka)<br/>2. Dina onye ọrịa laa; bulie ogwe aka n'elu ọkwa obi<br/>3. Kpọọ 911/112/999 na igwe okwu<br/>4. Jide nrụgide na-adịghị agbaji 15-20 mins (EGHỊ PEEKING)<br/>5. Gaa na ER maka nlele ịwa ahụ akwara ọ bụrụgodị na ọbara ọgbụgba kwụsịrị"]

    CrisisType -->|"2. Mepee, gbawara agbawa, ma ọ bụ kateta olu na-agba ọbara"| CathEmerg["CENTRAL DIALYSIS CATHETER Emergency:<br/>(Ihe ize ndụ nke Venous Air Embolism & Hemorrhage) <br/>1. Mkpọgide plastic slide mwekota ma ọ bụ kink/tuo tube tightly<br/> (Kwagide n'etiti mgbawa/oghe oghere na obi onye ọrịa) <br/>2. mkpuchi mkpuchi na gauze na-adịghị mma; Ejila mkpasa nso tube<br/>3. Dina onye ọrịa n'akụkụ ekpe na isi ya dị ala ma ọ bụrụ na ikuku amịpụtara ya<br/>4. Kpọọ 911/112/999 ozugbo"]

    CrisisType -->|"3. Ọrịa Dialysis Agbaghara + Ụkwụ dị arọ/adịghị ike,<br/>Egbugbere ọnụ/Mkpịsị aka na-ada ụda, Ọkụ Ọdịnaya/Na-adịghị Agbanwe"| HyperK["HYPERKALEMIA (Elu Potassium): <br/>1. Kpọọ 911 / 112 / 999: Kwuwapụta 'Onye Ọrịa Dialysis nwere Hyperkalemia'<br/>2. Rịọ ụgbọ ihe mberede ALS maka 12-Lead ECG + IV Calcium Rescue<br/>3. NPO siri ike (Nri / ihe ọṅụṅụ efu); were Emergency Resin Binder ONLY<br/> ma ọ bụrụ na ị mụrụ anya ma depụta ya nke ọma na atụmatụ mmemme ọdachi."]

    CrisisType -->|"4. Agbaghara dialysis + na-eku ume maka ikuku, <br/> Ụkwara Pink Froth, enweghị ike ịgha ụgha"| FluidOverload["FLASH PULMONARY EDEMA (Mkpụrụ mmiri siri ike): <br/>1. Kpọọ 911/112/999 ozugbo<br/>2. Nọdụ onye ọrịa BOLT UPRIGHT (ogo 90) na ụkwụ na-akụda ala<br/>3. Na-enye oxygen / sublingual nitroglycerin dị elu ma ọ bụrụ na enyere ya iwu"]

    CrisisType -->|"5. Ahụ ọkụ/Ụdị oyi + Kateta na-acha uhie uhie ma ọ bụ<br/> Akpa na-ekpochapụ arịa ọbara ọbara + mgbu afọ"| DialSepsis["CATHETER SEPSIS ma ọ bụ PD PERITONITIS:<br/>Ngalaba Mberede UGBUA maka Ọbara/PD Ọdịbendị Mmiri<br/>na ọgwụ nje nje Intravenous ma ọ bụ Intraperitoneal ozugbo."]

Akụkụ 1: Ịkwụsị AV Fistula ma ọ bụ Ọbara na-eyi ndụ egwu (Pinpoint Finger & Bottle-Cap Protocol)¶

Kedu ihe kpatara dialysis fistulas ji agba ọbara nke ukwuu (yana ihe kpatara skabs na-egbu maramara ji bụrụ bọmbụ oge)¶

N'oge hemodialysis ugboro atọ n'izu, a na-etinye akwa abụọ buru ibu \(14\text{- to} 16\text{-gauge}\) agịga n'ime ịwa onye ọrịa ** arteriovenous (AV) fistula** (akwara akwara nke a na-adọkpụ ozugbo na vein n'ime nkwojiaka ma ọ bụ ogwe aka elu) ma ọ bụ ** AV tubethe plastic syncing na FE A na-enye ihe na-eme ka ọbara dị nro heparin nke mere na ọbara ha anaghị agbakọta na igwe dialysis.

Ụdị ọbara ọgbụgba fistula abụọ dị iche na-apụta n'èzí ụlọọgwụ: 1. ** Mgbe ọ gachara n'ebe a na-ahụ maka ọrịa nrịanrịa, plọg ọhụrụ platelet na-emechi otu n'ime oghere agịga abụọ ahụ na-awụpụ mgbe onye ọrịa buliri ngwa ahịa, hulata ogwe aka ya, ụkwara, ma ọ bụ na-akụda ọbara ha na mberede, ka ọ na-ekesa n'ọbara ha. 2. ** Aneurysm oge na-adịghị anya / Pseudoaneurysm Rupture (Ihe mberede ahụ "Na-egbuke egbuke Black Scab"):** N'ime ọnwa ma ọ bụ afọ nke mkpagharị ugboro ugboro n'otu ebe ahụ, mgbidi nke fistula ma ọ bụ aka aka nwere ike gbatịa n'ime mpụta ** anaurysm ma ọ bụ pseudoaneurysm ***. Ọ bụrụ na akpụkpọ ahụ dị n'elu mpụta ahụ na-aghọ ** mpempe akwụkwọ dị nro, siri ike, na-egbukepụ egbukepụ, na-acha uhie uhie, na-acha uhie uhie, ma ọ bụ na-etolite skaab ojii (eschar) gbara ọchịchịrị nke na-adịghị agwọ ọrịa ruo ọtụtụ izu **, mgbidi arịa akwara na-apụ n'anya n'akpụkpọ ahụ. Ọ bụrụ na skaab ojii ahụ daa na ịsa ahụ ma ọ bụ na-akpụ ya n'oge ụra, kọlụm mgbali elu nke jets ọbara gafere n'ime ụlọ ahụ.

Nzọụkwụ-site-Nzọụkwụ: Ụzọ Ntụpụta Otu mkpịsị aka na karama¶

Soro usoro ikike ị nweta ọbara ọgbụgba nke ndị National Kidney Foundation (NKF)**Kidney Care UK/UK Kidney Association na Vascular Access Society kuziri:

1. ** Kpuchie oghere ahụ (Wepụ akwa akwa ọcha nwere ọbara):**
2. Ị nweghị ike ịkwụsị ụgbọ elu pinpoint nke nrụgide dị elu ma ọ bụrụ na ị na-agbanye kpuru ìsì na ikpo akwa akwa mmiri. Lee anya ozugbo na akpụkpọ fistula ka ịchọta kpọmkwem \(1\text{- to }3\text{-millimeter}\) oghere ebe ọbara na-aputa.
3. ** Were otu mkpịsị aka, isi mkpịsị aka, ma ọ bụ okpu karama rọba dị ọcha tinye nrịba pinpoint:**
4. Nhọrọ A (Mkpịsị aka / Isi mkpịsị aka): Mpịakọta otu obere gauze na-adịghị ọcha (ma ọ bụ jiri mkpịsị aka mkpịsị aka gị dị ọcha ma ọ bụrụ na ọ nweghị gauze na-erute) wee pịa ** ozugbo gbadaa ozugbo n'elu oghere pinpoint**.
5. Nhọrọ B (The Clean Plastic Bottle-Cap Technique): Ọtụtụ ngalaba dialysis na-enye ndị ọrịa ihe pụrụ iche Fistula Clamp ma ọ bụ kụziere Clean Plastic Bottle-Cap Method (iji okpu gbagọrọ agbagọ dị ọcha site na karama mmiri ma ọ bụ soda, ma ọ bụ ihe mberede * HemCon / Celox * hemostatic pad):
   • Ịpị okpu karama dị ọcha ozugbo n'elu obere gauze pad na saịtị nkwụsị na-elekwasị anya, nrụgide otu gburugburu \(2\text{-centimeter}\) mgbanaka ntụpọ ahụ na-egwepịa obosara nke ogwe aka ahụ, ma na-ebelata ike ọgwụgwụ mkpịsị aka mgbe ị na-echere 15 nkeji maka ụgbọ ihe mberede.
   • (Rịba ama: Na-anọnyere onye ọrịa mgbe niile ma were aka jide okpu karama ma ọ bụ mkpịsị aka ya n'ebe ọ bụla; etinyela okpu siri ike gburugburu gburugburu ogwe aka wee pụọ, n'ihi na ọbara ọgbụgba nwere ike ịbanye n'akụkụ akụkụ n'okpuru akpụkpọ ahụ n'ime nnukwu hematoma ma ọ bụrụ na okpu ahụ apụọ n'etiti.)
6. ** Hazie Nrụgide Gị ("Kwụsị Ọbara, Na-enwe Obi Ụtọ"):**
7. Pịa nke ọma ka ** ọbara efu na-esi n'okpuru mkpịsị aka gị pụta**.
8. Ọ bụrụ na ọ ga-ekwe omume, pịasie ike ka ị mechie oghere dị n'elu mgbidi fistula na-emechighị mgbidi nke ala kpamkpam: ị kwesịrị ka na-anụ ụda mkpọtụ dị nro (** ihe na-akpali akpali *) n'okpuru mkpịsị aka gị. Agbanyeghị, ** ọ bụrụ na ọbara na-aga n'ihu na-agbapụta, gbasie ike ruo mgbe ọbara ọgbụgba niile kwụsịrị, n'ihi na ịkwụsị ịwụfu ọbara na-ebute ụzọ.
9. ** Dobe onye ọrịa n'azụ ya ma welie ogwe aka ya elu:**
10. Mee ka onye ọrịa dinara ala ma ọ bụ sofa ozugbo. Ọbara ngwa ngwa na-akpata nkụda mmụọ na mberede (vasovagal ma ọ bụ hemorrhagic syncope); ọ bụrụ na onye ọrịa ahụ na-eguzo n'ebe a na-asa ahụ na-asa ahụ mgbe ha dara mbà, ha ga-adọkapụ ogwe aka ha n'aka gị wee tie isi ha.
11. Welie ogwe aka dialysis ** n'elu ọkwa nke obi *** iji belata venous na nrụgide hydrostatic n'ime fistula.
12. Jide nrụgide na-agbajighị maka nkeji 15 ruo 20 zuru oke (Elela anya n'oge):
13. Lee elekere anya. Jide mkpịsị aka gị n'ebe opekata mpe **15 ruo 20 nkeji na-aga n'ihu ** ruo mgbe ndị ọrụ ahụike rutere wee weghara ya.
14. Ntụle ụlọ ọgwụ amanyere iwu ọ bụrụgodị na ọbara na-akwụsị kpamkpam:
15. Akwụsịla ụgbọ ihe mberede ma ọ bụ nọrọ n'ụlọ mgbe ọbara fistula kwụsịrị. Ọ bụrụ na pseudoaneurysm nke nwere obere mgbidi ma ọ bụ aka aka butere ọbara ahụ, mkpụkọ ahụ na-esighị ike a kpụrụ n'okpuru mkpịsị aka gị na-efepụkwa ugboro ugboro ka awa 2 gachara site na ọbara ọgbụgba na-egbu egbu. Onye dọkịta na-awa vaskụla ga-enyocha ohere ozugbo maka nlegharị anya ịwa ahụ, ntinye stent-graft, ma ọ bụ ligation.

Ihe ịrịba ama ịdọ aka ná ntị nke mgbawa Fistula na-abịa (Mgbe a ga-aga na ER Tupu Ọ Awụsa)¶

Lelee dialysis AV fistula ma ọ bụ akado kwa ụbọchị. Gaa na Ngalaba Mberede ma ọ bụ kpọọ dọkịta na-awa ahụ Vascular Access n'otu ụbọchị ahụ (tupu ọ gbawa) ma ọ bụrụ na ị hụ nke ọ bụla n'ime ise ndị a "Ọkọlọtọ uhie tupu agbawa":

"Iwu Atọ Ọ dịghị mgbe ọ bụla" maka ichekwa ogwe aka ịnweta dialysis¶

Iji gbochie fistula ka ọ ghara ịgbawa ma ọ bụ mechie n'oge ọnọdụ ahụike ọ bụla ma ọ bụ enyemaka mbụ: - ** ewerela AV fistula ma ọ bụ aka akado agụ ọbara mgbali elu** n'ogwe aka (ma ewerela BP n'ogwe aka ebe a na-eme atụmatụ fistula n'ọdịnihu). - Agbala ọbara ọbara ma ọ bụ bido ahịrị intravenous (IV) na ogwe aka ohere dialysis. - Ekwela ka eriri nche siri ike, aka na-agbanwe agbanwe, obere akpa, akpa nri, ma ọ bụ ihi ụra ka isi dabere na ogwe aka ahụ.

Akụkụ 2: Mberede Dialysis Agbaghara: Hyperkalemia na Flash Pulmonary edema¶

Akụrụ dị mma na-enyocha ** 150 ruo 180 lita ọbara kwa ụbọchị **, na-ewepu oke nri potassium (\(K^+\)), mmiri, sodium, acid na uremic toxins. Onye ọrịa hemodialysis nke na-eme ntakịrị ma ọ bụ enweghị mmamịrị (anuric) na-adabere kpamkpam na oge dialysis nke awa 4 ugboro atọ n'izu (Monday/ Wenezdee/Friday ma ọ bụ Tuzdee/Thursday/Saturday). Mgbe onye ọrịa tụfuru ọbụlagodi ** otu ma ọ bụ abụọ dialysis sessions *** (ma ọ bụ n'ime ogologo awa 72 ogologo izu ụka n'etiti Friday/Saturday na Monday/Tuesday), ihe mberede abụọ na-eyi ndụ egwu na-etolite ngwa ngwa:

1. Hyperkalemia na-eyi ndụ egwu (Potassium Blood Blood, "Onye Nkwụsị Obi Silent")¶

A na-ekpochi potassium ọbara nkịtị n'etiti \(3.5\ederede na }5.0\ederede { mmol/L}\) (\(mEq/L\)). Mgbe potassium na-arịgo n'elu ** $ 6.0 ederede { ka } 6.5 ederede mmol/L}$** mgbe nnọkọ dialysis furu efu (ma ọ bụ mgbe ị risịrị nri potassium dị elu, mmerụ ahụ anụ ahụ, ọbara ọgbụgba afọ, ma ọ bụ na-ewere ACE inhibitors / spironolactone / NSAIDs), ọ na-ebelata voltaji eletrik izu ike nke mkpụrụ ndụ akwara na mkpụrụ ndụ akwara obi (**).

** Gịnị kpatara hyperkalemia ji dị egwu: *** N'adịghị ka ọtụtụ ọrịa, ** hyperkalemia nwere ike ime ka njide obi na-egbu egbu na mberede (sine-wave ventricular fibrillation ma ọ bụ asystole) na ọ fọrọ nke nta ka ọ bụrụ ịdọ aka ná ntị mbụ , ma ọ bụ ọ nwere ike iṅomi ihe mberede akwara ozi dị ka ọrịa Guillain-Barre: - ** Ihe ịrịba ama ịdọ aka ná ntị Neuromuscular mbụ (Ọ na-atụkarịkarị): - ** Tingling ma ọ bụ "mkpọ na agịga" (paresthesias)** gburugburu egbugbere ọnụ, ire, aka na ụkwụ. - Na-agbago ngwa ngwa adịghị ike ụkwụ dị arọ (Hyperkalemic Flaccid Paralysis): Onye ọrịa ahụ na-eche na ọ bụ "oduru" na ụkwụ ha, enweghị ike ibili n'oche ma ọ bụ akwa, na adịghị ike na-arịgo na ogwe na ogwe aka. - Ọgbụgbọ siri ike, ọgbụgbọ, ma ọ bụ ọgbụgbọ afọ. - ** Ihe ịrịba ama ịdọ aka ná ntị obi: *** - ** Obi mgbawa na-adịghị ngwa ngwa (bradycardia)**, mwụda obi, obi mgbawa, isi ọwụwa, ma ọ bụ nkụda mmụọ. - Na paramedic's ** 12-lead ECG *, potassium na-ebili na-emepụta ọganihu mara mma: ** ogologo, tent "T-waves" \(\ rightarrow\) flattened/na-anọghị P-ebili mmiri na ogologo oge PR $ aka nri $ ** gbasaa mgbagwoju QRS mgbagwoju anya ** $ ziri ezi na-akwụsị n'ime obi.

** Ka ndị ọrụ ahụike na ụlọ ọgwụ si echekwa onye ọrịa hyperkalemic n'ime nkeji:** Mgbe ị na-agwa onye na-ezipụ 911/112/999 * "Onye ọrịa dialysis nke na-enweghị ọgwụgwọ na-adịghị ike ụkwụ na nke a na-enyo enyo na hyperkalemia,"* ndị ọrụ ahụike na ndị dọkịta mberede na-eme usoro nzọpụta nke ụzọ atọ: 1. ** Mee ka akwara obi guzosie ike n'ime nkeji 1 ruo 3:** Intravenous ** Calcium Gluconate (\(10\%\), \(10\text{ to }30\text{mL}\))** ma ọ bụ ** Calcium Chloride* adịghị ewetulata potassium n'ọbara, mana ọ ** ngwa ngwa na-echebe akwara obi n'ime mkpụrụ obi potassium anaghị akwụsị ihie ọkụ. 2. ** Mgbanwe Potassium N'ime sel n'ime nkeji 15 ruo 30:** Intravenous ** insulin nkịtị ($ 10\text{ units}$) jikọtara ya na dextrose intravenous (glucose), nnukwu dose nebulized ** albuterol (salbutamol, $10 $ ** ederede * ruo }20$ intravenous) bicarbonate *** (ma ọ bụrụ acidic) na-achụpụ potassium n'ọbara na-abanyeghachi na sel ahụ nwa oge. 3. ** Wepụ Potassium kpamkpam na ahụ: Ihe na-ekekọta potassium nke eriri afọ (** sodium zirconium cyclosilicate [Lokelma], patiromer [Veltassa], ma ọ bụ sodium polystyrene sulfonate [Kayexalate]) na ** hemodialysis pụtara ìhè (ọgwụgwọ ahụ doro anya).

2. Nnukwu Mfesa Mfesa (Flash Pulmonary Edema) na Uremic Pericarditis¶

Na-enweghị mmepụta mmamịrị akụrụ, iko mmiri ọ bụla, ofe, ice, ma ọ bụ mkpụrụ osisi nke onye ọrịa dialysis na-eri na-anọ ozugbo n'ime ọbara na anụ ahụ. Mgbe ọgwụgwọ 1 ruo 2 gachara ọgwụgwọ dialysis, lita 3 ruo 6 nke oke mmiri nwere ike ịbanye n'ime ngụgụ (* nnukwu cardiogenic / volume pulmonary edema*) na gburugburu obi (uremic pericarditis / cardiac tamponade ): - ** Mgbaàmà nke Flash Pulmonary edema: - Oke iku ume na-eme ka ọ bụrụ ihe agaghị ekwe omume ịdina ala n'àkwà (orthopnea). - Na-eku ume maka ikuku, iku ume ("asthma obi"), ụda ume ma ọ bụ na-ama jijiji, na ụkwara pink, sputum na-esi ísì ụtọ. - Ọzịza siri ike ( edema) na nkwonkwo ụkwụ, ụkwụ, azụ azụ, na gburugburu anya, jikọtara ya na mbelata ọbara mgbali na-agafekarị \(180/110\text{mmHg}\). - ** Mgbaàmà nke Uremic Pericarditis:** - Nhụsianya dị nkọ, nke na-ama n'obi mgbu n'azụ ọkpụkpụ ara nke ** na-akawanye njọ mgbe ị dinara ala n'azụ ma na-akawanye mma mgbe ị na-anọdụ ala ma na-adabere n'ihu *. - ** Ndokwa enyemaka mbụ ozugbo maka ibufe mmiri mmiri: - Nọdụ ala onye ọrịa kwụ ọtọ n'ogo ogo 90 nwere ụkwụ abụọ na-adaba n'akụkụ ihe ndina ma ọ bụ oche. Gravity holds roughly \(500\text{ to }800\text{ milliliters}\) nke ọbara venous n'ụkwụ dị ala kama ikwe ka ọ banye n'ime akpa ume juru. - Ewelila ụkwụ nke onye ọrịa dialysis jujuru mmiri, ma jidekwa mmiri niile nke ọnụ mgbe ị na-eche ụgbọ ihe mberede.

Ịlanahụ Ọdachi: "Ụbọchị atọ nke Potassium dị ala, Nri Mberede Mgbochi Mmiri"¶

N'oge oké ifufe, idei mmiri, blizzards, ma ọ bụ ike mgbụsị akwụkwọ mgbe ụlọ ọgwụ dialysis na-emechi nwa oge maka awa 48 ruo 72, na-eso ** National Kidney Foundation (NKF) na Ụlọ Ọrụ Maka Nchịkwa na Mgbochi Ọrịa (CDC) "Diet Renal Emergency Emergency 3-Day"** na-eme ka potassium na ngụgụ na-adịghachi ndụ ruo mgbe ọ ga-amaliteghachi.

Ihe mberede pụrụ iche na ndị ọrịa peritoneal Dialysis (PD): Akpa Cloudy Peritonitis¶

Ndị ọrịa na-eme ** Peritoneal Dialysis (PD)** n'ụlọ na-eji catheter silicone dị nro na afọ ha (** Tenckhoff catheter ) na-eche ihe mberede pụrụ iche a na-akpọ PD Peritonitis ihu: - ** Otu esi amata ya ozugbo: Lelee n'ime akpa drainage plastic doro anya mgbe mgbanwe ọ bụla gasịrị. Dị ka ọ na-adịkarị, mmiri mmiri dialysis peritoneal na-agbapụta (* exfluent**) na-adị ka mmamịrị na-acha odo odo (ị ga-enwe ike ịgụ akwụkwọ akụkọ nke ọma site na akpa zuru ezu). ** Ọ bụrụ na mmiri a gbapụrụ agbapụ dị ka urukpuru, mmiri ara ehi, isi awọ, ma ọ bụ pink, ma ọ bụ ọ bụrụ na onye ọrịa ahụ enwee mgbu afọ, nro, ọgbụgbọ, ma ọ bụ ahụ ọkụ, were nnukwu peritonitis nje bacteria. - Ihe omume ozugbo: 1. ** Chekwaa akpa mmiri mmiri na-ekpuchi ígwé ojii *** (Kwụchie ya ma buru ya gaa ụlọ ọgwụ ma ọ bụ ụlọ ọgwụ PD ka ndị nọọsụ wee nweta mmiri ozugbo na akpa ahụ maka ọnụ ọgụgụ cell na omenala nje). 2. Kpọọ onye nọọsụ na-ahụ maka ọrịa nrịanrịa nke 24-hour Peritoneal Dialysis / On-Call Nephrologist ma ọ bụ gaa na ngalaba ihe mberede ozugbo maka **intrapereritoneal (IP) ma ọ bụ ọgwụ nje na-egbu egbu **. 3. ** Ọ bụrụ na PD catheter na mberede na-ebipụ ma ọ bụ ihe nfefe ahụ na-akwụsị nke ọma ma ọ bụ na unyi: ** Ngwa ngwa kpoo plastik ọcha ** Beta-Clamp ** (ma ọ bụ tuo / kink tube catheter dị nro nke ọma n'etiti mgbatị ahụ na akpụkpọ afọ gị), kpuchie oghere ahụ na gauze na-adịghị mma, ** agbanyela mmiri n'ime oghere mepere emepe PD ma ọ bụ gaa na ụlọ mberede gị ozugbo. nkwụnye mgbanwe/ngbanwe-ngbanwe na ọgwụ nje prophylactic.

Ederede nzikọrịta ozi maka 911/112/999 na Triage ụlọ ọgwụ¶

• ** Maka Fistula AV ma ọ bụ ọbara ọgbụgba:**

  • "Achọrọ m ụgbọ ihe mberede mberede na [Kpọmkwem Address]. Onye ọrịa ahụ bụ onye ọrịa hemodialysis nke ogwe aka ya AV [fistula / graft] gbawara agbawa ma na-agba ọbara nke ukwuu. Ana m ejide mkpịsị aka otu mkpịsị aka ozugbo na ebe agịga ahụ, etinyewo onye ọrịa ahụ larịị, ma welie ogwe aka n'elu obi. Anyị kwesịrị ibuga nkwado ndụ dị elu n'ụlọ ọgwụ nwere akwara akwara. "*

• Maka onye ọrịa dialysis efunahụ ya nwere hyperkalemia a na-enyo enyo ma ọ bụ bufee mmiri mmiri:

  • "Achọrọ m ụgbọ ihe mberede mberede na [kpọmkwem Adreesị] maka onye ọrịa hemodialysis nke ikpeazụ dialysis nnọkọ bụ [X] ụbọchị gara aga na [Day]. 12-edu ECG na inye calcium gluconate intravenous ozugbo."

Ndepụta nleba anya akpa ihe mberede onye ọrịa dialysis¶

• ** Mpempe akwụkwọ ọgwụgwọ Hemodialysis ọhụrụ gị ("Run Sheet"):** Na-egosi ** ịdị arọ (arọ nke ebumnuche)**, nha nzacha dialyzer, ọnụọgụ ọbara, mkpokọta bath potassium dialysate, na dose heparin ka ụlọ ọgwụ mberede ọ bụla nwere ike kpọpụta gị n'enweghị nsogbu.
• ** 2 ruo 3 okpu karama plastik dị ọcha, paịlị gauze $ 4 na-adịghị mma, yana pad hemostatic azụmahịa (ChitoGauze / Celox) ** n'akpa ma ọ bụ obere akpa gị oge niile.
• ** Mkpọchi vaskụla rọba dị nro (catheter clamp)** ma ọ bụrụ na ị nwere igbe ma ọ bụ olu Permcath, ma ọ bụ ọcha Beta-Clamp ma ọ bụrụ na ị nọ na Peritoneal Dialysis.
• ** Mberede ụbọchị 3 nke ngwugwu ihe nkedo potassium na-eweda ala* (sodium zirconium cyclosilicate [Lokelma] ma ọ bụ patiromer [Veltassa]) na ihe nkedo phosphate.

Ajụjụ a na-ajụkarị¶

Kedu ihe kpatara ijikọ akwa nhicha n'akụkụ dialysis fistula na-agba ọbara na-eme ka ndị ọrịa na-agbapụta ọbara?¶

Fistula arteriovenous (AV) na-ebu ọbara akwara n'okpuru nrụgide dị elu na 600 ruo 2,000 milliliters kwa nkeji site na obere oghere 1 ruo 2-millimita n'ime akpụkpọ ahụ. Ikpuchi akwa akwa ịsa ahụ buru ibu n'ogwe aka na-ezochi ebe ọbara ọgbụgba ahụ anya wee gbasaa nrụgide na-adịghị ike n'akụkụ ebe sara mbara kama ikpuchi obere oghere ahụ. N'ime nkeji 3 ruo 5, onye ọrịa ahụ nwere ike tufuo ọkara ogo ọbara ya n'ime akwa nhicha ahụ wee nweta njide obi na-egbu egbu. Na-ele anya ozugbo na ọnya ahụ wee pịa otu mkpịsị aka, isi mkpịsị aka, ma ọ bụ okpu rọba dị ọcha ozugbo na oghere ahụ maka nkeji 15 ruo 20 na-aga n'ihu.

Ọ bụrụ na dialysis fistula na-agba ọbara akwụsị ọbara mgbe nkeji iri na ise nke mkpịsị aka na-arụ n'ụlọ, gịnị kpatara m ka ga-eji gaa ụlọ mberede?¶

Ọbara na-apụta ozugbo site na dialysis fistula ma ọ bụ akado n'èzí ụlọọgwụ na-ebutekarị site na mkparị na nbibi nke mgbidi aneurysm dị n'okpuru ma ọ bụ ọrịa arịa zoro ezo. Ọbụlagodi mgbe mkpirisi nwa oge na-emechi oghere akara n'okpuru mkpịsị aka gị, oke akwara ozi n'ime fistula na-afụkarị nke na-akpụ akpụ azụ ka awa ole na ole gachara, ọtụtụ mgbe mgbe onye ọrịa na-ehi ụra n'àkwà. A ga-enyocha ọbara fistula ọ bụla n'ụlọ ozugbo na ngalaba mberede site n'aka onye ọkachamara vaskụla.

Kedu ka m ga-esi mara ma onye na-ahapụghị oge dialysis nwere nnukwu potassium (hyperkalemia) dị egwu?¶

Ọbara potassium dị elu na-emebi ọkụ eletrik nke irighiri akwara na mọzụlụ tupu ọ kwụsị obi. Lezienụ anya maka adịghị ike dị arọ na mberede na ụkwụ abụọ (ihe isi ike iguzo ọtọ ma ọ bụ ije ije), ịma jijiji ma ọ bụ ịma jijiji n'akụkụ egbugbere ọnụ, ire, aka, ma ọ bụ ụkwụ, ọgbụgbọ na-akọwaghị, ma ọ bụ usu na-adịghị ngwa ngwa ma ọ bụ na-adịghị agbanwe agbanwe. N'ihi na hyperkalemia nwere ike ime ka njide obi na mberede n'oge ọ bụla, kpọọ 911/112/999 ozugbo ka ndị na-ahụ maka ahụike nwere ike mee ECG ma nye calcium na-ekpuchi obi.

Kedu ihe m ga-eme ma ọ bụrụ na skaab ojii etolite n'elu mpụta na dialysis fistula?¶

Akpụkpọ anụ ojii gbara ọchịchịrị (eschar), akpụkpọ akwụkwọ na-egbu maramara, ọbara ọbara, ma ọ bụ ntakịrị ntanye ọbara na-apụta gburugburu akpụkpa ochie n'elu fistula AV na-agbapụta agbawa bụ akara ịdọ aka ná ntị ịwa ahụ ozugbo nke mgbawa ọdachi na-abịa. AKWỤKWỌ, kpụchaa, ma ọ bụ saa akpụkpa ahụ nke ọma, ekwela ka onye ọ bụla tinye agịga dialysis site na ma ọ bụ nso skaab ahụ, debe okpu karama dị ọcha na gauze n'aka gị, gaa ozugbo na ngalaba mberede ma ọ bụ dọkịta na-awa ahụ gị n'otu ụbọchị ahụ ka enwere ike ịrụzi mgbidi ahụ tupu ọ gbawa.

enyochara isi mmalite¶

• ** National Kidney Foundation (NKF, United States): *** * KDOQI Usoro Ntuzi Ahụike Clinical maka Nweta Vascular: 2019 Mmelite * (Lok et al., * American Journal of Kidney Diseases *, njikwa mberede nke AV fistula / graft hemorrhage, pseudoaneurysms, na ntụzịaka okpu / ntule ndị mmadụ na usoro Ntuzi Ntuzi maka Nerpoint People) Ọrịa akụrụ na-adịghị ala ala.
• ** UK Kidney Association (UKKA), Vascular Society of Great Britain and Ireland (VSGBI), na British Society of Interventional Radiology (BSIR):**
• ** European Resuscitation Council (ERC) na American Heart Association (AHA): *** Ntuziaka maka Mweghachi nke Obi na Nchekwa Obi Mberede: Electrolyte Abnormalities na Hyperkalemia na-eyi ndụ egwu na ndị ọrịa dialysis *.
• ** International Society for Peritoneal Dialysis (ISPD): ** * ISPD Peritonitis Ntuziaka Ntuziaka: 2022 Mmelite na Mgbochi na Ọgwụgwọ * (Li et al., * Peritoneal Dialysis International *).
• ** Centers for Disease Control and Mgbochi Ọrịa (CDC, United States) & Nzaghachi Mberede Emergency Community Kidney (KCER):** Njikere Mberede na Nri Ọdachi Ọdachi Ụbọchị 3 maka Ndị Ọrịa Hemodialysis.

Ntuziaka emetụtara¶

• Nnukwu njikwa ọbara ọgbụgba, ịkwakọba ọnya, na njem nlegharị anya
• Ahụhụ akụrụ dị oke njọ, rhabdomyolysis, na nhụsianya mmamịrị gbara ọchịchịrị
• Sepsis na nchọpụta ujo septic na nzaghachi mberede
• Nchọpụta ujo na njikwa enyemaka mbụ
• Ntughari obi obi (CPR) na ntuziaka AED