Dialysis Fistula Bleed (Bottle-Cap Protocol) ndi Zowopsa za Dialysis Zophonya¶

Kwa munthu amene akulandira chithandizo cha hemodialysis chifukwa cha kulephera kwa impso (End-Stage Renal Disease, kapena ESRD), fistula yawo arteriovenous (AV) fistula, AV graft, kapena catheter yapakati ya venous dialysis catheter ndiyo njira yawo yamoyo, komanso ndi mitsempha yothamanga kwambiri yomwe imatha kuchititsa kuti munthu afe pasanathe mphindi 3 mpaka 5 ngati akuphulika. Fistula ya AV yokhwima imalumikiza mwachindunji mtsempha ku mtsempha wapa mkono, kunyamula \(600\malemba{ mpaka }2,000\mawu{mililita}\) (\(0.6\text{ to }2.0\text{litres}\)) ya magazi osakanizidwa mphindi imodzi, amene amaposa gawo limodzi mwa magawo atatu a mtima wonse wa thupi. Panthawi imodzimodziyo, kusowa ngakhale gawo limodzi kapena awiri a hemodialysis (panthawi ya mphepo yamkuntho, kuzima kwa magetsi, kapena matenda) kumayambitsa anthu awiri opha anthu osalankhula mofulumira: ** hyperkalemia (poizoni wamagazi a potaziyamu) omwe amawopsyeza moyo (poizoni wamagazi a potaziyamu)** omwe amatha kuyimitsa mtima popanda chenjezo, ndi **acute uremic fluid overload (flash pulmonary edema) ** yomwe imasefukira m'mapapo. Thandizo loyamba limafuna luso lodziwa Lozani Chala Chimodzi / Kupanikizika kwa Botolo (osakulunga chopukutira chachikulu kuzungulira fistula yotuluka magazi), kuteteza mkono wa dialysis ku ma cuffs a kuthamanga kwa magazi kapena ma tourniquets, ndikuzindikira kufooka koyambirira kwa hyperkalemia kusanachitike kumangidwa kwa mtima.

Chitani izi tsopano¶

1. Pa AV fistula kapena kumezanitsa magazi: Kanikizani chala CHIMODZI kapena kapu ya pulasitiki yoyera pabowo lolozerapo nthawi yomweyo. Osataya masekondi 10 kufunafuna mabandeji. Ikani chala chanu chopanda kanthu kapena chala chamlozera (kapena kapu kakang'ono koyera kopyapyala kopyapyala/botolo la pulasitiki) ** pamwamba pa bowo loboola singano kapena chilonda* pomwe magazi akutuluka. Ikani mwamphamvu, yolunjika pansi, yokwanira kuletsa magazi pamene mukumvabe kugwedezeka ("chisangalalo") cha magazi omwe akuyenda mu fistula pansi pa chala chanu, ndikuchigwira mosalekeza osasuzumira kwa 15 mpaka mphindi 20.
2. Imbani foni nambala yanu yazadzidzi nthawi yomweyo pa sipikala ndipo mukweze mkono wanu pamwamba pa mlingo wa mtima. Imbani 911 ku United States ndi Canada, 112 kudutsa European Union, 999 ku United Kingdom, kapena muwone zonse. manambala angozi. Muuzeni wodwala kuti ** agone chagada chagada** pansi kapena pabedi (kuti asakomoke ndikuchotsa mkono wawo kutali ndi chala chanu) ndikugwira dzanja lomwe likutuluka magazi ** lokwera pamwamba pa mlingo wa mtima wawo **. Ngakhale kutuluka kwa magazi kutayima pakatha mphindi 15 kunyumba, nthawi iliyonse ya dialysis yofikira kuphulika kapena kuphulika kwa nkhanambo iyenera kuwunikiridwa mu dipatimenti yazadzidzidzi, ngati khoma lochepa kwambiri la aneurysm (pseudoaneurysm) limatha kuphulika mwakupha munthu akagona maola angapo pambuyo pake.
3. OSATI kupaka ma tourniquet pokhapokha ngati wodwala akumwalira chifukwa cha kukha magazi kosalamulirika komanso kuthamanga kwa magazi kwalephera kotheratu. Kupaka chotchinga kapena chotchinga cha kuthamanga kwa magazi pa dialysis kumatseka mkono wake ndi kuwononga njira ya moyo ya wodwalayo. Komabe, "Moyo Umabwera Patsogolo pa Limb kapena Fistula": ngati fistula aneurysm yomwe yawonongeka ikaphulika ndipo kupanikizika kwapatsogolo sikungathe kuwongolera kukha mwazi kowopsa kwa mtima ndi mantha, ikani mawonekedwe a windlass pamwambapa (pafupifupi) fistula molunjika paphewa kuti apulumutse moyo wa wodwalayo (onani kutuluka magazi).
4. **Kwa Catheter ya Central Venous Dialysis yolumikizidwa kapena yosatsekedwa (Permcath / Vas-Cath pachifuwa kapena khosi): Gwirani chubu ndikugoneka wodwala ku mbali yakumanzere nthawi yomweyo.
5. Nthawi yomweyo tsinani chubu chotseka ndi zala zanu (kapena jambulani cholembera cha pulasitiki pa catheter chotsekedwa, kapena pindani/kukitsani chubu mwamphamvu pakati).
6. Iloni wodwalayo ** chathyathyathya kumanzere kwawo ndikupendekekera pansi pang'ono ** (**Durant's / left lateral Trendelenburg position **) kuti agwire thovu lililonse mu atrium yakumanja kutali ndi mapapo, ndikuyitanitsa 911 / 112 / 999.
7. Kwa wodwala dialysis yemwe waphonya mwadzidzidzi mwendo wofooka, dzanzi, kugunda kwapang'onopang'ono, kapena zizindikiro za pachifuwa: Imbani 911 / 112 / 999 kuti mumve "Wokayikira Hyperkalemia." Potaziyamu ikakwera pamwamba pa \(6.5\mawu{mpaka }7.0\text{mmol/L}\) ($mEq/L}) itatha kuphonya mwendo wamagetsi, imachititsa chiphe cha mtima. Musalole kuti wodwalayo adye kapena kumwa chilichonse, ndipo pemphani opereka chithandizo mwamsanga ndi 12-lead ECG ndi mtsempha wa calcium gluconate / calcium chloride.
8. Kwa wodwala dialysis yemwe waphonya akupumira mpweya chifukwa cha kuchuluka kwa madzimadzi: Akhazikitseni bolt mowongoka madigiri 90 ndi miyendo ikulendewera pansi. Musamakakamize wodwala dialysis wodzaza madzi kuti agone. Kukhala mowongoka ndi miyendo ikulendewera pansi madzi ochulukirapo m'miyendo kutali ndi mapapu pomwe ambulansi imathamangira ku hemodialysis mwadzidzidzi.

Mtengo wa chisankho cha Emergency triage ndi dialysis crisis¶

Gwiritsani ntchito tchati chachipatala ichi kuti muyankhe pakagwa mwadzidzidzi kapena vuto la metabolic mu hemodialysis kapena peritoneal dialysis wodwala.

flowchart TD
    Start["Zadzidzidzi kwa Wodwala Dialysis<br/>(Hemodialysis AV Fistula, Graft, Catheter,<br/>kapena Dialysis Session)"] --> CrisisType{"Kodi vuto lalikulu ladzidzidzi ndi liti pakali pano?"}

    CrisisType -->|"1. Kutulutsa magazi kuchokera ku Arm AV Fistula kapena Graft"| FistulaBleed["HEMODIALYSIS ACCESS HEMORRHAGE PROTOCOL:<br/>1. Dinani CHIMALIRO CHIMODZI kapena BOTTLE CAP molunjika pa dzenje loloza<br/> (MUSAMAngile chopukutira chosambira chachikulu m'manja)<br/>2. Lalani wodwala pansi; kwezani mkono pamwamba pa mlingo wa mtima<br/>3. Imbani 911/112/999 pa speakerphone<br/>4. Gwirani kukakamiza kosasweka kwa mphindi 15-20 (POSAYENERA)<br/>5. Pitani ku ER kuti mukawone Opaleshoni ya Mitsempha ngakhale magazi atasiya"]

    CrisisType -->|"2. Catheter Yotsegula, Yosweka, Kapena Yotulutsa Magazi/Mkhosi"| CathEmerg["CENTRAL DIALYSIS CATHETER EMERGENCY:<br/>(Kuopsa kwa Venous Air Embolism & Hemorrhage)<br/>1. Clamp pulasitiki slide clamp OR kink / pinch chubu mwamphamvu<br/> (Dinani pakati pa ming'alu / kutseguka kumapeto ndi chifuwa cha wodwalayo)<br/>2. Chivundikiro chachitsulo chokhala ndi gauze wosabala; OSAMAGWIRITSE ntchito lumo pafupi ndi chubu<br/>3. Ikani wodwala kumbali yakumanzere mutu uli pansi ngati mpweya ulowa mkati<br/>4. Imbani 911/112/999 Nthawi yomweyo"]

    CrisisType -->|"3. Dialysis Yaphonya + Miyendo Yolemera/Yofooka,<br/>Milomo Yoyima/Zala Zala, Kugunda Pang’onopang’ono/Kusakhazikika"| HyperK["HYPERKALEMIA YOWONJEZERA MOYO (Potaziyamu Yokwera):<br/>1. Imbani 911 / 112 / 999: Nenani 'Wodwala Dialysis ndi Hyperkalemia' <br/>2. Funsani Ambulansi ya ALS ya 12-Lead ECG + IV Calcium Rescue<br/>3. Mosamalitsa NPO (Ziro chakudya / madzi); tengani Emergency Resin Binder POKHA<br/> ngati muli maso komanso momveka bwino mu Disaster Action Plan"]

    CrisisType -->|"4. Dialysis Waphonya + Kupuma Mpweya,<br/>Kutsokomola Froth Pinki, Sangame Pathyathyathya"| FluidOverload["FLASH PULMONARY EDEMA (Kuchulukira Kwa Madzi Kwambiri):<br/>1. Imbani 911/112/999 Nthawi yomweyo<br/>2. Khalani oleza mtima KULIMBIKITSA (90 madigiri) ndi miyendo ikulendewera pansi<br/>3. Perekani mpweya wothamanga kwambiri / sublingual nitroglycerin ngati watchulidwa"]

    CrisisType -->|"5. Fever/Kuzizira + Red Catheter OR<br/>Cloudy Peritoneal Dialysis Drain Bag + Belly Pain"| DialSepsis["CATHETER SEPSIS KAPENA PD PERITONITIS:<br/>Dipatimenti Yadzidzidzi TSOPANO ya Zikhalidwe Zamadzi Amwazi/PD <br/>ndipo Maantibayotiki Omwe Amalowa Mwamtsempha kapena Olowa m'mitsempha"]

Gawo 1: Kuyimitsa Chiwopsezo cha AV Fistula kapena Graft Bleed (Loza Chala ndi Botolo-Cap Protocol)¶

Chifukwa Chake Ma Fistula A Dialysis Amatulutsa Magazi Mwachiwawa (ndi Chifukwa Chake Masamba Onyezimira Ndi Mabomba A Nthawi)¶

Panthawi ya hemodialysis katatu pa sabata, singano ziwiri zazikuluzikulu za \(14{- mpaka }16\text{-gauge}\)$ zimayikidwa mu opaleshoni arteriovenous (AV) fistula (mtsempha wamba wosokedwa mwachindunji ku mtsempha wa pamkono kapena kumtunda) kapena klzzwxh007 PT), pulasitiki ndi pulasitiki yolumikizira wodwalayo wopatulira magazi heparin kuti magazi awo asatseke mu makina a dialysis.

Mitundu iwiri ya fistula imatuluka kunja kwa chipatala: 1. Ngano Yoyamba Kutulukanso Magazi (Maola 1 mpaka 6 Kwawo): Mukachoka pamalo opangira dialysis, pulagi yatsopano ya mapulateleti yomwe imamata mabowo awiri oboola singanoyo imatuluka pamene wodwala akunyamula zinthu, kupindika mkono wake, kutsokomola, kapena kugunda tepiyo mwangozi m'magazi, pamene magazi ake akuzungulira. 2. Kuchedwa Kwambiri kwa Aneurysm / Pseudoaneurysm Kuphulika (Mdzidzi Wodzidzimutsa wa "Mkaka Wakuda Wonyezimira): Pakapita miyezi kapena zaka zomangika mobwerezabwereza pamalo omwewo, khoma la fistula kapena graft limatha kufalikira aneurysm kapena pseudoaneurysm. Ngati khungu pamwamba pa chotupacho likhala papepala lopyapyala, lothina, lonyezimira, lopanda mtundu, lofiira, kapena litakhala ndi nkhanambo yakuda (eschar) yomwe sichira kwa milungu ingapo, khoma la chotengeracho limakokoloka pakhungu. Ngati nkhanambo yakudayo itagwa m'bafa kapena ikagwa m'tulo, ndiye kuti m'chipindacho mumakhala magazi othamanga kwambiri.

Tsatanetsatane-pang'onopang'ono: Njira Yolozera Chala Chimodzi ndi Botolo-Kapu¶

Tsatirani ndondomeko yovomerezeka ya kutayika kwa magazi m'mitsempha yophunzitsidwa ndi National Kidney Foundation (NKF), Impso Care UK / UK Kidney Association, ndi Vascular Access Society:

1. Vulani Bowo Lenileni (Vulani Matawulo Omwe Avithira Magazi):
2. Simungathe kuyimitsa jeti yokhotakhota kwambiri ngati mukukankhira mwakhungu mulu wa nsalu yonyowa. Yang'anani pakhungu la fistula kuti mupeze \(1\malemba{- mpaka }3\text{-millimeter}\) dzenje lomwe magazi akutuluka.
3. Ikani Kupanikizika kwa Pinpoint ndi Chala Chimodzi, Chala Chala Chala Chimodzi, Kapena Chovala Choyera cha Pulasitiki:
4. Njira A (Chala Chala / Chala Chala Chala): Pindani kachidutswa kakang'ono kakang'ono ka nsalu yopyapyala (kapena gwiritsani ntchito chala chanu choyera ngati chala chanu chala chaching'ono/chala cholozera ngati palibe yopyapyala) ndipo dinani yolunjika pansi pamwamba pa bowo loloza.
5. Njira B (Njira Yoyera ya Botolo la Botolo la Pulasitiki): Magawo ambiri a dialysis amapereka odwala ** Fistula Clamp ** kapena aphunzitse ** Njira Yoyera ya Botolo la Pulasitiki ** (pogwiritsa ntchito kapu yoyera yokhotakhota kuchokera m'madzi kapena botolo la soda, kapena mwadzidzidzi * HemCon / Celox * hemostatic pad):
   • Kukanikizira kapu ya botolo loyera pamwamba pa chotchingira chaching'ono pamalo obowola kumakhazikika, kukakamiza kofananako kuzungulira \(2\text{-centimeter}\) mphete yachilema popanda kuphwanya m'lifupi mwake lonse la mkono, ndikuchepetsa kutopa kwa chala podikirira mphindi 15 kuti ambulansi ifike.
   • (Zindikirani: Nthawi zonse khalani ndi wodwalayo ndipo gwirani chipewa cha botolo kapena chala mokhazikika ndi dzanja; musamange chipewa cholimba kuzungulira mkono wanu ndikuchokapo, chifukwa kutuluka magazi kungathe kutsata m'mbali mwa khungu mpaka ku hematoma yaikulu ngati chipewacho chatsika pakati.)
6. ** Sinthani Kupanikizika Kwanu ("Imitsani Kutaya Magazi, Sungani Chisangalalo"):**
7. Kanikizani mwamphamvu kuti ziro magazi atuluke pansi pa chala chanu.
8. Ngati ndi kotheka, kanikizani mwamphamvu kuti mutseke bowo lomwe lili pakhoma lakumtunda kwa fistula popanda kugwetsa khoma lakumunsi kutseka kotheratu: muyenera kumangomvabe kugwedezeka kwamphamvu (chisangalalo) pansi pa chala chanu. Komabe, **ngati magazi akupitiriza kutuluka, kanikizani mwamphamvu mpaka kutaya magazi kutha, chifukwa kusiya kutaya magazi nthawi zonse kumakhala koyambirira **.
9. Ikani Odwala Pamsana Pawo ndikukweza mkono:
10. Muuzeni wodwalayo kuti agone pansi kapena pa sofa nthawi yomweyo. Kutaya magazi mofulumira kumayambitsa kukomoka mwadzidzidzi (**vasovagal kapena hemorrhagic syncope **); ngati wodwala atayima pa sinki ya bafa pamene akomoka, amang'amba mkono wake kutali ndi dzanja lanu ndikugunda mutu wake.
11. Kwezani mkono wa dialysis ** pamwamba pa mlingo wa mtima ** kuti muchepetse kuthamanga kwa venous ndi hydrostatic mkati mwa fistula.
12. Gwirani Kupanikizika Kosasweka kwa Mphindi 15 mpaka 20 (Osayang'ana Poyambirira):
13. Yang'anani pa koloko. Gwirani chala chanu pamalo osachepera 15 mpaka 20 mphindi zosalekeza mpaka azachipatala afika ndikuwongolera.
14. Kuwunika Kovomerezeka Kwachipatala Ngakhale Kutaya Kwamagazi Kukasiya:
15. Osaletsa ambulansi kapena kukhala kunyumba pambuyo poti fistula isiya kutuluka magazi. Ngati pseudoaneurysm yokhala ndi mipanda yopyapyala kapena kumezanitsa komwe kuli ndi kachilomboko kudayambitsa magazi, magazi osalimba omwe amaundana pansi pa chala chanu nthawi zambiri amatulukanso pakatha maola awiri ndikupha magazi. Dokotala wa opaleshoni yam'mitsempha ayenera kuyang'ana momwe angapezere nthawi yomweyo kuti akonzenso opaleshoni, kuika stent-graft, kapena ligation.

Zizindikiro zochenjeza za Kuphulika kwa Fistula (Pamene Muyenera Kupita ku ER Isanatuluke Magazi)¶

Yang'anani dialysis AV fistula kapena kumezanitsa tsiku lililonse. Pitani ku dipatimenti ya Zadzidzidzi kapena muimbireni Vascular Access Surgeon tsiku lomwelo (isanaphulike) ngati muwona iliyonse mwa zisanu izi "Pre-Rupture Red Flags":

"Malamulo Atatu Opanda Malamulo" Oteteza Arm ya Dialysis Access¶

Kuti fistula isaduke kapena kutsekeka panthawi iliyonse yachipatala kapena chithandizo choyamba: - OSATI kuwerengera kuthamanga kwa magazi pa mkono ndi AV fistula kapena kumezanitsa (ndipo musatenge BP pa mkono pomwe fistula yamtsogolo ikukonzekera). - OSATI kutulutsa magazi kapena kuyambitsa mzere wolowetsa mtsempha (IV) mumkono wofikira dialysis. - MUSAmalole zomangira zotchinga, manja zotanuka, zikwama, matumba a golosale, kapena kugona mutu utatsamira pamkono umenewo.

Gawo 2: Zadzidzidzi Zadzidzidzi za Dialysis: Hyperkalemia ndi Flash Pulmonary Edema¶

Impso zathanzi zimasefa 150 mpaka 180 malita a magazi tsiku lililonse, kutulutsa zakudya zambiri potaziyamu (\(K^+\)), madzi, sodium, asidi, ndi poizoni wa uremic. Wodwala wa hemodialysis yemwe amapanga mkodzo pang'ono kapena osatulutsa (** anuric **) zimadalira kwathunthu magawo awo a dialysis a maola 4 katatu pa sabata (Lolemba/Lachitatu/Lachisanu kapena Lachiwiri/Lachinayi/Loweruka). Wodwala akaphonya ngakhale ** gawo limodzi kapena awiri a dialysis ** (kapena panthawi yayitali ya maola 72 kumapeto kwa sabata pakati pa Lachisanu/Loweruka ndi Lolemba/Lachiwiri), ngozi ziwiri zoyika moyo zimayamba mwachangu:

1. Hyperkalemia Yoika Moyo Pachiwopsezo (Potaziyamu Yokwera M'magazi, "Silent Heart Stopper")¶

Potaziyamu m'magazi wokhazikika amakhala wokhoma pakati pa \(3.5\mawu{ndi}5.0\mawu{mmol/L}\) (\(mEq/L\)). Pamene potaziyamu ikukwera pamwamba pa \(6.0\text{mpaka }6.5\text{mmol/L}\) pambuyo pophonya gawo la dialysis (kapena mutadya zakudya za potaziyamu wambiri, kuvulala kwa minofu, kutuluka magazi m'mimba, kapena kutenga ACE inhibitors/spironolactone/NSAIDs), kumachepetsa mphamvu yamagetsi yopumula ya maselo a ** cardiom cell ndi ma cell a mtima.

Chifukwa chiyani Hyperkalemia Ndi Yowopsa Kwambiri: ** Mosiyana ndi matenda ambiri, **hyperkalemia imatha kuyambitsa kumangidwa kwamtima mwadzidzidzi (sine-wave ventricular fibrillation kapena asystole) popanda chenjezo lisanachitike *, kapena imatha kutengera vuto la minyewa ngati Guillain-Barre syndrome: - Zizindikiro Zoyamba Zochenjeza za Neuromuscular (Nthawi zambiri Zosowa): - Kulira kapena "zikhomo ndi singano" (paresthesias) kuzungulira milomo, lilime, manja, ndi mapazi. - Kufooka kwambiri kwa mwendo wokwera kwambiri (Hyperkalemic Flaccid Paralysis): Wodwala mwadzidzidzi amamva kuti miyendo yake "yapangidwa ndi mtovu," sangathe kuyimirira pampando kapena pabedi, ndipo kufooka kumakwera kupita ku thunthu ndi manja. - Mseru kwambiri, kusanza, kapena kupweteka m'mimba. - Zizindikiro za Chenjezo la Mtima: - Kugunda kwa mtima pang'onopang'ono mwadzidzidzi (bradycardia), kudumpha kwa mtima, kugunda kwa mtima, chizungulire, kapena kukomoka. - Pa chithandizo chamankhwala ** 12-kutsogolera ECG **, kukwera kwa potaziyamu kumapanga kupita patsogolo kwachidule: ** wamtali, wokhala ndi "mafunde a T-pamtunda" ** $ kumanja $ kuphwanyidwa / kusakhalapo kwa mafunde a P ndi nthawi yayitali ya PR $ rightarrow $ ** yowonjezera QRS zovuta ** $ muvi wa kumanja $ siime kugunda kwachiwiri * "pamtima".

** Momwe Ma Paramedics ndi Zipatala Amapulumutsira Wodwala Wa Hyperkalemic Mphindi: ** Mukauza 911 / 112 / 999 dispatcher "Wodwala dialysis yemwe adaphonya chithandizo chofooka mwendo komanso kukayikira hyperkalemia," othandizira ndi madotolo azadzidzidzi amatsatira njira zitatu zopulumutsa moyo: 1. Simitsa Minofu Yamtima Mphindi 1 mpaka 3: Mtsempha Kalcium Gluconate (\(10\%\), \(10\text{ to }30\text{ mL}\))** kapena Calcium Chloride samatsitsa potaziyamu m'magazi, koma nthawi yomweyo imatchinjiriza nembanemba yamtima mkati mwa minyewa yamagetsi potaziyamu amachotsedwa. 2. Sinthani Potaziyamu M'kati mwa Maselo mu Mphindi 15 mpaka 30: Mtsempha insulin yokhazikika (\(10\text{ units}\)) yophatikizidwa ndi intravenous dextrose (glucose), nebulized albuterol (salbutamol, $10\text{}mg ndi 20)carbon carbon yochuluka (ngati acidic) amachotsa potaziyamu m'magazi kubwerera m'maselo amthupi kwakanthawi. 3. Chotsani Potaziyamu Kwamuyaya M'thupi: Zomangira potaziyamu zam'mimba (sodium zirconium cyclosilicate [Lokelma], patiromer [Veltassa], kapena sodium polystyrene sulfonate [Kayexalate]) ndi mankhwala odziwikiratu a hemodialysis (mankhwala otsimikizika).

2. Acute Fluid Overload (Flash Pulmonary Edema) ndi Uremic Pericarditis¶

Popanda kutulutsa mkodzo wa impso, chikho chilichonse chamadzi, supu, ayezi, kapena zipatso zomwe wodwala dialysis amadya zimakhala mkati mwa magazi ndi minofu. Mukaphonya 1 mpaka 2 mankhwala a dialysis, 3 mpaka 6 malita amadzimadzi ochulukirapo amatha kubwerera m'mapapo (acute cardiogenic/volume pulmonary edema) ndi kuzungulira mtima (**uremic pericarditis / tamponade yamtima ): - Zizindikiro za Flash Pulmonary Edema: - Kupuma movutikira kwambiri komwe kumapangitsa kosatheka kugona pabedi (orthopnea). - Kupumira mpweya, kupuma movutikira ("mpweya wamtima"), kugwedezeka kapena kugwedezeka kwa mpweya, ndi kutsokomola kofiira kofiira. - Kutupa koopsa (edema) m'miyendo, m'miyendo, m'munsi, ndi m'maso, komwe kumayenderana ndi kuthamanga kwa magazi komwe nthawi zambiri kumapitilira \(180/110\text{ mmHg}\). - ** Zizindikiro za uremic pericarditis: ** - Ululu wakuthwa, wobaya pachifuwa kuseri kwa fupa la pachifuwa lomwe ** limakula kwambiri likagona chagada ndipo limamveka bwino mukakhala tsonga ndi kutsamira. - Poyikira Thandizo Loyamba Pakuchulukira Kwamadzi: - Mukhazikitseni boti mowongoka ndi magiredi 90 miyendo yonse ikulendewera m’mbali mwa bedi kapena mpando. Mphamvu yokoka imatenga pafupifupi \(500\text{ mpaka }800\text{milliliters}\) ya magazi a venous m'miyendo yakumunsi m'malo mowalola kuti alowe m'mapapo odzaza. - Musamakweze miyendo ya wodwala dialysis wochulukirachulukira, ndikusiya zakumwa zonse zapakamwa podikirira ambulansi.

Kupulumuka Pangozi: "Potaziyamu Yotsika ya Masiku atatu, Chakudya Chadzidzidzi Choletsa Madzi"¶

Panthawi ya mphepo yamkuntho, kusefukira kwa madzi, mphepo yamkuntho, kapena kuzimitsa magetsi pamene zipatala za dialysis zimatsekedwa kwakanthawi kwa maola 48 mpaka 72, kutsatira ** National Kidney Foundation (NKF) ndi Centers for Disease Control and Prevention (CDC) "3-Day Emergency Renal Diet"** imasunga potaziyamu ndi madzimadzi am'mapapo mpaka kupulumuka:

Zadzidzidzi Zadzidzidzi mu Peritoneal Dialysis (PD) odwala: Cloudy Bag Peritonitis¶

Odwala omwe amachita Peritoneal Dialysis (PD) kunyumba pogwiritsa ntchito catheter yofewa ya silikoni m'mimba mwawo (Tenckhoff catheter) amakumana ndi vuto lapadera lotchedwa PD Peritonitis: - Mmene mungachiwone nthawi yomweyo: Yang'anani m'thumba la pulasitiki loyera mukasinthana. Nthawi zambiri, peritoneal dialysis fluid (**effluent **) imawoneka bwino ngati mkodzo wachikasu wotumbululuka (muyenera kuwerenga zolemba zamanyuzipepala momveka bwino muthumba lathunthu). Ngati madzi okhetsedwa akuwoneka ngati amtambo, amkaka, otuwa, kapena apinki, KAPENA wodwala akayamba kuwawa m'mimba, kumva kuwawa, nseru, kapena kutentha thupi, tenga Acute Bacterial Pertonitis. - Zochitika Mwamsanga: 1. Sungani chikwama cha mitambo (chitsekeni ndikupita nacho kuchipatala kapena kuchipatala cha PD kuti anamwino athe kutulutsa madzi kuchokera m'thumba kuti awerenge kuchuluka kwa maselo ndi chikhalidwe cha mabakiteriya). 2. Imbani foni Namwino wanu wa maola 24 a peritoneal Dialysis / On-Call Nephrologist kapena pitani ku dipatimenti yazadzidzi nthawi yomweyo kuti mupeze intraperitoneal (IP) kapena maantibayotiki olowetsa m'mitsempha. 3. Ngati catheter ya PD yadulidwa mwangozi kapena seti yotumizira imaduka mwaukhondo kapena dothi: Nthawi yomweyo sungani pulasitiki yoyera Beta-Clamp (kapena tsinani / sungani chubu chofewa molimba pakati pa chotupacho ndi khungu lanu la m'mimba), tsegulani potulukapo ndi yopyapyala wosabala, musathire madzimadzi mu chubu lotseguka nthawi yomweyo, ndikupita kuchipinda chanu chadzidzidzi. kusintha kwa adapter/transfer-set ndi prophylactic antibiotics.

Zolemba zenizeni za 911/112/999 ndi Hospital Triage¶

• Kwa AV Fistula kapena Graft Bleed:

  *"Ndikufuna ambulansi yadzidzidzi ku [Adilesi Yeniyeni]. Wodwala ndi wodwala matenda a hemodialysis amene mkono wake AV [fistula / graft] waphulika ndipo akutuluka magazi kwambiri. Ndikugwira pinpoint chala chimodzi cholunjika mwachindunji pamalo a singano, ndagoneka wodwalayo, ndikukweza mkono pamwamba pa mtima. Timafunikira chithandizo chamankhwala chothandizira moyo ku chipatala * ".

• Kwa Wodwala Dialysis Wophonya Womwe Akuganiziridwa Kuti Ndi Hyperkalemia kapena Kuchulukira Kwa Madzi:

  "Ndikufuna ambulansi yadzidzidzi ku [Adiresi Yeniyeni] kwa wodwala hemodialysis yemwe gawo lake lomaliza la dialysis linali [X] masiku apitawo pa [Tsiku]. [Iye/Iye] tsopano ali ndi [kufooka kwakukulu kwa mwendo ndi kunjenjemera / kugunda kwapang'onopang'ono / kupuma movutikira kwambiri ndipo sangathe kugona mosatekeseka]. Tikukayikira kuti Hyperkalemia yoopsa kwambiri [ndi/kapena Flash paramediing] Chonde dispa 12-lead ECG ndi kupereka mtsempha wa calcium gluconate nthawi yomweyo."

Odwala omwe ali ndi dialysis mu thumba ladzidzidzi¶

• Mapepala anu aposachedwa kwambiri a Hemodialysis Treatment Sheet ("Run Sheet"): Akuwonetsa Kulemera kwanu (kulemera komwe mukufuna), kukula kwa sefa ya dialyzer, kuthamanga kwa magazi, kuchuluka kwa potaziyamu osambira, ndi mlingo wa heparin kotero kuti chipatala chilichonse chadzidzidzi chikhoza kukuthandizani.
• Zipewa 2 mpaka 3 zoyera za mabotolo apulasitiki, zopyapyala za \(4\times4\) zopyapyala, ndi padi yamalonda ya hemostatic (ChitoGauze / Celox) m'thumba kapena chikwama chanu nthawi zonse.
• Chingwe chosalala cha pulasitiki (catheter clamp) ngati muli ndi chifuwa kapena khosi Permcath, kapena Beta-Clamp yoyera ngati muli ndi peritoneal Dialysis.
• **Mapaketi adzidzidzi amasiku atatu a mapaketi opangira potaziyamu-kutsitsa ** (sodium zirconium cyclosilicate [Lokelma] kapena patiromer [Veltassa]) ndi zomangira za phosphate.

Mafunso omwe amafunsidwa pafupipafupi¶

Chifukwa chiyani kukulunga chopukutira pa dialysis fistula yomwe imatuluka magazi kumapangitsa kuti odwala azikhetsa magazi mpaka kufa?¶

Fistula ya arteriovenous (AV) imanyamula magazi otsika pansi pa kuthamanga kwapakati pa 600 mpaka 2,000 milliliters pa mphindi imodzi kupyolera mu kabowo kakang'ono ka 1 mpaka 2-millimeter pakhungu. Kumanga chopukutira chosamba chosamba m'manja kumabisa malo omwe akutuluka magazi kuti asawoneke komanso kufalikira mofooka pamalo ambiri m'malo motseka kabowo kakang'ono. Mkati mwa mphindi zitatu kapena zisanu, wodwalayo amatha kutaya theka la kuchuluka kwa magazi ake mu chopukutira ndi kugwidwa ndi mtima wakupha. Nthawi zonse yang'anani pabalalo ndikusindikiza chala CHIMODZI, chala chachikulu, kapena kapu ya botolo lapulasitiki loyera pa dzenjelo kwa mphindi 15 mpaka 20 mosalekeza.

Ngati matenda a dialysis fistula akusiya kutuluka magazi pambuyo pa mphindi 15 za kupsyinjika kwa chala kunyumba, ndichifukwa chiyani ndikufunikabe kupita kuchipatala?¶

Kutaya magazi kodziwikiratu kuchokera ku dialysis fistula kapena kumezanitsa kunja kwa chipatala nthawi zambiri kumachitika chifukwa cha kupatulira ndi kukokoloka kwa khoma lamkati la mitsempha yamagazi kapena matenda obisika otengera chombo. Ngakhale magaziwo akamatsekereza bowo lomwe lili pansi pa chala chanu, kuthamanga kwa magazi mkati mwa fistula nthawi zambiri kumapangitsa kuti magazi aziundana pakadutsa maola angapo, nthawi zambiri wodwalayo akagona pabedi. Nyumba iliyonse ya fistula imatuluka magazi iyenera kuyang'aniridwa mwamsanga mu dipatimenti yadzidzidzi ndi katswiri wa mitsempha.

Kodi ndingadziwe bwanji ngati munthu amene adaphonya gawo la dialysis ali ndi potaziyamu wowopsa (hyperkalemia)?¶

Kuchuluka kwa potaziyamu m'magazi kumawononga mphamvu yamagetsi ya minyewa ndi minofu isanayimitse mtima. Yang'anirani kufooka kwakukulu kwadzidzidzi m'miyendo yonse iwiri (kuvuta kuyimirira kapena kuyenda), dzanzi kapena kunjenjemera mozungulira milomo, lilime, manja, kapena mapazi, nseru wosadziwikiratu, kapena kugunda kwapang'onopang'ono kapena kosakhazikika. Chifukwa hyperkalemia imatha kuyambitsa kumangidwa kwamtima mwadzidzidzi nthawi iliyonse, imbani 911/112/999 nthawi yomweyo kuti azachipatala athe kupanga ECG ndikuyika calcium yoteteza mtima m'mitsempha.

Kodi ndingatani ngati nkhanambo yakuda ipanga chotupa pa dialysis fistula?¶

Mphere wakuda (eschar), khungu lonyezimira ngati pepala, kufiira, kapena madontho ting'onoting'ono amagazi omwe akutuluka pa nkhanambo yakale pa AV fistula kapena kumezanitsa ndi chizindikiro cha maopaleshoni owopsa omwe akubwera. OSATIKHA, kukanda, kapena kuchapa nkhanambo kwambiri, OSATI kuti aliyense alowetse singano ya dialysis kupyola kapena pafupi ndi nkhanamboyo, sungani kapu ya botolo yoyera ndi yopyapyala m'manja mwanu, ndipo pitani kuchipatala kapena kwa dokotala wa opaleshoni ya mitsempha tsiku lomwelo kuti khomalo likonzedwe lisanaphulike.

Magwero afufuzidwa¶

• National Kidney Foundation (NKF, United States): KDOQI Clinical Practice Guideline for Vascular Access: Kusintha kwa 2019 (Lok et al., American Journal of Kidney Diseases, chithandizo chadzidzidzi cha AV fistula/graft hemorrhage, pseudoaneurysms, ndi botolo-kapu / NKF njira yopangira zovuta za anthu) Matenda a Impso.
• UK Kidney Association (UKKA), Vascular Society of Great Britain and Ireland (VSGBI), ndi British Society of Interventional Radiology (BSIR): Kutaya Kwachiwopsezo Kwa Moyo Kuchokera ku Mitsempha ya Mitsempha ya Arteriovenous: Bottle-Cap / Pinpoint Pressure Patient Safety Alert and Clinical Guidelines.
• European Resuscitation Council (ERC) ndi American Heart Association (AHA): *Malangizo a Cardiopulmonary Resuscitation and Emergency Cardiovascular Care: Electrolyte Abnormalities and Life-threateing Hyperkalemia mu Dialysis Odwala *.
• International Society for Peritoneal Dialysis (ISPD): Malangizi a Malangizo a ISPD Peritonitis: Kusintha kwa 2022 pa Kupewa ndi Kuchiza (Li et al., Peritoneal Dialysis International).
• Centers for Disease Control and Prevention (CDC, United States) & Impso Community Emergency Response (KCER): Kukonzekera Mwadzidzidzi ndi Zakudya Zamasiku Atatu za Renal Disaster Disaster for Hemodialysis Patients.

Maupangiri ogwirizana¶

• Kuwongolera magazi kwambiri, kunyamula mabala, ndi ma tourniquets
• Kuvulala kwakukulu kwa impso, rhabdomyolysis, ndi kuyesa kwa mkodzo wakuda
• Sepsis ndi septic shock kuzindikira ndi kuyankha mwadzidzidzi
• Kuzindikira modzidzimutsa komanso kasamalidwe ka chithandizo choyamba
• Cardiopulmonary resuscitation (CPR) ndi AED guide