Gutegura ibiza kubakoresha pompe ya insuline nabarwayi ba Dialysis: Guhindura intoki za siringi hamwe nimirire ya Potasiyumu¶

Iyo inkubi y'umuyaga, umwuzure, kwimura inkongi y'umuriro, cyangwa amashanyarazi y'iminsi myinshi isenyutse, abantu babana na diyabete iterwa na insuline cyangwa indwara y'impyiko zanyuma bahura n’ikibazo cyo guhitana ubuzima bwabo mu masaha 12 kugeza 72. Niba pompe ya insuline yamenetse, igatakaza ingufu za batiri, cyangwa ikabura uburyo bwo kwinjiza ibintu mugihe cyo kwimuka, glucose yamaraso ihitana abantu benshi diabete ya ketoacidose mugihe cyamasaha 4 kugeza 8 keretse niba umurwayi ashobora guhita ahindurwamo intoki za syringe akoresheje gahunda yabanje kubarwa. Muri icyo gihe, niba imihanda yuzuye cyangwa umuriro w'amashanyarazi wahagaritse ibigo by’indwara ya hemodialyse y’indwara mu gihe cy’iminsi ibiri cyangwa itatu, abarwayi b’impyiko za anuric bahura n’umutima wicecekeye bitewe na potasiyumu y’amaraso yiyongera cyangwa guhumeka bitewe n’amazi arenze urugero keretse bahise bafunga ibiryo bikabije by’iminsi 3 byihutirwa. Mbere yuko ibyihutirwa bibaho, bika umuyoboro wabigenewe wabigenewe imiti yangiza ubushyuhe, gufata mu mutwe uko wabyitwaramo dialyse fistula na hyperkalemia byihutirwa, kandi uzigame aho utuye nimero yihutirwa (911 muri Amerika na Kanada, 112 mu bihugu by’Uburayi, 999 mu Bwongereza) ku ikarita itagira amazi.

Kora ubu¶

1. ** Shira kandi uhindure ikarita yawe ya Insulin Pump Basal na Bolus Igenamiterere uyumunsi. Andika kopi imwe yanduye imbere ya diyabete yawe go-bag hanyuma ubike kopi ya kabiri mumufuka wawe.
2. ** Bika insuline ikora cyane, insina ya U-100, hamwe ninshinge zamakaramu imbere mubikoresho byihutirwa. ** Pompe ya insuline irimo insuline ikora byihuse (nka lispro, aspart, cyangwa glulisine). Baza umuganga wawe wa endocrinologue kugirango yandike ibikenewe kuri ** ikaramu ya insuline ya basal ikora igihe kirekire (nka insuline glargine cyangwa insuline degludec), byibuze ** 30 sterile U-100 insuline ya insuline ** (0.3 mL cyangwa 0.5 mL ubushobozi), na ** milimetero 4 cyangwa urushinge rw'ikaramu ya milimetero 5 kugirango ubashe guhinduranya inshinge nyinshi za buri munsi (MDI) mugihe pompe ivunitse cyangwa yatakaje imbaraga.
3. ** Gupakira metero gakondo ya glucose yamaraso, imirongo 100 yipimisha, imirongo ya ketone, hamwe na glucagon yiteguye gukoresha. Buri gihe ujye upakira glucometer gakondo yintoki hamwe na bateri yibiceri-selile, amaraso cyangwa inkari ** ibizamini bya ketone **, izuru cyangwa auto-inshinge ** glucagon **, na garama 300 za glucose cyangwa ibinini bya glucose byihuta.
4. ** Ku barwayi ba hemodialyse: Shyira Hemodialysis wanditse "Run Sheet" hamwe na Vascular Access Bleed Kit mu gikapu kitarimo amazi. Gapakira iyi mpapuro hamwe na ** 3 isukuye yamacupa ya plastike isukuye **, sterile 10 x 10 centimeter (4 x 4 inch) amakariso ya gaze, hamwe na clamp ya catheter.
5. ** Wubake iminsi 3 yabugenewe-Potasiyumu, Sodium nkeya, Isukari Yihutirwa Yibiryo byihutirwa. abazungu cyangwa bogeje sodium-sodium tuna) hiyongereyeho igikombe gito cyo gupima kugirango ugabanye amazi yose kugeza kuri mililitiro ** 500 kugeza kuri 700 (ounci 16 kugeza 24) kumasaha 24 **.
6. ** Baza neprologue wawe kubijyanye n’ibiza by’ibipaki bya potasiyumu yo mu kanwa. ** Niba wakiriye neza indwara ya hemodialyse, baza umuganga w’impyiko niba ugomba gutwara ibintu byihutirwa by’iminsi 3 byitwa potassium yo mu kanwa igezweho (nka ** sodium zirconium cyclosilicate ** cyangwa ** patiromer **) hamwe n'amabwiriza yanditse mugihe utangiriye gufata ivuriro niba utangiye gufata.

Igiti cyemezo: Kunanirwa kwa pompe ya insuline cyangwa gufunga ivuriro rya dialyse mugihe cyibiza¶

Koresha iyi triage mugihe mugihe cyijimye, kwimuka, cyangwa umuyaga ukabije kugirango wirinde diyabete ya ketoacidose, hypoglycemia ikabije, gufatwa k'umutima wa hyperkalemique, hamwe na flash pulmonary edema.

flowchart TD
    Start["Ibiza byibasiwe: Kubura amashanyarazi, kwimuka, cyangwa gufunga ivuriro"] --> PatientType{"Ni ubuhe buryo bwo kwivuza bukoreshwa?"}

    PatientType -->|"Pompe ya insuline / Umukoresha CGM"| PumpCheck{"Pompe ya insuline yaba idahwitse, yishyuwe, kandi yinjizwamo ibikoresho?"}
    PumpCheck -->|"Yego, gukora bisanzwe"| PumpConserve["1. Shira pompe yumuriro muri banki yingufu zishobora kwishyurwa 50%; 2. Kurinda inzabya za insuline mumifuka ikoreshwa namazi (15C kugeza 30C); 3. Kugenzura igenzura rya CGM; gumana urutoki rwa metero na glucose kumubiri"]
    PumpCheck -->|"Oya: Pompe yacitse, itose, bateri yapfuye, cyangwa hanze ya infusion"| PumpFail["SHAKA KUBIKORESHWA BIKORESHWA (MDI) PROTOKOL AKANYA:; 1. Kuraho urumogi rwa pompe kuruhu kugirango wirinde urujijo; 2. Kuramo ikarita yanditswemo Pomp-to-Syringe Ikarita iva mu gikapu; 3. Ufite Insuline Yibanze Yigihe kirekire (Glargine / Degludec)?"]

    PumpFail -->|"Nibyo, gira Insuline Basal"| GiveBasal["Gutera inshinge zateganijwe amasaha 24-Gukora Basal dose ukoresheje ikaramu cyangwa U-100; + Shyiramo insuline yihuta mbere yo kurya no gukosora glucose"]
    PumpFail -->|"Nta Insuline Yibanze iboneka"| RapidBridge["AKARERE KA RAPID-GUKORA: Injiza ibarwa 3-kugeza-4-Amasaha Yibanze ahwanye na insuline yihuta; ukoresheje U-100 syringe buri masaha 3 kugeza kuri 4 kumanywa nijoro + ketone"]

    PatientType -->|"Hemodialysis cyangwa Peritoneal Dialysis Murebwayire"| DialCheck{"Ese ikigo cya dialyse yawe yo hanze irakinguye cyangwa iragerwaho?"}
    DialCheck -->|"Ivuriro rifunze cyangwa umuhanda wuzuye"| DialDiet["SHAKA IMINSI 3 YIHUTIRWA RENAL PROTOCOL YO GUKIZA:; 1. Tangira byimazeyo iminsi 3-Potasiyumu (<1.500 mg / kumunsi) Kurya ako kanya; 2. Gabanya amazi ya TOTAL gufata 500 kugeza 700 mL (16 kugeza 24 oz) mumasaha 24; 3. Hamagara umurongo wa telefone w’ibiza / KCER kugirango ubone aho ufunguye; 4. Fata ibyihutirwa bya potasiyumu byihutirwa niba byateganijwe na neprologue"]
    DialDiet --> RedFlags{"Intege nke zose zamaguru, kunanirwa iminwa, guhubuka buhoro, cyangwa guhumeka umwuka?"}
    RedFlags -->|"Yego"| CallEMS["Hamagara 911/112/999 Ako kanya:; Menyesha 'Dialysis Patient hamwe na Hyperkalemia ukekwaho cyangwa Indwara y'ibihaha'; Icara bolt uhagaze kuri dogere 90 n'amaguru amanitse"]
    RedFlags -->|"Oya"| MonitorWeight["Gupima buri munsi (kugabanya inyungu kugera kuri 0.5-1.0 kg / kumunsi) hanyuma wimuke ufungure ibitaro"]

Igice cya 1: Pompe ya insuline hamwe no gutegura ibiza bya CGM (Igikoresho cyo Kurokoka Pomp-Failure)¶

Kurenga kimwe cya kabiri cyabantu barwaye diyabete yo mu bwoko bwa 1 hamwe nabenshi barwaye diyabete yo mu bwoko bwa insuline yo mu bwoko bwa 2 bishingikiriza kuri ** ikomeza iterwa na insuline yo mu bwoko bwa insuline (CSII) ** ikoresheje pompe zometse kuri pompe cyangwa pompe yamashanyarazi, ifatanije na ** Continuous Glucose Monitor (CGM) ** muri sisitemu ya Automatic Insulin Delivery (AID) Hybrid ifunze-loop. Mugihe ibyo bikoresho bitanga igenzura ryumunsi-kuwundi, ryerekana ingingo enye zoroshye zo gutsindwa mugihe cyibiza:

1. ** Kwishingikiriza kuri elegitoroniki na Bateri: ** Amapompo agezweho ya pompe na pompe-pompe ikora kuri bateri ya lithium-ion yimbere (cyangwa bateri yihariye ya lithium AA) ipfa muminsi 2 kugeza 5 idafite amashanyarazi.
2. ** Ibyuma bya Infusion ibikoresho: ** Ntushobora gukuramo insuline muri karitsiye ya pompe yabanje kuzuzwa cyangwa kuyitera mumubiri wawe keretse ufite ** inshinge ya U-100 ya insuline ** (cyangwa inshinge z'ikaramu z'ikaramu ya insuline). Niba plastike yawe ya nyuma yashizemo kink kumukandara mugihe urimo gupakira imodoka yimuka, pompe yawe iba plastike idafite akamaro.
3. ** Kubura Depot ya Subcutaneous Basal: ** Kuberako pompe zinjiza gusa insuline ikora byihuse (insuline lispro, insuline aspart, cyangwa insuline glulisine) igera muminota 60 kugeza kuri 90 kandi igashira mumasaha 3 kugeza kuri 5, guhagarika itangwa rya pompe bisiga umubiri hamwe na insuline zeru mumasaha 2 kugeza 3.
4. ** Igicu na Smartphone Ifunga: ** Abakoresha benshi babika ibiciro byabo byibanze, ibipimo bya karbasi, nibintu byunvikana gusa muri menu ya pompe cyangwa portal igicu. Iyo ecran ya pompe ivunitse cyangwa bateri ya terefone ipfuye, ntamurwayi cyangwa umuganga wihutirwa wihutirwa uzi insuline ya buri munsi.

Intambwe ku yindi: Gutegura Ikarita yawe Yanditse-Kuri-Siringe Ikarita¶

Buri mukoresha wa pompe ya insuline agomba kwicarana numu endocrinologue wabo cyangwa Impamyabumenyi Yizewe na Diyabete Yita ku Burezi (CDCES) rimwe mu mwaka kugirango yuzuze ikarita yumubiri, idafite amazi ** Ikarita yo Guhindura Ikarita Yihutirwa **. Ntuzigere ukeka kuri dosiye ya insuline mugihe cyibibazo. Ikarita yawe igomba kwandika iyi mibare itandatu neza:

Nigute ushobora kuva muri pompe ya insuline yananiwe kugera inshinge zintoki (Scenarios ebyiri)¶

Iyo pompe yawe yananiwe, ikarohama mumazi yumwuzure, cyangwa ikabura aho yashizemo infusion, kumubiri ** kudafungura no gukuramo ibishishwa bya pompe ishaje ya kanseri cyangwa pompe ako kanya ** bityo ukaba uzi neza ko nta insuline itunguranye isohoka, hanyuma ukurikire ibintu bihuye nibikoresho byawe:

Urugero A: Ufite Insuline Yibanze-Yigihe kirekire (Glargine, Detemir, cyangwa Degludec) NA Insuline Yihuta¶

Ubu ni bwo buryo bwizewe, busanzwe bwa zahabu bwo kugarura ibiza byasabwe n’ishyirahamwe ry’Abanyamerika Diyabete (ADA) **, ** Diyabete yo mu Bwongereza **, hamwe n’ishyirahamwe ry’ibiza ry’ibiza rya Diyabete (DDRC) **: 1. ** Koresha gahunda yawe ya Long-Acting Insuline ukoresheje ikaramu cyangwa U-100 syringe: ** Reba ikarita yawe yo guhindura kugirango umuganga wawe abare mbere yo kubara rimwe-buri munsi (cyangwa kabiri-buri munsi). Kuberako insuline ikora cyane ifata ** amasaha 2 kugeza kuri 4 ** kugirango igere kubikorwa byuzuye nyuma yo guterwa bwa mbere cyane, gahunda yawe yinzibacyuho yanditse irashobora kugutegeka gutanga akantu gato 1-kugeza-2-y-amasaha-yihuta-yihuta mugihe nyacyo cyo guhagarika pompe niba isukari yamaraso yawe imaze kuba hejuru. 2. ** Kugabanya insuline yibanze kuri 10% kugeza kuri 20% mugihe ukora imirimo ikomeye yibiza cyangwa kugaburira ibiryo: ** Gutwara imifuka yumucanga, gukora urugendo rurerure kugirango wimuke, cyangwa kurya utuntu duto twihutirwa byongera cyane insuline. Muganire "Kugabanya Ibikorwa Byibanze Kugabanuka" (akenshi 80% byibanze bisanzwe) kurikarita yawe yanditse mbere. 3. ** Tanga Insuline Yihuta mbere yo kurya no gukosora glucose: ** Koresha formulaire yawe yanditse ** ICR ** na ** ISF ** ukoresheje ikaramu ikora byihuse cyangwa siringi U-100 yakuwe mumashanyarazi yawe yihuta. Tegereza byibuze amasaha 3 kugeza kuri 4 hagati ya dosiye yo gukosora ** kugirango wirinde "guteranya insuline" (gutera inshinge ya kabiri yo gukosora mbere yuko ishoti ryihuta ryihuta rirangira gukora, bitera hypoglycemia itinze cyane).

Scenario B: Pompe yawe yaravunitse kandi GUSA ufite vial / cartridge yawe ya Insuline Yihuta-Yihuta (Nta Insuline Yibanze ikora)¶

Niba warimutse ukoresheje pompe yawe gusa hamwe na vial yayo ya insuline ikora byihuse (lispro, aspart, cyangwa glulisine) kandi ukaba udafite insuline yibanze ikora: 1. ** Urashobora gukuramo insuline ikora byihuse mu kirahure cy'ikirahure, ikigega cya pompe ya pulasitike, cyangwa se septum ya rubber ku isonga ry'ikaramu ya insuline ikoreshwa ukoresheje siringi isanzwe ya U-100. ** 2. ** Ntuzigere utera dose yuzuye yamasaha 24 ukoresheje insuline ikora byihuse: ** Gutera ibice 20+ bya insuline ikora byihuse icyarimwe bizatera hypoglycemia yica muminota 90. 3. ** Kurikiza amasaha 3 kugeza kuri 4-Yihuta-Gukora Micro-Basal Gahunda: ** Kuberako insuline ikora yihuta imara amasaha 3 kugeza kuri 4 munsi yuruhu, ugomba gushyiraho induru hanyuma ugatera ** igice cyamasaha 3 cyangwa amasaha 4 yumuti wawe wibanze buri masaha 3 kugeza kuri 4, amasaha 24 kumunsi (harimo kubyuka kabiri mugihe cya nijoro) **, wongeyeho ifunguro hamwe na farumasi ikorwa hamwe na farumasi ikabije, kugeza wageze kuri farumasi ikabije. - * Urugero ruva mu ikarita yawe yanditse: * Niba pompe yawe isanzwe 0.8 units/hour ijoro ryose, amasaha 4 yintoki yihuta-ikora ikiraro ni $ 0.8 inshuro 4 = 3.2 inyandiko {ibice} $ (byegeranijwe neza ukurikije amabwiriza ya muganga wawe 3 units kuri syringe U-100) yatewe inshinge buri masaha 4.

Iminsi 14 ya Diyabete & CGM Ibiza Go-Bag Kugenzura Urutonde¶

Gapakira ibyo bikoresho mumufuka wikingiye, udafite amazi ufata-ugenda ubitswe kuruhande rwumuryango wawe:

• ** Laminated Yanditse Pompe-kuri-MDI Ikarita yo Guhindura ** hamwe niminsi 14 yimiti yose yo mumanwa.
• ** Insuline Yihuta-Yihuta-Yibanze-Yibanze ya Insuline Yububiko ** ibitswe mumufuka ukonjesha byoroshye, wongeyeho umufuka wa ** ukoreshwa mumazi ukonjesha umufuka ** ukomeza insuline hagati ya dogere 15 $ inyandiko {C na dogere 30 C $ ($ 59 dogere inyandiko {F kugeza kuri dogere 86 dogere F $) ** muminsi 28 idafite amashanyarazi cyangwa urubura. Reba kurinda insuline n'imiti umutekano mugihe umuriro wabuze.
• ** 30 kugeza kuri 50 sterile U-100 insuline ya insuline ** (0.3 mL cyangwa 0.5 mL ingano) NA ** 30 kwisi yose ya mm 4 inshinge zamakaramu **.
• ** 5 kugeza 7 bya pompe yibikoresho, ibigega, cyangwa ibishishwa bifata **, wongeyeho guhanagura inzitizi zuruhu hamwe na kaseti yubuvuzi.
• ** 2 kugeza kuri 3 ibyuma bya sensor ya CGM hamwe na kabili ya transmitter **, hiyongereyeho ** 20.000 mAh USB power bank ** hamwe numuyoboro wamashanyarazi usabwa na pompe yawe niyakira (hiyongereyeho bateri ya lithium AA niba bishoboka).
• ** Imigenzo ya Fingerstick Amaraso Glucose Meter, igikoresho cyo kuguriza, bateri y'ibiceri (CR2032), hamwe na 100 zo kwipimisha ** muri vial zabo zafashwe.
• ** Amaraso ya Beta-Ketone Yipimishije cyangwa Ibice bya Ketone ** Kugenzura niba Diabete ya Ketoacidose ya mbere igihe cyose glucose irenze ** $ 13.9 inyandiko {mmol / L} $ ($ 250 inyandiko {mg / dL} $) ** cyangwa mugihe cy'uburwayi.
• ** Ibikoresho bibiri byo gutabara Glucagon bidateganijwe ** (spray yamazuru cyangwa auto-injeneri yamazi) hiyongereyeho ** 300 + garama ya karubone yoroheje yihuta ** (ibinini bya glucose, udupaki twa glucose, cyangwa udupaki twubuki).
• ** Igikoresho cyurugendo rwikariso rwikuramo ** (cyangwa icupa ryimyenda yo kumesa icupa ryanditseho ** "SHARPS BIOHAZARD" **).

Igice cya 2: Hemodialyse na peritoneal dialyse yiteguye guhangana nibiza¶

Abarwayi bafite Icyiciro cya 5 Indwara Yimpyiko Zidakira (Indwara Yimpyiko Yanyuma, cyangwa ESRD) batunzwe na gatatu-buri cyumweru ** muri centre hemodialysis **, ** home hemodialysis **, cyangwa buri munsi ** peritoneal dialyse (PD) ** bari mubantu bafite ibibazo by’ubuvuzi mu mpanuka kamere zose. Isomo rimwe ryamasaha 4 ya hemodialyse risaba hafi litiro 120 kugeza 160 (litiro 32 kugeza 42) za ultra-pure revers-osmose amazi yatunganijwe ** hamwe nimbaraga zamashanyarazi zitatu. Iyo inkubi y'umuyaga, umutingito, ubukonje bukabije, cyangwa imyuzure bikuyeho umuvuduko w’amazi wa komini cyangwa amashanyarazi, amavuriro ya dialyse y’indwara yo mu karere kose arashobora gufunga icyarimwe mu masaha 48 kugeza kuri 96.

Ingingo ya 1: Fata "Kubaga hakiri kare" Isomo rya Dialysis Yibiza¶

Igihe cyose inkubi y'umuyaga, inkubi y'umuyaga, cyangwa imyuzure ikomeye iteganijwe mbere y'amasaha 48 kugeza kuri 72, abatanga dialyse yo hanze bakora ** "Gahunda yo Kubaga Dialysis Yambere" ** (gukora amasaha 24 yo guhinduranya amasaha 24 kugirango uhamagare umurwayi wese * mbere yuko * umuyaga utangira kugwa). - ** Ntuzigere usiba isomo rya dialyse mbere yumuyaga kugirango upakire cyangwa wimure utabimenyeshejwe: ** Kubona dialyse neza mbere yumuyaga biguha isuku ya amasaha 48 kugeza kuri 72 ya metabolike ya metabolike ifite potasiyumu nkeya na zeru zirenze urugero. - ** Niba wimukiye mu wundi mujyi, fata urupapuro rwanditseho Hemodialysis Yanditse: ** Ikigo icyo ari cyo cyose "umushyitsi" dialyse cyangwa ishami ryihutirwa ryibitaro mukarere kawe ka evacuation ukenera neza neza ** Target Dry Weight (kilogram / pound) **, ubwoko bwinjira mumitsi, protocole ya heparin protokole, hamwe na dialyse ya potasiyumu ($ 1 inyandiko {K}, 2 text {K} bidatinze udatera arththmias cyangwa hypotension.

Ingingo ya 2: Funga kumunsi wiminsi 3 Yihutirwa-Potasiyumu, Amazi Yimpyiko Zifata Amazi mugihe impanuka yibasiye¶

Niba umutingito utunguranye, umwuzure utemba, cyangwa umwijima bikubuza kugera kuri dialyse, ** ibyo washyize mumunwa mumasaha 72 ari imbere bigena niba urokoka . Hatabayeho kuyungurura impyiko, ibintu bibiri byica abarwayi babuze-dialyse byihuse: 1. ** Potasiyumu yimirire (K +): ** Itera potasiyumu yamaraso hejuru ya $ 6.0 inyandiko {kugeza} 7.0 inyandiko {mmol / L} $, itera ubumuga bwamaguru bwamaguru no gufatwa kumutima gutunguranye (fibrillation ventricular cyangwa asystole). 2. ** Fluid na Sodium (Na +): ** Buri mililitiro y'amazi unywa iguma mu mitsi y'amaraso yawe, bigatuma umuvuduko w'amaraso ugera ku rwego rwo hejuru kandi ukuzuza ibihaha byawe amazi ( acute flash pulmonary edema **).

Kurikiza kumugaragaro ** Impyiko zihutirwa zihutirwa (KCER) **, ** Fondasiyo yigihugu yimpyiko (NKF) **, na ** CDC Iminsi 3 Yihutirwa Yihutirwa Yumunsi ** kugeza igihe uzagarukira kumashini ya dialyse:

Amategeko yihariye kubarwayi ba Diyabete Diyabete (Gucunga ibintu byombi hamwe)¶

Hafi 40% kugeza 50% byabarwayi ba dialyse nabo barwaye diyabete. Mugihe c'ibiza, ** ingeso ebyiri zisanzwe zishyamirana **: 1. ** NTUKIGERE ukoresha umutobe wa Orange, Umuneke, Shokora, cyangwa Amata kugirango uvure isukari nke yamaraso (hypoglycemia) niba uri kuri dialyse: ** Ikirahuri kimwe $ 240 inyandiko {mL} $ ($ 8 inyandiko {oz} $) ikirahuri cyumutobe wa orange kirimo hafi ** $ 500 inyandiko {mg} $ ya potasiyumu hiyongereyeho igikombe cyuzuye cyamazi **. Ahubwo, kuvura hypoglycemia (<3.9 mmol/L cyangwa <70 mg/dL) byonyine hamwe na ** ibinini bya glucose, glucose gel tubes, isukari ikomeye ya bombo, ubuki, cyangwa isukari yameza yashonga mu kiyiko 1 cyamazi **, irimo potasiyumu ya zeru ** na fluide idakwiriye **. 2. ** Irinde Hard-Candy / Isukari ya Calorie Boosters ** yanditse kurutonde rwimirire yimpyiko itari diyabete keretse niba urimo kuvura cyane isukari yo mumaraso make cyangwa utwikiriye karubone hamwe na insuline. Ahubwo, koresha ** amavuta ya elayo, amavuta ya canola, amavuta adafite umunyu, cyangwa foromaje ya foromaje ** kumashanyarazi ya sodium nkeya n'umuceri wera kugirango ubone karori yibanze utiriwe utera glucose yamaraso cyangwa potasiyumu yamaraso.

Igice cya 3: Kurinda imiyoboro yawe yimitsi hamwe nurugo rwa peritoneal dialyse mugihe gikomeye¶

1. Ukuboko AV Fistula / Igishushanyo hamwe na Catheter yo hagati Ibikoresho byihutirwa¶

Nkuko bisobanuwe muri twe dialyse fistula yamennye kandi yabuze dialyse ubufasha bwambere, buri murwayi wa hemodialyse agomba kugumisha ibikoresho byo gukingira byiziritse ku mufuka wabo: - ** Igikoresho cyo Kugenzura Amaraso Amashanyarazi: ** Gupakira ** 3 isukuye ya plastike isukuye-icupa ryamacupa **, sterile 10 x 10 cm (4 x 4 in) kwaduka ya gaze, hamwe na paje ya hemostatike. Niba urushinge rwa fistula rwacitse mugihe cyo kwimuka, ** ntuzigere uzinga igitambaro kinini cyo kogeramo ukuboko **; kanda ** urutoki rumwe cyangwa icupa rya pulasitike isukuye isukuye ** mu buryo butaziguye ku mwobo wa pin point mu minota 15 kugeza kuri 20 ikomeza mugihe uzamura ukuboko hejuru yumutima no guhamagara ubutabazi. - ** Kugaragara cyane "NTA BP / OYA IV / DIALYSIS ACCESS INGABO" Alert Medical Alert Wristband: ** Mugihe cyo gutura mu kajagari cyangwa gutabara, wambare umugozi utukura w’ubuvuzi utukura ku kuboko kwa fistula ku buryo inkeragutabara zitigera zinjiza umuvuduko w’amaraso cyangwa ngo winjize umurongo wa IV mu buzima bwawe bwo kubaga. - ** Hagati ya Catheter yo hagati (Permcath) Clamp hamwe n imyambaro itagira amazi: ** Niba ukoresheje dialyse ukoresheje igituza cyangwa ijosi, funga ** clamp ya plastike yimitsi ihindagurika **, imyambaro idafite amazi (Tegaderm), hamwe na capile sterile. Ntuzigere wemerera amazi yumwuzure cyangwa amazi ya robine adatetse gukoraho catheter; niba catheter tubing yamenetse cyangwa ingofero iguye, ** kanda cyangwa kanda umuyoboro ako kanya hagati yo kuruhuka nigituza cyawe ** hanyuma uryame kuruhande rwawe rwibumoso ** umutwe wawe hasi ** kugirango wirinde umwuka mubi.

2. Urugo Peritoneal Dialysis (PD) Mugihe Amashanyarazi¶

Abarwayi bakoresha imashini yamagare yikora (** APD / CCPD **) ijoro ryose murugo barashobora kurokoka umuriro wiminsi myinshi nibategura hakiri kare: - ** Gumana iminsi 7 kugeza kuri 14 Yintoki Twin-Bag CAPD Ibikoresho (Y-set hamwe nudukapu twa drain) mububiko: ** Mugihe amashanyarazi yananiranye kandi umukerarugendo wawe wijoro wihagaritse gukora, hindura ako kanya kuri ** guhanahana imbaraga (Gukomeza Ambulatory Peritoneal Dialysis, cyangwa CAPD) **. Manika igikapu cyumuti hejuru yuburebure bwigitugu hanyuma ushire igikapu cyamazi hasi hasi kugirango gravit itwarwe kandi yuzuze inda yawe nta mashanyarazi. - ** Nigute wasusurutsa neza imifuka yumuti wa PD udafite amashanyarazi cyangwa microwave: ** Ntuzigere ushiramo amazi ya PD akonje cyane, kandi ** ntuzigere ushyushya umufuka wa PD muri microwave ** cyangwa ngo winjize ibyambu bya plastike mumazi yanduye (bitera peritonite yica). Ahubwo, uzingire igikapu cyumye gifunze mu gitambaro cyumye cya ** gisukuye hamwe nubushyuhe bwo mu ntoki cyangwa amacupa y’amazi ashyushye ** (kugumisha amazi yose ku byambu), cyangwa ufate umufuka hejuru yumubiri wawe munsi yigitambaro kugeza ugeze ku bushyuhe bwumubiri ($ 37 dogere C / 98,6 F $). - ** Antisepsis y'intoki idafite amazi: ** Niba amazi ya robine ari munsi y'amazi abira cyangwa akazimya, koresha amaboko yawe amasegonda 60 ukoresheje ** 60% kugeza 80% ukoresheje inzoga zishingiye ku nzoga **, wambare mask yo kubaga, hanyuma uzimye abafana mbere yo guhuza gahunda yawe yo kohereza PD.

Inomero zihutirwa zo mukarere hamwe na protocole yikigo¶

Mugihe c'ibiza byo mu karere, imiyoboro ya dialyse hamwe n’ihuriro rya diyabete itangiza umurongo wa telefoni utishyurwa utishyurwa ku barwayi bimuwe kugira ngo bafungure amavuriro, kashe ya insuline yihutirwa, hamwe n’ubuvuzi:

• ** Amerika: **
• ** Ubuvuzi bwihutirwa: ** Hamagara ** 911 **.
• ** Umuyoboro wihutirwa wimpyiko (KCER) Umurongo wa telefoni: ** Hamagara ** 1-866-901-3773 ** kugirango umenye amavuriro ya dialyse afunguye.
• ** Fondasiyo yigihugu yimpyiko (NKF) Umurongo wubufasha: ** Hamagara ** 1-855-NKF-CARES (1-855-653-2273) ** (Umurongo wihutirwa wa DaVita: ** 1-800-400-8331 **; Umurongo wibiza wa Fresenius: ** 1-800-626-1297 **).
• ** Ihuriro ry’ibiza Diyabete (DDRC) & ADA: ** Hamagara ** 1-800-DIABETES (1-800-342-2383) ** cyangwa urebe ** Ubuvuzi bwiteguye (RxOpen.org) ** kuri farumasi ifunguye.
• ** Kanada: **
• ** Ibikorwa byihutirwa: ** Hamagara ** 911 . Menyesha umuyoboro wimpyiko wintara ( Fondasiyo Yimpyiko yo muri Kanada **: ** 1-800-361-7494 ) na ** Diyabete Kanada ** ( 1-800-BANTING **).
• ** Ubwongereza: **
• ** Ibikorwa byihutirwa: ** Hamagara ** 999 ** (cyangwa ** 112 ), cyangwa ** NHS 111 ** kugirango byandikirwe insuline byihutirwa cyangwa guhuza impyiko. Iyandikishe hakiri kare ku bigo byawe byingirakamaro ' Serivise Yibanze Yambere Kwiyandikisha (PSR) ** kugirango ubone imbaraga zo kugarura no gutanga amazi.
• ** Umuryango w’ubumwe bw’ibihugu by’i Burayi: **
• ** Ibikorwa byihutirwa: ** Hamagara ** 112 **. Witwaze ** Ishyirahamwe ryimpyiko zi Burayi (ERA) ** ikarita y’ibiza hamwe n’ikarita yawe y’Ubwishingizi y’Uburayi (EHIC) ** hamwe n’urupapuro rwanditse rwa dialyse.
• ** Ositaraliya na Nouvelle-Zélande: **
• ** Ibikorwa byihutirwa: ** Hamagara ** 000 ** muri Ositaraliya cyangwa ** 111 ** muri Nouvelle-Zélande. Menyesha ** Ubuzima bwimpyiko Australiya ** (** 1800 454 363 ) cyangwa ** Ubuzima bwimpyiko Nouvelle-Zélande ** ( 0800 543 639 **), hanyuma wiyandikishe nkumukiriya wa ** Ubufasha bwubuzima ** hamwe namashanyarazi hamwe nibikorwa byamazi.
• ** Ubuhinde na Aziya-Pasifika: **
• ** Ibikorwa byihutirwa: ** Hamagara ** 112 ** mubuhinde, ** 119 ** mubuyapani, ** 995 ** muri Singapuru, cyangwa ** 999 ** muri Maleziya na Hong Kong. Gumana kopi yumubiri yandikiwe na dialyse, Hepatite B iheruka, Hepatite C, nibisubizo bya laboratoire ya sida, na gahunda ya insuline.

Ibibazo bikunze kubazwa¶

Kuki umukoresha wa pompe ya insuline adashobora gutegereza amasaha 12 kugeza 24 kugirango amashanyarazi cyangwa pompe isimbure igere?¶

Pompe ya insuline itera gusa insuline ikora byihuse, ikava mumaraso mugihe cyamasaha 3 kugeza 5. Kuberako nta insuline yibanze ikora ibitse munsi yuruhu, guhagarika itangwa rya pompe bitera kubura insuline byuzuye mumasaha 2 kugeza kuri 3. Hatari insuline yibanze, umwijima usuka glucose na ketone acide mumaraso, bigatuma Diyabete Ketoacidose yangiza ubuzima (DKA) mumasaha 4 kugeza 8. Buri mukoresha wa pompe agomba gutwara insuline ndende ikora, insina U-100, hamwe namakarita yanditse kugirango ahindurwe ako kanya iyo pompe yananiwe.

Nshobora gukuramo insuline mu ikaramu ya insuline ikoreshwa cyangwa ikarito ya pompe nkoresheje seringe isanzwe U-100 niba ikaramu cyangwa pompe bimenetse?¶

Nibyo, mugihe insuline iri imbere yikaramu cyangwa cartridge isanzwe ya U-100 yibanze (ibice 100 kuri mililitiro). Niba ikaramu ya insuline ivanze cyangwa pompe ivunitse kandi ukaba udafite inshinge cyangwa ikaramu, shyiramo reberi septum hejuru yikaramu ya U-100 cyangwa cartridge ukoresheje inzoga, shyiramo urushinge rusanzwe rwa U-100 insuline muri membrane, hanyuma ushushanye igipimo cyawe cyuzuye. Ntuzigere ushushanya insuline yibanze (U-200, U-300, cyangwa U-500) muri siringi U-100 udafite amabwiriza yo guhindura abaganga.

Kuki insimburangingo zishingiye kuri potasiyumu (nka NoSalt cyangwa Lite Salt) zica abarwayi ba dialyse mugihe cyibiza?¶

Ibicuruzwa byinshi "sodium-sodium" isimbuza ibirungo bisimbuza sodium chloride na chloride ya potasiyumu nziza. Ikiyiko kimwe cyumusemburo wa potasiyumu chloride usimbuye umunyu urimo miligarama 2,500 kugeza 2.800 za potasiyumu, hafi inshuro ebyiri miligarama 1.500 ntarengwa yibiza kumunsi kumurwayi wa anuric hemodialysis. Kunywa umunyu wa potasiyumu mugihe dialyse yatinze birashobora gutera potasiyumu ya serum hejuru ya 6.5 mmol / L mumasaha kandi bigatera gufatwa kumutima gitunguranye.

Nigute umuntu urwaye diyabete no kunanirwa kw'impyiko kuri dialyse agomba kuvura isukari nke mu maraso (hypoglycemia)?¶

Ntuzigere ukoresha umutobe w'icunga, ibitoki, amata, cyangwa shokora kugirango uvure hypoglycemia niba uri kuri dialyse, kuko umutobe wa orange n'ibitoki byuzuyemo potasiyumu n'amazi menshi. Ahubwo, kurikiza "Itegeko rya 15" ukoresheje garama 15 za karubone nziza, idafite potasiyumu idafite imbaraga: guhekenya ibinini bya glucose 3 kugeza kuri 4, kanda igituba 1 cya glukose, kumira ikiyiko 1 cyubuki cyangwa isukari yo kumeza, cyangwa unywe kuri bombo isukari ikomeye, hanyuma usuzume glucose yamaraso yawe muminota 15.

Ni izihe nyandiko amavuriro y'abashyitsi asaba mbere yo kuvura umurwayi wa dialyse yimuwe?¶

Ibigo byihutirwa byihutirwa bikenera urupapuro rwawe rwo kuvura Hemodialysis ("Urupapuro rwiruka") rugaragaza uburemere bwintego yawe yumye, urugero rwa dialyzer, umuvuduko wamaraso na dialyse, umuvuduko wa potasiyumu na calcium, urugero rwa heparin, urutonde rwimiti, hamwe na Hepatitis B, Hepatite C, hamwe nibisubizo bya laboratoire ya sida. Kubika kopi yamuritse muri go-bag yawe birinda gutinda kwa triage.

Kuyobora¶

• Kurinda insuline n'imiti yangiza ubushyuhe umutekano mugihe umuriro wabuze
• Dialysis fistula yavuye amaraso (icupa-cap protocole) kandi yabuze dialyse hyperkalemia yihutirwa
• Diyabete ketoacidose (DKA) na hyperosmolar hyperglycemic leta
• Kwitegura byihutirwa kubantu bafite ubumuga bakeneye ubuvuzi

Inkomoko nubuyobozi¶

• ** Impyiko zihutirwa zihutirwa (KCER) & Ibigo bishinzwe kurwanya no gukumira indwara (CDC, Amerika): ** * Gutegura ibihe byihutirwa: Imfashanyigisho kubantu kuri Dialysis * (CMS Pub.
• ** Fondasiyo yigihugu yimpyiko (NKF, Reta zunzubumwe zamerika) & Ishyirahamwe ryimpyiko zo mubwongereza (UKKA): ** * Gutegura ibihe byihutirwa: Indwara zimpyiko zidakira hamwe no kugenzura indwara ya Hemodialysis *.
• ** Ihuriro ry’ibiza bya Diyabete (DDRC), Ishyirahamwe ry’Abanyamerika Diyabete (ADA), & Sosiyete Endocrine: ** * Gahunda y’abarwayi ba Diyabete Gutegura gahunda y’abarwayi no kuva muri pompe ya insuline ukajya inshinge nyinshi za buri munsi (MDI) *.
• ** Reta zunzubumwe zamerika Ubuyobozi bushinzwe ibiribwa nibiyobyabwenge (FDA): ** * Pompe ya insuline hamwe nogukurikirana glucose ikomeza umutekano mugihe cyibiza *.
• ** Sosiyete Mpuzamahanga ishinzwe Dialysis ya Peritoneyale (ISPD): ** * Amabwiriza ya ISPD yo gukumira indwara zanduza Diyalisite ya Peritoneyale no guhanahana ibiza *.