I-Dialysis Fistula Bleed (Bottle-Cap Protocol) kanye Nezimo Eziphuthumayo Ze-Dialysis Eziphuthelwe¶

Kumuntu othola i-hemodialysis yokunakekelwa ngenxa yokwehluleka kwezinso (End-Stage Renal Disease, noma i-ESRD), i-arteriovenous (AV) fistula, i-AV graft, noma i-central venous dialysis catheter* iyindlela yakhe yokuphila ngokomzimba, kodwa futhi iwumsele we-vascular high-pressure okwazi ukubangela ukukhishwa okubulalayo esikhathini esingaphansi kwemizuzu emi-3 kuya kwemi-5 uma ibhoboza iphuma. I-AV fistula evuthiwe ixhuma ngokuqondile umthambo womthambo osengalweni, iphethe \(600\text{ ukuya }2,000\text{ milliliters}\) (\(0.6\text{ to }2.0\text{ liters}\)) yegazi eline-arterialized njalo ngomzuzu owodwa, okungaphezu kwengxenye yesithathu yawo wonke umzimba ophumayo wenhliziyo. Ngesikhathi esifanayo, ukuphuthelwa ngisho neseshini ye-hemodialysis eyodwa noma ezimbili (ngesikhathi kunesiphepho, ukunqamuka kukagesi, noma ukugula) kubangela ababulali ababili abathule ngokushesha: i-hyperkalemia esongela ukuphila (i-potassium yegazi enobuthi) engamisa inhliziyo ngaphandle kwesixwayiso, kanye nokugcwala okukhulu kwe-uremic fluid (flash pulmonary edema) egcwala amaphaphu. Usizo lokuqala ludinga ukwazi Ukukhomba Umunwe Owodwa / I-Bottle-Cap Pressure (ungalokothi usonge ithawula elikhulu elikhulu eduze kwe-fistula eyophayo), ukuvikela ingalo ye-dialysis kuma-cuffs womfutho wegazi noma ama-tourniquets, nokubona ubuthakathaka bangaphambi kwesikhathi kwe-hyperkalemia ngaphambi kokuba kuboshwe inhliziyo.

Yenza lokhu manje¶

1. Ngokopha i-AV fistula noma igrafti: Cindezela umunwe OWODWA noma ikepisi lebhodlela lepulasitiki elihlanzekile ngqo embotsheni ekhonjiwe. Ungamoshi imizuzwana eyi-10 ufuna amabhandeshi. Beka isithupha sakho esingenalutho noma umunwe wokukhomba (noma isikwele esincane segauze esiyisikwele / isivalo sebhodlela lepulasitiki) ngqo ngqo phezu kwembobo yokubhoboza inaliti noma isilonda lapho igazi ligobhoza khona. Faka ingcindezi eqinile, egxile ezansi, eyanele ukumisa ukopha ngenkathi uzwa ukudlidliza ("ukuthokoza") kwegazi eligeleza ku-fistula ngaphansi komunwe wakho, bese uyibamba ngokuqhubekayo ngaphandle kokulunguza15 ukuya kumaminithi angu-20.
2. Shayela inombolo yakho yasendaweni yezimo eziphuthumayo ngokushesha ocingweni lwesipikha futhi uphakamise ingalo ngaphezu kwezinga lenhliziyo. Dayela u-911 e-United States nase-Canada, 112 ngaphesheya kwe-European Union, 999 e-United Kingdom, noma ubone konke izinombolo eziphuthumayo. Cela isiguli silale phansi ngomhlane phansi noma embhedeni (ukuze singaquleki bese sisusa ingalo yaso emunweni wakho) futhi sibambe ingalo eyophayo iphakame ngaphezu kwezinga lenhliziyo yaso. Ngisho noma ukopha okuqondile kuma ngemva kwemizuzu engu-15 ekhaya, konke ukuphuma kokufinyelela ngemva kwe-dialysis noma ukuphuka kotwayi kufanele kuhlolwe eMnyangweni Wezimo Eziphuthumayo, njengoba udonga oluncane lwe-aneurysm olunwetshiwe (pseudoaneurysm) lungaqhuma lubulale phakathi namahora ambalwa kamuva.
3. UNGAYIgcobi i-tourniquet ngaphandle kwalapho isiguli sibulawa ukopha okungalawuleki futhi umfutho wokukhomba oqondile wehlulekile ngokuphelele. Ukufaka i-tourniquet noma i-blood cuff ku-dialysis kuyavala ingalo futhi kucekele phansi umzila wokuphila wesiguli wokuhlinzwa. Nokho, "Ukuphila Kuza Ngaphambi Kwelungu noma I-Fistula": uma i-fistula aneurysm ewohlokile iqhuma yavuleka futhi umfutho oqondile awukwazi ukulawula ukopha kwe-arterial esisongela ukuphila ukwethuka, sebenzisa i-windlass tourniquet ngenhla (okuseduze) ne-fistula ngasehlombe ukuze usindise impilo yesiguli (bona ukopha).
4. Ukuze uthole i-Central Venous Dialysis Catheter enqanyuliwe noma engavaliwe (I-Permcath / Vas-Cath esifubeni noma entanyeni): Bamba ishubhu bese ulalisa isiguli ngohlangothi lwaso LWESINXELE ngokushesha. Uma ikepisi liwa esifubeni noma nge-dialysis catheter noma ishubhu lepulasitiki livuleka, umoya ungamuncwa enhliziyweni (ukukhipha umoya we-venous) kuyilapho kuphuma umoya we-venous*:
5. Ngokushesha cindezela ishubhu le-catheter livale ngeminwe yakho (noma cindezela i-clamp yesilayidi sepulasitiki ku-catheter ivaliwe, noma usonge/ukhahlele ishubhu ngokuqinile phakathi nendawo).
6. Lalisa isiguli sicaba ngohlangothi lwaso LWESINXELE ikhanda laso litshekele phansi kancane (Indawo kaDurant's / left lateral Trendelenburg) ukuze ubambe noma yimaphi amabhamuza omoya ngokuphepha ku-atrium engakwesokudla kude namaphaphu, bese ushayela ku-911 / 112/999.
7. Esigulini se-dialysis esigejiwe esinobuthakathaka obungazelele bomlenze, ukuba ndikindiki, ukushaya kwenhliziyo kancane, noma izimpawu zesifuba: Shayela ku-911 / 112 / 999 ukuze uthole "I-Hyperkalemia Esolwayo." Uma i-potassium ikhuphuka ngaphezu kuka-\(6.5\umbhalo{kuya ku-}7.0\text{mmol/L}\) (\(mEq/L}\)) ngemva kokulahlekelwa i-dialysis yenhliziyo. Ungasivumeli isiguli sidle noma siphuze noma yini, futhi ucele abezimo eziphuthumayo ngokushesha nge-ECG engu-12 eholayo kanye ne-intravenous calcium gluconate / calcium chloride*.
8. Esigulini esigejiwe se-dialysis sihefuzela umoya ngokugcwala koketshezi: Bahlalise phansi baqonde kuma-degree angu-90 imilenze ilenge phansi. Ungalokothi uphoqe isiguli se-dialysis esigcwele uketshezi ukuthi silale sicaba. Ukuhlala uqonde imilenze ilenge phansi amachibi amanzi amaningi ngokweqile emilenzeni kude namaphaphu kuyilapho i-ambulensi ibaphuthumisa ku-hemodialysis ephuthumayo.

Isihlahla sesinqumo se-Emergency triage kanye ne-dialysis crisis¶

Sebenzisa leli shidi lokugeleza lomtholampilo ukuze uphendule kunoma yisiphi isimo esiphuthumayo sokufinyelela kwemithambo noma inkinga ye-metabolic ku-hemodialysis noma isiguli se-peritoneal dialysis.

flowchart TD
    Start["Isimo esiphuthumayo esigulini se-Dialysis<br/>(I-Hemodialysis AV Fistula, Graft, Catheter,<br/>noma Iseshini Ye-Dialysis Ephuthiwe)"] --> CrisisType{"Siyini isimo esiphuthumayo esiyinhloko njengamanje?"}

    CrisisType -->|"1. Ukopha nge-Arm AV Fistula noma i-Graft"| FistulaBleed["I-HEMODIALYSIS YOKUFINYELELA I-HEMORRHAGE PROTOCOLI:<br/>1. Cindezela ONE FINGER noma BOTTLE CAP ngqo embotsheni ekhombe<br/> (UNGALOKOTHI usonge ithawula lokugeza elikhulu engalweni)<br/>2. Lalisa isiguli flat; phakamisa ingalo ngaphezu kwezinga lenhliziyo<br/>3. Shayela ku-911 / 112 / 999 ngocingo lwesipikha<br/>4. Bamba ingcindezi enganqamuki imizuzu engu-15-20 (AKUKHO UKUBHEKA)<br/>5. Iya ku-ER ukuze uhlole Ukuhlinzwa Kwemithambo ngisho noma kunqamuka ukopha"]

    CrisisType -->|"2. Isifuba esivulekile, esiqhekekile, noma esophayo/Ipayipi lentamo"| CathEmerg["ESIPHUTHUMAYO SESIKHATHI SESIKHATHINI SOKUSHIYA KWE-DIALYSIS:<br/>(Ingozi Ye-Venous Air Embolism & Hemorrhage)<br/>1. I-clamp plastic slide clamp NOMA kink/pinch ishubhu ngokuqinile<br/> (Bamba phakathi komfantu/ovulekile ekugcineni kanye nesifuba sesiguli)<br/>2. Ukumboza ihabhu nge-gauze oyinyumba; UNGALOKOTHI usebenzise isikelo eduze kweshubhu<br/>3. Lalisa isiguli ngohlangothi LWESINXELE ikhanda liphansi uma umoya ungenwe<br/>4. Shayela ku-911/112/999 Ngokushesha"]

    CrisisType -->|"3. I-Dialysis ephuthelwe + Imilenze Enzima/Ebuthakathaka,<br/>Izindebe Ezilumayo/Iminwe, Ukushaya kwenhliziyo Kanensa/Okungajwayelekile"| HyperK["I-HYPERKALEMIA Esongela Impilo (I-Potassium Ephezulu):<br/>1. Shayela ku-911 / 112 / 999: Memezela 'Isiguli Se-Dialysis esine-Hyperkalemia'<br/>2. Cela I-Ambulensi ye-ALS Ye-ECG eholayo engu-12 + IV Calcium Rescue<br/>3. I-Strictly NPO (Ukudla/ujusi ongu-Zero); thatha i-Emergency Resin Binder KUPHELA<br/> uma uphapheme futhi uchazwe ngokucacile Kuhlelo Lwesenzo Senhlekelele"]

    CrisisType -->|"4. I-Dialysis ephuthelwe + Ukuhefuzela Umoya,<br/>Igwebu Eliphinki Elikhwehlelayo, Awukwazi Ukuqamba Amanga"| FluidOverload["I-FLASH PULMONARY EDEMA (Ukugcwala Kwe-Fluid Kakhulu):<br/>1. Shayela ku-911 / 112 / 999 Ngokushesha<br/>2. Hlala nesineke UBHUTILE UQINILE (90 degrees) imilenze ilengela phansi<br/>3. Lawula i-oksijeni egeleza kakhulu / i-nitroglycerin engaphansi kolimi uma kunqunyiwe"]

    CrisisType -->|"5. Imfiva/Ukugodola + I-Red Catheter NOMA<br/>Isikhwama Sokukhipha I-Peritoneal Dialysis Esinafu + Nobuhlungu Besisu"| DialSepsis["I-CATHETER SEPSIS NOMA PD PERITONITIS:<br/>Umnyango Wezimo Eziphuthumayo MANJE Wegazi/i-PD Fluid Cultures<br/>kanye nama-Antibiotics asheshayo e-Intravenous noma Intraperitoneal"]

Ingxenye 1: Ukumisa I-AV Fistula Esongela Impilo noma I-Graft Bleed (Khombisa Iphrothokholi Yomunwe Ne-Bottle-Cap)¶

Kungani I-Dialysis Fistula Yopha Kakhulu Kakhulu (Futhi Kungani Ama-Scabs Acwebezelayo Amabhomu Esikhathi)¶

Phakathi ne-hemodialysis kathathu ngeviki, izinalithi ezimbili ezinkulu ze-\(14\text{- kuya }16\text{-gauge}\) $ zifakwa ku-fistula yesiguli arteriovenous (AV) fistula (umthambo womdabu othungwe ngokuqondile emthanjeni osesihlakaleni noma engalweni engenhla) noma klzzwxh:09 PT), i-plastic FE inikezwa i-vein synthetic i-blood-thinning i-heparin ukuze igazi labo lingahluleli emshinini wokucofa igazi.

Izinhlobo ezimbili ezihlukene zokopha kwe-fistula zenzeka ngaphandle komtholampilo: 1. I-Early Post-Dialysis-Re-Beedle-Site (Ihora Lokuqala Eliyihora Eliyisi-6 Ekhaya): Ngemva kokuphuma esikhungweni se-dialysis, ipulaki ye-platelet entsha evala imbobo eyodwa yezinaliti zokubhoboza iyaphuma lapho isiguli siphakamisa igilosa, sigobisa ingalo yaso, sikhwehlela, noma singqubuzana ngephutha itheyipu isazungeza igazi. 2. I-Spontaneous Aneurysm/Ukuphuka Kwe-Pseudoaneurysm (Isimo Esiphuthumayo "Solwelwesi Olumnyama"): Ezinyangeni noma iminyaka yokudinga ngokuphindaphindiwe endaweni efanayo, udonga lwe-fistula noma i-graft lunganwebeka lube yiqhubu i-aneurysm noma i-pseudoaneurysm. Uma isikhumba esingaphezu kwaleyo qhubu siba nephepha, siqine, sicwebezele, sikhishwe umbala, sibebomvu, noma sibe notwayi olumnyama (eschar) olungapholi amasonto, udonga lomkhumbi olunemithambo luguguleka ngokoqobo esikhumbeni. Uma lolo qweqwe olumnyama luwa eshaweni noma luklwejwa ngesikhathi sokulala, ikholomu yomfutho ophakeme wamajethi egazi egumbini lonke.

Isinyathelo ngesinyathelo: Indlela yokukhomba Umunwe owodwa kanye ne-Bottle-Cap¶

Landela iphrothokholi esemthethweni yokopha emithanjeni efundiswa iNational Kidney Foundation (NKF), Ukunakekelwa Kwezinso UK / UK Kidney Association, kanye Ne-Vascular Access Society:

1. Veza Imbobo Eqondile (Khumula Amathawula Agcwele Igazi Axege Kakhulu):
2. Awukwazi ukumisa ijethi ekhomba ngomfutho ophezulu uma ucindezela ngokungaboni inqwaba yendwangu emanzi. Bheka ngqo esikhumbeni se-fistula ukuze uthole imbobo enembile engu-\(1\text{- ukuya }3\text{-millimeter}\) lapho igazi liphuma khona.
3. Sebenzisa Ukucindezela Okukhomba Ngomunwe OWODWA, Isithupha, noma Ikepisi Lebhodlela Lepulasitiki Elihlanzekile:
4. Inketho A (Umunwe/Isithupha): Songa ucezu olulodwa oluncane lwe-gauze oyinyumba (noma sebenzisa isithupha sakho esingenalutho/umunwe wenkomba uma ingekho i-gauze efinyelelekayo) bese ucindezela u-qonde phansi ngqo phezu kwembobo ekhonjiwe*.
5. Inketho B (I-Clean Plastic Bottle-Cap Technique): Amayunithi amaningi okuhlanza igazi ahlinzeka iziguli nge-Fistula Clamp ekhethekile noma afundise Indlela Ehlanzekile Yebhodlela Lebhodlela Lepulasitiki (usebenzisa i-twist-off cap evamile ephuma ebhodleleni lamanzi noma lesoda, noma isimo esiphuthumayo * HemCon / Celox* hemostatic pad):
   • Ukucindezela ikepisi yebhodlela ehlanzekile ngokuqondile phezu kwephedi ye-gauze encane endaweni yokubhoboza kugxilisa ukuqina, ukucindezela okufanayo eduze neringi engu-\(2\text{-centimeter}\) yesici ngaphandle kokuchoboza bonke ububanzi bengalo, futhi kunciphisa ukukhathala komunwe ngenkathi ulinde i-ambulensi imizuzu engu-15.
   • (Qaphela: Hlala nesiguli ngaso sonke isikhathi futhi ubambe isivalo sebhodlela noma umunwe unganyakazi ubambe endaweni yawo ngesandla; ungalokothi unamathisele ikepisi eliqinile elizungeze isiyingi sengalo bese uhamba, njengoba ukopha kungalandela emaceleni ngaphansi kwesikhumba kufake i-hematoma enkulu uma ikepisi liphuma phakathi.)
6. Linganisa Ingcindezi Yakho ("Yeka Ukuphuma Kwegazi, Gcina Ukuthokoza"):
7. Cindezela ngokuqinile ngokwanele ukuthi akukho gazi elivuzayo ngaphansi komunwe wakho.
8. Uma kungenzeka, cindezela kakhulu ngokwanele ukuze uvale imbobo odongeni olungaphezulu lwe-fistula ngaphandle kokukhiya udonga olungezansi luvaleke ngokuphelele: kufanele uzizwe kahle ukudlidliza okuthambile (ukuthokoza) ngaphansi kwesihloko somunwe wakho. Nokho, uma igazi liqhubeka nokuphuma, cindezela kakhulu kuze kuphele ukopha, ngoba ukumisa ukopha njalo kuza kuqala.
9. Misa Ifulethi Lesiguli Emhlane Waso Futhi Uphakamise Ingalo:
10. Cela isiguli silale phansi noma kusofa ngokushesha. Ukulahlekelwa igazi ngokushesha kubangela ukuquleka okungazelelwe (vasovagal noma i-hemorrhagic syncope); uma isiguli simi kusinki yokugezela lapho siquleka, sizodabula ingalo yaso esandleni sakho bese sishaya ikhanda.
11. Phakamisa ingalo ye-dialysis ** ngaphezu kwezinga lenhliziyo ** ukuze unciphise i-venous kanye ne-hydrostatic pressure ngaphakathi kwe-fistula.
12. Bamba Ingcindezi Enganqamuki Imizuzu eyi-15 kuye kwengama-20 egcwele (Ungalokothi Ubheke Kusenesikhathi):
13. Bheka iwashi. Bamba umunwe wakho endaweni okungenani engu-15 kuya kumaminithi angu-20 aqhubekayo* kuze kufike abezimo eziphuthumayo bathathe izintambo.
14. Ukuhlolwa Okuphoqelekile Kwesibhedlela Ngisho Noma Ukopha Kuyeka Ngokuphelele:
15. Ungalokothi ukhansele i-ambulensi noma uhlale ekhaya ngemva kokuyeka ukopha okuzenzakalelayo kwe-fistula. Uma i-pseudoaneurysm enodonga oluncane olubiyelwe noma ukuxhunyelelwa okuthelelekile kubangele ukopha, ihlule elintekenteke elakheke ngaphansi komunwe wakho livame ukufutheka futhi ngemva kwamahora ama-2 ngokopha okubulalayo. Udokotela ohlinza imithambo kufanele ahlole ukufinyelela ngokushesha ukuze kubuyekezwe ukuhlinzwa, ukubekwa kwe-stent-graft, noma ukuxhunywa.

Izimpawu eziyisixwayiso zokuqhekeka kwe-Fistula okuzayo (Kufanele Uye Nini ku-ER Ngaphambi Kokopha)¶

Hlola i-dialysis AV fistula noma uxhunyelelwe nsuku zonke. Hamba Kumnyango Wezimo Eziphuthumayo noma ushayele Udokotela Wokuhlinza I-Vascular Access ngalolo suku (ngaphambi kokuthi kuqhume) uma ubona noma iyiphi kulawa amahlanu "Amafulegi Abomvu Angaphambi Kokuphuka":

"Imithetho Emithathu Ayisoze Yakho" Yokuvikela Ingalo Yokufinyelela I-Dialysis¶

Ukugcina i-fistula ingaqhume noma ihlule phakathi nanoma yisiphi isimo sezokwelapha noma sosizo lokuqala: - UNGALOKOTHI uthathe umfutho wegazi ufunda engalweni nge-AV fistula noma i-graft (futhi ungalokothi uthathe i-BP engalweni lapho kuhlelwa khona i-fistula yesikhathi esizayo). - UNGALOKOTHI udonse igazi noma uqale umugqa womthambo (IV) engalweni yokufinyelela ku-dialysis. - UNGALOKOTHI uvumele amabhande ewashi aqinile, imikhono enwebekayo, izikhwama, izikhwama zegrosa, noma ukulala uqamele ikhanda kuleyo ingalo.

Ingxenye 2: Izimo Eziphuthumayo Ze-Dialysis Eziphuthelwe: I-Hyperkalemia ne-Flash Pulmonary Edema¶

Isihlungi sezinso ezinempilo amalitha angu-150 kuya kwangu-180 egazi nsuku zonke, ekhipha ukudla okungaphezu kokuvamile potassium (\(K^+\)), amanzi, sodium, asidi, kanye nobuthi be-uremic. Isiguli se-hemodialysis esenza umchamo omncane noma esingawuchazi nhlobo (anuric) sincike ngokuphelele emaseshini aso okudaya amahora angu-4 kathathu ngesonto (ngoMsombuluko/uLwesithathu/uLwesihlanu noma ngoLwesibili/uLwesine/uMgqibelo). Uma isiguli sigeja ngisho iseshini eyodwa noma ezimbili zokudayela (noma phakathi negebe elide lempelasonto yamahora angu-72 phakathi kukaLwesihlanu/uMgqibelo kanye noMsombuluko/NgoLwesibili), izimo eziphuthumayo ezimbili ezisongela ukuphila ziba ngokushesha:

1. I-Hyperkalemia Esongela Impilo (I-Potassium Yegazi Ephezulu, "I-Silent Heart Stopper")¶

I-potassium esegazini evamile ikhiywe ngokuqinile phakathi kokuthi \(3.5\text{ kanye }no-5.0\text{ mmol/L}\) (\(mEq/L\)). Lapho i-potassium ikhuphuka ngaphezu \(6.0\text{kuya ku-}6.5\text{ mmol/L}\) ngemva kweseshini ye-dialysis egejiwe (noma ngemva kokudla ukudla okune-potassium ephezulu, ukulimala kokuchotshozwa kwezicubu, ukopha emathunjini, noma ukuthatha i-ACE inhibitors/spironolactone/NSAIDs), ikhulula amandla kagesi okuphumula wamaseli** emisipha yenhliziyo).

Kungani I-Hyperkalemia Iyingozi Kangaka: Ngokungafani nezifo eziningi, i-hyperkalemia ingabangela ukuboshwa kwenhliziyo okubulala kungazelelwe (i-sine-wave ventricular fibrillation noma i-asystole) cishe ngaphandle kwesixwayiso sangaphambilini, noma ingalingisa isimo esiphuthumayo sezinzwa njenge-Guillain-Barre syndrome: - Izimpawu Zokuqala Zesexwayiso Ze-Neuromuscular (Ezivamise Ukuphuthelwa): - Ukuluma noma "izikhonkwane nezinaliti" (paresthesias) ezindebeni, olimini, ezandleni nasezinyaweni. - Ubuthakathaka bomlenze osindayo obukhuphuka ngokushesha (I-Hyperkalemic Flaccid Paralysis): Isiguli sizwa ngokuphazima kweso imilenze yaso "yenziwe ngomthofu," ayikwazi ukusukuma esihlalweni noma embhedeni, futhi ubuthakathaka bukhuphukela esiqwini nasezingalweni. - Isicanucanu esinamandla, ukuhlanza, noma ukuqunjelwa kwesisu. - Izimpawu Zokuxwayisa Ngenhliziyo: - Ukushaya kwenhliziyo okuhamba kancane kungazelelwe (i-bradycardia), ukushaya kwenhliziyo eyeqiwe, ukushaya kwenhliziyo, isiyezi, noma ukuquleka. - Ku-ECG** yezimo eziphuthumayo**, i-potassium ekhuphukayo idala ukuqhubekela phambili kwakudala: mude, "amagagasi e-T aphakeme" amade, afakwe itende$ ayisicaba/angekho amagagasi e-P kanye nesikhawu se-PR eside \(\rightarrow\) inkimbinkimbi ye-QRS enwetshiwe \(\rightarrow\)sine iphethini ebulalayo*" ivele imise inhliziyo ebulalayo*

Izimo Eziphuthumayo Nezibhedlela Zisisindisa Kanjani Isiguli Se-Hyperkalemic Ngamaminithi: Uma utshela umthumeli we-911 / 112/999 "Isiguli se-Dialysis esiphuthelwe ukwelashwa ngenxa yobuthakathaka bomlenze kanye ne-hyperkalemia esolwayo," abezimo eziphuthumayo nodokotela bezimo eziphuthumayo benza ukulandelana kwezinyathelo ezintathu zokusindisa impilo: 1. Qinisekisa Imisipha Yenhliziyo Emaminithini angu-1 kuya kwangu-3: Ngemithambo I-Calcium Gluconate (\(10\%\), \(10\text{ ukuya }kuya ku-}30\text{ mL}\)) noma I-Calcium Chloride ayiyehlisi i-potassium egazini, kodwa ivikela ulwelwesi lukagesi ngokushesha ngaphakathi kwenhliziyo ukuze ivimbele inhliziyo kagesi i-potassium iyasuswa. 2. Shift Potassium Ngaphakathi Kumaseli Ngemizuzu engu-15 ukuya kwengama-30: Ngemithambo i-insulin evamile (\(10\text{ units}\)) ebhangqwe ne-dextrose ye-intravenous (glucose), umthamo ophezulu we-nebulized klzzwxh:0061 (uma i-acidic) ikhipha i-tassium emgudwini wegazi ibuyele kumaseli omzimba okwesikhashana. 3. Khipha I-Potassium Unomphela Emzimbeni:** Izibophezelo ze-potassium zesisu somlomo (**sodium zirconium cyclosilite [Lokelma], patiromer [Veltassa], noma i-sodium polystyrene sulfonate [Kayexalate]) kanye **nekhambi eliphuthumayo le-hedialysis** (ukwelapha okuqondile).

2. I-Acute Fluid Overload (I-Flash Pulmonary Edema) kanye ne-Uremic Pericarditis¶

Ngaphandle kokukhishwa komchamo wezinso, yonke inkomishi yamanzi, isobho, iqhwa, noma isithelo isiguli esidliwa yi-dialysis sihlala singaphakathi ngqo emgudwini wegazi nezicubu. Ngemva kokuphuthelwa ukwelashwa kwe-dialysis oku-1 kuya kwezingu-2, amalitha ama-3 kuye kwayi-6 oketshezi okweqile angabuyela emaphashini (i-acute cardiogenic/volume pulmonary edema) kanye nasenhliziyweni (**uremic pericarditis / tamponade yenhliziyo **): - Izimpawu ze-Flash Pulmonary Edema: - Ukuphefumula kanzima okwenza kube kungenzeki ukucambalala embhedeni (i-orthopnea). - Ukuhefuzela, ukuhefuzela ("isifuba somoya senhliziyo"), ukugegetheka noma imisindo yokuphefumula ekhencezayo, kanye nokukhwehlela okuphinki, isikhwehlela esinamagwebu. - Ukuvuvukala okukhulu (i-edema) emaqakaleni, emilenzeni, emhlane ongezansi, naseduze kwamehlo, okuhambisana nokukhuphuka komfutho wegazi okuvamise ukudlula u-\(180/110\text{ mmHg}\). - Izimpawu ze-Uremic Pericarditis: - Ubuhlungu besifuba obubukhali, obuhlabayo ngemuva kwethambo lebele obaba bubi kakhulu uma ulele phansi ngomhlane futhi uba ngcono lapho uhlezi futhi uncike phambili. - Indawo Yosizo Lokuqala Olusheshayo Yokugcwala Kwe-Fluid: - Hlalisa ibhawodi lesiguli liqonde nge-engeli engamadigri angu-90 yomibili imilenze ilenge phansi eceleni kombhede noma isihlalo. Amandla adonsela phansi abamba cishe u-\(500\text{kuya }800\text{milliliters}\) wegazi le-venous emilenzeni engezansi esikhundleni sokulivumela ligcwale emaphashini aminyene. - Ungalokothi uphakamise imilenze yesiguli se-dialysis esigcwele uketshezi, futhi ugodle lonke uketshezi oluphuzwayo ngesikhathi ulinde i-ambulensi.

Ukusinda enhlekeleleni: "I-Potassium Ephansi Yezinsuku Ezi-3, Ukudla Okuphuthumayo Okukhawulelwe Uketshezi"¶

Ngesikhathi seziphepho, izikhukhula, iziphepho zeqhwa, noma ukucima kukagesi lapho imitholampilo ye-dialysis ivaliwe okwesikhashana amahora angu-48 kuya kwangu-72, kulandela I-National Kidney Foundation (NKF) kanye neCenters for Disease Control and Prevention (CDC) "I-3-Day Emergency Renal Diet" igcina i-potassium ne-dialysis emazingeni okuphila kuze kube yilapho ekwazi ukusinda.

Izimo eziphuthumayo ezikhethekile ezigulini ze-Peritoneal Dialysis (PD): I-Cloudy Bag Peritonitis¶

Iziguli ezenza i-Peritoneal Dialysis (PD) ekhaya zisebenzisa i-silicone catheter ethambile esiswini sazo (Tenckhoff catheter) zibhekene nesimo esiphuthumayo esiyingqayizivele esibizwa ngokuthi PD Peritonitis: - Indlela yokuyibona ngokushesha: Bheka esikhwameni sokudonsa amanzi sepulasitiki esicacile ngemva kokushintshana ngakunye. Ngokuvamile, uketshezi lwe-peritoneal dialysis oluchithiwe (**i-effluent **) lubukeka lucace njengomchamo ophuzi ophaphathekile (kufanele ukwazi ukufunda umbhalo wephephandaba ngokucacile esikhwameni esigcwele). Uma uketshezi olukhishiwe lubukeka luguqubele, lubisi, lumnyama, noma lubomvana, NOMA uma isiguli siba nobuhlungu besisu, ukuzwela, isicanucanu, noma imfiva, thatha i-Acute Bacterial Pertonitis. - Isenzo Esisheshayo: 1. Gcina isikhwama esinamafu sokudonsa amanzi (sibambe usivale uhambe naso esibhedlela noma emtholampilo we-PD ukuze abahlengikazi bakwazi ukudonsa uketshezi ngokuqondile esikhwameni ukuze uthole inani lamaseli kanye nesiko lamagciwane). 2. Shayela Umhlengikazi wakho We-Peritoneal Dialysis wamahora angu-24 / U-On-Call Nephrologist noma uye eMnyangweni Wezimo Eziphuthumayo ngokushesha ukuze uthole intraperitoneal (IP) noma ama-antibiotics emthanjeni. 3. Uma i-catheter ye-PD isika ngephutha noma isethi yokudlulisa inqamuka ngokuhlanzekile noma ekungcoleni: Ngokushesha qinisa ipulasitiki emhlophe I-Beta-Clamp (noma cindezela/uncinze ishubhu le-catheter elithambile liqine phakathi kwesikhumba sakho nesisu sakho), vala imbobo evulekile nge-gauze eyinyumba, **ungalinge uthele uketshezi eshubhuni evulekile ngokushesha ukuze uthole iyunithi ye-PD, futhi uye ekamelweni lakho eliphuthumayo i-adaptha/ushintsho olusethiwe kanye nama-antibiotic e-prophylactic.

Umbhalo oqondile wokuxhumana we-911 / 112 / 999 kanye ne-Hospital Triage¶

• Nge-AV Fistula noma I-Graft Bleed:

  "Ngidinga i-ambulensi yezimo eziphuthumayo [Ikheli Eliqondile]. Isiguli siyisiguli se-hemodialysis esinengalo engu-AV [fistula / graft] ephukile futhi yopha kakhulu. Ngibambe ukucindezela okuqondile komunwe owodwa endaweni yenaliti, ngilalise isiguli, futhi ngiphakamise ingalo ngaphezu kwenhliziyo. Sidinga ukuhlinzwa okusekelwe emithanjeni okuthuthukisiwe okuya esibhedlela ngemithambo yegazi."

• Esigulini Esigejiwe Sokuhlolwa Komshini Esine-Hyperkalemia Esolwayo noma Ukugcwala Kwe-Fluid:

  "Ngidinga i-ambulensi yezimo eziphuthumayo kokuthi [Ikheli Eliqondile] lesiguli se-hemodialysis esiseshini yokuhlanza okokugcina yaba ezinsukwini ezingu- [X] ezedlule ngo-[Usuku]. Manje [Useno]buthakathaka kakhulu emlenzeni kanye nokuluma / ukushaya kwenhliziyo okuhamba kancane / ukuphefumula kanzima futhi akakwazi ukulala phansi]. Sisola ukuthi i-Hyperkalemia esongela ukuphila [kanye/noma i-Flash] I-Edema ye-Pulmonary Please disclaimer 12-lead ECG kanye nokunikeza i-calcium gluconate emthanjeni ngokushesha."

Uhlu lokuhlola lwesikhwama esiphuthumayo lwesiguli se-Dialysis¶

• Amakhophi Eshidi lakho lakamuva Lokwelapha I-Hemodialysis ("Ishidi Lokuqalisa"): Libonisa Isisindo Somzimba Esomile (isisindo esiqondiwe), usayizi wesihlungi se-dialyzer, izinga lokugeleza kwegazi, i-dialysate potassium bath concentration, ne-heparin dose ukuze noma yisiphi isibhedlela esiphuthumayo sikushayele ucingo ngokuphepha.
• Amakepisi amabhodlela epulasitiki ahlanzekile angu-2 ukuya kwangu-3, ​​amaphedi e-gauze angenalutho ka-\(4\times4\), kanye nephedi ye-hemostatic yokuhweba (ChitoGauze / Celox) ephaketheni lakho noma esikhwameni sakho ngaso sonke isikhathi.
• I-plastic vascular clamp ebushelelezi (i-catheter clamp) uma unesifuba noma intamo i-Permcath, noma i-Beta-Clamp emhlophe* uma usebenzisa i-Peritoneal Dialysis.
• Ukunikezwa okuphuthumayo kwezinsuku ezingu-3 kwamaphakethe okuhlanganisa okwehlisa i-potassium (i-sodium zirconium cyclosilicate [Lokelma] noma i-patiromer [Veltassa]) nezibophezelo ze-phosphate.

Imibuzo evame ukubuzwa¶

Kungani ukusonga ithawula kwi-dialysis fistula esophayo kubangela iziguli zophe zize zife?¶

I-arteriovenous (AV) fistula ithwala igazi le-arterial ngaphansi kwengcindezi ephezulu engamamililitha angu-600 kuya kwangu-2,000 ngomzuzu ngembobo encane engu-1-to-2-millimeter esikhumbeni. Ukusonga ithawula lokugeza elingalo eliwugqinsi kufihla indawo yokopha ukuze ingabonakali futhi kusabalalisa ingcindezi ngokubuthakathaka endaweni ebanzi esikhundleni sokuvala imbobo encane. Phakathi nemizuzu emi-3 kuya kwemi-5, isiguli singalahlekelwa uhhafu womthamo wegazi laso ethawulani futhi sibe nokuboshwa kwenhliziyo okuyingozi. Njalo ubheke ngqo enxebeni bese ucindezela umunwe OWODWA, isithupha, noma ikepisi lebhodlela lepulasitiki elihlanzekile ngqo embobeni okuyimizuzu eyi-15 ukuya kwengama-20 eqhubekayo.

Uma i-fistula ye-dialysis esophayo iyeka ukopha ngemva kwemizuzu engu-15 yokucindezela kweminwe ekhaya, kungani ngisadinga ukuya egumbini lezimo eziphuthumayo?¶

Ukopha okuzenzakalelayo okuvela ku-dialysis fistula noma ukuxhunyelelwa ngaphandle komtholampilo kuvame ukubangelwa ukuncipha nokuguguleka kodonga olungaphansi lwe-aneurysm noma ukutheleleka komkhumbi okucashile. Ngisho nalapho ihlule lesikhashana livala imbobo ekhomba ngaphansi komunwe wakho, umfutho ophakeme we-arterial ongaphakathi ku-fistula uvame ukuvunguza elijiya libuye ngemva kwamahora ambalwa, ngokuvamile lapho isiguli silele embhedeni. Yonke i-fistula yasekhaya yokopha kufanele ihlolwe ngokushesha emnyangweni wezimo eziphuthumayo nguchwepheshe we-vascular.

Ngingabona kanjani uma umuntu ophuthelwe iseshini ye-dialysis ene-potassium ephezulu eyingozi (hyperkalemia)?¶

I-potassium ephezulu yegazi ifaka ubuthi ekujabuleni kukagesi kwemizwa nemisipha ngaphambi kokuba imise inhliziyo. Buka ubuthakathaka obunzima obungazelelwe kuyo yomibili imilenze (ubunzima bokusukuma noma ukuhamba), ukuba ndikindiki noma ukushoshozela ezindebeni, ulimi, izandla, noma izinyawo, isicanucanu esingachazeki, noma ukushaya kwenhliziyo okuhamba kancane noma okungajwayelekile. Ngenxa yokuthi i-hyperkalemia ingabangela ukuboshwa kwenhliziyo kungazelelwe nganoma yisiphi isikhathi, shayela ku-911 / 112 / 999 ngokushesha ukuze abezimo eziphuthumayo bakwazi ukwenza i-ECG futhi banikeze i-calcium evikela inhliziyo emthanjeni.

Yini okufanele ngiyenze uma utwayi olumnyama kwakheka phezu kweqhubu ku-dialysis fistula?¶

Uqweqwe olumnyama olumnyama (eschar), isikhumba esicwebezelayo esincanyana ngephepha, ububomvu, noma amathonsi egazi amancane aphuma utwayi oludala phezu kwe-AV fistula eqhumayo noma i-graft kuwuphawu oluyisixwayiso olusheshayo lokuqhekeka okuyinhlekelele okuseduze. UNGACULI, ukunwaya, noma ukugeza utwayi kancane, UNGAVUMI noma ubani ashuthe inaliti yokuhlanza idayilisasi phakathi noma eduze kwalolo qweqwe, gcina isivalo sebhodlela esihlanzekile negauze esandleni sakho, bese uqonda ngqo emnyangweni wezimo eziphuthumayo noma kudokotela ohlinza imithambo ngosuku olufanayo ukuze udonga lulungiswe ngaphambi kokuba luqhume.

Imithombo ihloliwe¶

• I-National Kidney Foundation (NKF, United States): KDOQI Clinical Practice Guideline for Vascular Access: 2019 Update (Lok et al., American Journal of Kidney Diseases, ukulawulwa kwezimo eziphuthumayo kwe-AV fistula/graft hemorrhage, pseudoaneurysms, kanye nebhodlela-cap / NKF indlela yokucindezela kwe-Pinpoint for People's Planning) Isifo Sezinso.
• Inhlangano Yase-UK Kidney (UKKA), I-Vascular Society of Great Britain and Ireland (VSGBI), kanye ne-British Society of Interventional Radiology (BSIR): Ukopha Okusongela Ukuphila Okuvela Ku-Arteriovenous Vascular Access: I-Bottle-Cap / I-Pinpoint Pressure Safety Patient Alert kanye Nemihlahlandlela Yomtholampilo.
• I-European Resuscitation Council (ERC) kanye ne-American Heart Association (AHA): Iziqondiso Zokuvuselelwa Kwenhliziyo Nezimo Eziphuthumayo Zokunakekelwa Kwenhliziyo: I-Electrolyte Abnormalities kanye Ne-Hyperkalemia Esongela Ukuphila Ezigulini Ze-Dialysis.
• I-International Society for Peritoneal Dialysis (ISPD): Izincomo Zomhlahlandlela we-ISPD Peritonitis: Isibuyekezo sango-2022 Sokuvimbela Nokwelashwa (Li et al., Peritoneal Dialysis International).
• Izikhungo Zokulawula Nokuvimbela Izifo (CDC, United States) & Nempendulo Ephuthumayo Yomphakathi Wezinso (KCER): Ukulungiselela Okuphuthumayo kanye Nokudla Kwezinsuku Ezingu-3 Kwenhlekelele Yezinso Ezigulini Ze-Hemodialysis.

Iziqondiso ezihlobene¶

• Ukulawula ukopha kakhulu, ukupakisha amanxeba, nama-tourniquets
• Ukulimala kwezinso okukhulu, i-rhabdomyolysis, kanye nokuhlolwa komchamo omnyama
• Ukubonwa kwe-Sepsis kanye nokushaqeka kwe-septic kanye nokusabela okuphuthumayo
• Ukuqashelwa ukushaqeka kanye nokuphathwa kosizo lokuqala
• Ukuvuselelwa kweCardiopulmonary (CPR) kanye nomhlahlandlela we-AED