Long-term hemodialysis complications

Many patients with advanced uremia are long-term hemodialysis, hemodialysis (referred to as hemodialysis) that artificial kidney dialysis, is the most commonly used in the treatment of advanced patients with uremia. What are the long-term hemodialysis complications? Many people are worried about this problem. In recent years, with the continuous improvement of dialysis technology, the patient's life can be extended, and some even extended for more than 20 years. But the resulting complications are more and more, and there have been very rapid, and endanger the patient's life,

1 hemodialysis complications imbalance syndrome

Unbalanced syndrome is one of the most common acute complications. Severe high blood urea nitrogen patients, began to dialysis prone to headache, nausea and vomiting, high blood pressure, convulsions, severe cases may have coma. In order to avoid imbalance syndrome, we take the following measures: (1) preoperative dexamethasone 5mg +5% GS20ml + 10% calcium gluconate 10ml intravenous injection. (2) to master the first dialysis time, generally for the first time 2h, after each time as the case increased by half an hour to 1h. (3) blood pressure every hour, pulse once. (4) using high sodium, bicarbonate dialysis. (5) the occurrence of syndrome can be used 5% GS40ml intravenous injection and the application of sedatives.

2 hemodialysis complications air embolism

Air embolism is a certain amount of air into the blood vessels, these gases and blood mixed with foam body fluid to reach the right heart and pulmonary artery, hinder the blood, can lead to heart failure, serious can lead to death. It has been proven that 6ml of air into the rabbit vein after a few minutes in the rabbit died. Foreign reports, animal experiments with dogs, according to 5ml / kg body weight, into the vein into the air, the dog soon died. The above situation shows that when a lot of air into the vein to form air embolism, can endanger the patient's life. In the hemodialysis process, coupled with the blood pump pressure, improper handling in the course of operation, can cause air embolism. Our hospital has 1 case, accounting for 0.01%, due to rescue timely, did not cause consequences. Lessons learned: (1) in the operation in case of a small amount of gas from the veins, can not panic, allowing patients to the left lateral position, take the head low enough high, so that the air blocking the right ventricle floating up, and leave the embolization , A small amount of air in the blood vessels, will soon be absorbed. (2) close observation of changes in condition, the clinical manifestations of air embolism, embolism because of different parts, different symptoms, such as pulmonary circulation is embolized, then from the venous system of air emboli, with the blood flow through the right heart into the pulmonary artery and its branches were blocked And reflex caused by pulmonary artery and coronary heart artery spasm, leading to acute heart failure, patients with dyspnea, pale skin, tachycardia and hypotension and other clinical manifestations. (3) blood, blood, blood rate should be slowed down. (4) strict inspection of the pipeline connection seal is intact.

3 hemodialysis complications within the pipeline coagulation

Dialysis pipeline coagulation often starts at the vein filter, due to a variety of reasons to make the fiber in the blood and blocked the pores of the filter, so that the blood gradually solidified, severe can be extended to the entire dialysis pipeline.

Coagulation often occurs after dialysis 1h, the performance of venous pressure continued to rise to> 100mmHg, even if the blood pump is still not down, indicating that the vein filter has been blocked blood clots, this time should close the blood pump, block blood flow, replace the vein Filter or all dialysis pipes.

Cause a lot of reasons for coagulation, such as insufficient use of heparin, low blood pressure, blood flow per minute <100ml, then the vein or the dialysis device when the blood stagnation time in the intravenous filter is too long, the filter has a foreign body or dialyzer aging. In addition, intravenous injection of certain drugs, such as promethazine, hypertonic glucose, etc. will also promote blood clotting. Patients with systemic infection, thrombocytosis, blood concentration, drug allergy caused by hypercoagulable state, should be taken seriously. To prevent coagulation in the pipeline, we take the following measures: (1) pay attention to the amount and usage of heparin. We are given at the beginning of dialysis heparin 20mg, after every 1h4mg, intravenous arterial puncture needle must have a certain heparin, flushing the pipeline, the pipeline should have a certain heparin, otherwise the blood leads to the pipeline blood will be sticking to the wall, causing Clotting. (2) to ensure that blood flow at about 200ml per minute. Blood flow should be too low to find the reasons for targeted treatment. (3) for patients with continuous hypercoagulable state, should try to get rid of the reasons, and the amount of heparin doubled, the bleeding tendency of patients with in vitro heparin. (4) strict flushing pipe to ensure smooth screen.

In order to avoid and reduce the complications in dialysis, such as hypotension, imbalance syndrome, convulsions and accidents, air embolism, blood leakage, coagulation occurs, should pay attention to the following links: (1) master dialysis time and dehydration. (2) to protect the dialyzer. (3) to strengthen the management of water treatment devices. (4) the rational use of heparin. (5) properly handle the patient's medication, monitoring out, coagulation status. (6) Strict piping. (7) in the whole process of hemodialysis strict aseptic operation, strict full pipeline closed connection.