How to protect vascular access during hemodialysis

Hemodialysis is an important treatment for patients with end-stage renal disease, and vascular access is the "lifeline" of hemodialysis patients. The vascular access is responsible for drawing blood out of the patient's body for purification and then returning the purified blood to the patient's body. Its smoothness is directly related to the dialysis effect and the patient's quality of life. Therefore, protecting the vascular access is crucial for hemodialysis patients. This article will introduce in detail how to protect the vascular access during hemodialysis.

1. Choosing the appropriate type of vascular access

The choice of vascular access should be determined by the doctor after comprehensive evaluation based on the patient's specific situation. Common vascular accesses include arteriovenous fistula (AVF), arteriovenous graft fistula (AVG) and central venous catheter (CVC). Among them, AVF is the most ideal choice because it has fewer complications, long service life and low risk of infection. AVG is suitable for patients with poor vascular conditions, while CVC is usually used for short-term or emergency purposes. Patients should work closely with their doctors to choose the most suitable type of vascular access to ensure long-term and stable dialysis effects.

2. Proper Care of Vascular Access

1. Arteriovenous fistula care. ① Keep the fistula site clean and wash it with soapy water before dialysis; ② Do not take a shower on the day after dialysis, keep the puncture site dry within 1 day, and avoid contact with water to prevent infection; ③ Wear clothes with loose sleeves and do not press on the limb on the fistula side when sleeping; ④ Do not draw blood, infuse, measure blood pressure, etc. on the limb on the fistula side; ⑤ Avoid lifting heavy objects, wearing watches, bracelets, etc. with the arm on the fistula side; ⑥ When there are nodules or ecchymoses in the fistula, apply thin potato slices for 20-30 minutes (3 times/day) 24 hours after the needle is removed, and use Hirudo ointment, and avoid the needle eye; ⑦ If there is a pseudoaneurysm, wear a wrist guard of appropriate tightness to prevent the tumor from enlarging and rupturing; ⑧ During dialysis, the fistula limb should not be moved at will (especially for new fistulas) to prevent local hematoma after puncture; ⑨ Self-check the fistula 2-3 times a day for tremors or vascular murmurs, and report to the doctor immediately if there is any abnormality; ⑩ Report to the doctor in time if there are symptoms of infection in the access and redness, swelling, heat, pain, bleeding, etc. at the puncture site.

2. Nursing of arteriovenous graft fistula. ① Keep the wound dressing clean and dry after surgery, and change the dressing on time; ② Closely observe whether there is redness, swelling, exudation, pain, etc. in the local area; ③ Avoid measuring blood pressure, drawing blood, infusing fluid, etc. on the limb on the graft fistula side; ④ Strictly disinfect the puncture site and use the correct puncture method to reduce vascular damage; ⑤ After dialysis, press accurately to stop bleeding to avoid uneven pressure affecting blood flow.

3. Care of central venous catheters. ① Do not allow any sharp objects to approach the catheter; ② Do not tear, pull, or twist the tape that secures the catheter; ③ Avoid showering when bathing. Please clean the area above the catheter by sponging to prevent the gauze from getting wet and easy to get infected; ④ Do not wear too tight clothes to prevent the catheter from slipping; ⑤ Do not use pillows that are too high when sleeping to avoid compressing the catheter; 6. Do not scratch the surrounding skin to cause itching and breakage; ⑥ If the catheter is placed on the inner thigh, you should reduce walking and sitting, and put on and take off pants slowly to avoid pulling the catheter; ⑦ The nurse will change the dressing on the dialysis day. If the gauze is wet or bloody on non-dialysis days, please go to the hospital to change it; ⑧ The catheter should not be used for other purposes except in emergency situations, such as blood drawing, infusion, etc.; 10. Compare the length of the catheter outside in front of the mirror every day.

3. Regularly check and maintain vascular access

Patients should go to the hospital regularly for ultrasound or angiography to evaluate the blood flow of the access and whether there is stenosis or thrombosis. These examinations can help doctors detect and evaluate potential problems in time to ensure the normal function of vascular access. Once a problem is found, it should be treated in time, such as through balloon dilatation or stent placement to clear the narrowed blood vessels. In addition, patients should check the tremor and murmur of the access by themselves before each dialysis. This can be done by touch and listening: gently touch the access site with your hand to feel whether there is a tremor; use a stethoscope or put your ear close to the access site to listen for a continuous "buzzing" sound. If the tremor is found to be weakened or disappeared, it should be reported to the doctor in time for early intervention.

4. Scientific diet and lifestyle

①Control the amount of water you drink: Avoid excessive blood volume that increases the burden on your vascular access, especially in the days between dialysis sessions. ②Balanced diet: Eat more foods rich in vitamin C and antioxidants, such as fresh fruits and vegetables. These nutrients help to enhance vascular elasticity and reduce the risk of vascular damage. At the same time, avoid high-fat, high-salt, and high-sugar foods, which increase the risk of atherosclerosis and affect the health and function of your vascular access. ③Moderate exercise: Moderate physical activity, such as walking and light aerobic exercise, helps promote blood circulation and reduce the risk of thrombosis. Exercise can improve blood flow throughout the body, reduce venous pressure and vascular resistance, and help maintain unobstructed vascular access. ④Good living habits: Maintaining good living habits is essential to protecting your vascular access. Quitting smoking and limiting alcohol, maintaining adequate sleep, and having a regular lifestyle can all help maintain the function of your vascular access.

5. Psychological Adjustment

The long-term stability of vascular access is not only related to physiological factors, but also closely related to the patient's psychological state. Long-term dialysis patients often face psychological pressure, such as anxiety and depression, and these negative emotions can affect the health of blood vessels. Patients should learn to regulate their emotions and face challenges in life positively. At the same time, they can relieve stress and maintain a good attitude through psychological counseling, participating in patient mutual aid groups, and cultivating hobbies.

"Medical Herald" 24th issue 42, author: Li Qinfang, Luoding People's Hospital