https://www.kidney.org/sites/default/files/Fistula%20Bulletin.pdf

Arteriovenous Fistula(AVF)ua lub "lifeline" rau cov neeg mob tau txais kev kho hemodialysis. Kev vam meej AVF cannulation cim qhov tseem ceeb thawj kauj ruam los lav qhov ua tau zoo ntawm kev lim ntshav txaus thiab ua kom lub neej ntev fistula. Nyob deb ntawm cov txheej txheem puncture niaj hnub, AVF cannulation yog ib qho kev kho mob zoo sib xws nrog cov kws tshaj lij anatomical, kev ua haujlwm zoo thiab cov neeg mob-kev saib xyuas tib neeg. Tsab ntawv xov xwm no piav qhia txog cov ntsiab lus tseem ceeb hauv kev kho mob thiab cov txheej txheem tseem ceeb ntawm kev sib tsoo rau AVF cannulation.

I. Ua ntej-cannulation Comprehensive Assessment and Planning: Foundation for Successful Cannulation

Kev vam meej cannulation hinges ntawm kev npaj ua ntej ua ntej, pib nrog kev ntsuas kev loj hlob ntawm lub hom phiaj AVF. Lub fistula paub tab nthuav tawm qhov kev zoo siab, qhov txawv txav ntawm cov hlab ntsha, cov ntshav txaus txaus (feem ntau siab dua 600 mL / min), thiab nyob rau sab nraud, cov phab ntsa vascular arterialized. Los ntawm kev tshuaj xyuas, palpation, auscultation ua ke nrog kev kuaj xyuas ultrasonic, cov kws kho mob tuaj yeem ntsuas qhov fistula txoj kab uas hla, subcutaneous qhov tob, vascular chav kawm thiab siv tau ntev ntawm ntu ntu. Ultrasound, suav tias yog tus qauv kub rau kev ntsuam xyuas, intuitively pom lub hauv paus lumen txoj kab uas hla, intimal kev ncaj ncees, thiab muaj vascular stenosis los yog thrombosis.

Tom ntej no los puncture site npaj. Cannulation yuav tsum ua raws li txoj hlua - ntaiv los yog lub pob khawm puncture raws tu qauv kom tsis txhob muaj aneurysmal dilatation lossis vascular stenosis induced los ntawm localized repetitive puncturing. Thawj qhov chaw yuav tsum tau muab tso rau qhov tsawg kawg nkaus ntawm 3 cm deb ntawm anastomosis ntawm ncaj, elastic vascular ntu. Cov koob txhaj tshuaj (ntshav tawm kawg) feem ntau yog qhia nyob ze, thaum lub koob venous (ntshav rov qab kawg) cov ntsiab lus distally; qhov inter- koob sib nrug yog pom zoo kom tshaj 5 cm kom txo tau cov ntshav recirculation.

II. Core Technical Procedures rau Precise Puncture

1. Xaiv cov koob txhaj tshuaj

Raws li tau teev nyob rau hauv cov ntaub ntawv cov khoom, tshwj xeeb AVF cannulation koob (xws li, 17G specification nrog ib tug txheej txoj kab uas hla ntawm 1.45 hli thiab puab txoj kab uas hla ntawm 1.19 hli) tsim cov khoom prerequisite rau standardized puncture. Fabricated los ntawm 316L stainless hlau, cov koob no xa cov biocompatibility superior thiab corrosion kuj nyob rau hauv - vivo cov ntshav ib puag ncig. Ntsis sib tsoo yog ib qho tseem ceeb ntawm cov txheej txheem tsim khoom: cov lus qhia ua tiav muaj qhov ua tau zoo ultra-siab sharpness (kev nkag mus los ntawm 50 g mus rau 100 g) thiab du tiav kom txo qis kev raug mob thiab puncture- mob. Advanced tsib-axis laser txiav yog saws los tsim qhov qhib sab nraud, ua kom cov ntshav ntws zoo thiab txo qhov kev pheej hmoo ntawm rab koob apposition tiv thaiv phab ntsa ntawm lub nkoj, ib qho cim ntawm premium- qib cannulation koob.

2. Aseptic Manipulation thiab tshuaj tua kab mob ntawm daim tawv nqaij

Cov txheej txheem nruj aseptic yog qhov tseem ceeb los tiv thaiv kev kis kab mob xws li bacteremia thiab subcutaneous abscesses. Tag nrho cov txheej txheem tshuaj tua kab mob yog siv nyob rau hauv puncture teb raws li sterile drape tso; cov neeg ua haujlwm yuav tsum tsis txhob muaj cov hnab looj tes tsis muaj menyuam ua ntej kev tswj xyuas.

3. Puncture Angle thiab Needle Insertion Maneuvers

Pa puncture lub kaum sab xis ntawm 20℃mus rau 30 degree. Rau superficially nyob fistulas, txo lub kaum sab xis ntawm 15℃-20℃los yog cov txheej txheem tangential nicking tuaj yeem siv los txo qhov kev pheej hmoo ntawm cov hlab ntsha tom qab phab ntsa perforation. Thaum nce qib, rab koob bevel yog khaws cia; Thaum tus yam ntxwv "muab" qhov kev xav ntawm lumen nkag mus rau qhov xav tau, lub koob hub yog flattened thiab nce mus txog qhov sib npaug ntawm cov hlab ntsha rau ib qho luv luv. Ultrasound-Guided Puncture (UGP) tau hloov zuj zus mus rau hauv kub- tus qauv kev coj ua, ua kom pom tseeb- lub sijhawm pom ntawm rab koob taw qhia kom ua tiav ib qho - dhau ntawm cov kab hluav taws xob intraluminal. Tshwj xeeb tshaj yog qhia rau cov tshiab fistulas matured, tob{12}} teem fistulas los yog cov neeg mob uas muaj vascular nkag tau yooj yim, UGP dheev txhim kho puncture zoo npaum li cas thiab txwv tsis pub muaj teeb meem xws li hematoma.

4. Koob Kev Ruaj Ntseg thiab Kev Txuas Tubing

Thaum muaj kev vam meej cannulation, cov khoom siv nplaum tshwj xeeb yog siv los kho cov koob tis kom ruaj khov rau ntawm daim tawv nqaij kom tiv thaiv kev txav ntawm rab koob lossis kev tawg. Kev lim cua nruj yog yuav tsum tau thaum txuas cov hlab ntshav ntxiv, nrog rau cov kev sib tshuam nruj kom tsis txhob muaj huab cua embolism.

III. Tshaj tawm -kev soj ntsuam tam sim thiab saib xyuas

Kev tshaj tawm tam sim ntawd- kev ntsuas cov txheej txheem yog qhov yuav tsum tau ua tom qab ua tiav cannulation, npog patency, xim thiab siab rov qab ntshav nrog rau qhov tsis hloov pauv auscultated vascular bruits. Tom qab kev txuas mus rau lub tshuab hemodialysis, kev soj ntsuam tas li ntawm cov hlab ntsha siab, lub siab ntawm cov hlab ntsha thiab cov ntshav txaus yog ua kom paub tseeb tias ua raws li cov hom phiaj ua ntej. Kev nyeem ntawv txawv txav feem ntau qhia txog qhov tsis zoo ntawm rab koob, lub nkoj - phab ntsa apposition los yog cov kab mob hauv cov hlab ntsha.

Xaus

Precise AVF cannulation yog ib qho kev ua haujlwm zoo uas suav nrog kev soj ntsuam ua ntej, kev npaj chaw, kev ua haujlwm tau zoo thiab cov cuab yeej tsim nyog. Cov kws kho mob yuav tsum tau hais kom cov txheej txheem theoretical thiab polished tes- ntawm kev txawj ntse, nrog rau kev txawj ntse thiab kev lav phib xaub rau cov neeg mob kev nyab xeeb. Tsav los ntawm qhov nrov ntawm kev pom kev pom zoo xws li kev taw qhia ultrasound thiab kev kho mob ntawm siab -kev ua tau zoo cannulation koob tsim los ntawm precision laser machining, AVF puncture txuas ntxiv mus rau kev txhim kho qhov tseeb, kev nyab xeeb thiab kev nplij siab. Lub hom phiaj ntawm qhov kawg yog txhawm rau khaws cov neeg mob cov kab mob vascular lifelines, txhim kho cov txiaj ntsig ntawm kev lim ntshav thiab txhawb nqa tag nrho lub neej zoo.