护理干预对提高血液透析患者双腔深静脉置管质量的探讨_血液透析患者的原因和干预
[摘要] 目的 探讨提高对维持性血液透析患者留置双腔导管的护理质量的方法。 方法 对本科2004年8月～2007年12月共34例维持规律血液透析患者进行带涤纶套双腔右颈静脉置管术38例次，实施以下护理措施：置管前了解患者血管状况。置管时实行心电监护、严格执行无菌操作；导管固定前用0.9%氯化钠溶液清洗穿刺口，采用高举平台法固定导管和无张力法黏贴敷料。严密观察局部是否出血。导管使用时密切观察血流情况，严防导管开口的直接污染。透析结束，先予0.9%氯化钠溶液冲管后再用肝素盐水封管。采用脉冲式冲洗导管和持续正压封管。实施全程心理指导和健康宣教等。 结果 38例次中36例次置管过程顺利。2例次置管不顺利，改变置管静脉后成功置入。1例男性患者在置管过程中出现了烦躁、大汗、呼吸困难、心动过速，对症处理后症状消失。本组总留置时间为228个月，平均留置时间6.5（2～22）个月，最长12个月。 结论 规范的护理干预对提高双腔深静脉置管的成功率，减少感染和堵管，预防并发症，延长置管寿命有积极的意义。
[关键词] 深静脉置管；护理；血液透析；护理质量
[中图分类号] R473 [文献标识码] A [文章编号] 1674-4721（2012）07（c）-0167-02
Study the nursing care for hemodialysis patients with deep double-lumen venous catheter
YＡＮＧ Jin
Department of Internal Medicine, Guangzhou First People"s Hospital in Guangdong Province, Guangzhou 510180, China
[Abstract] Objective To study how to improve the nursing quility in hemodialysis patients with deep double-lumen venous catheter. Methods During August 2004 to December 2007 total of 34 patients (38 cases) with deep venous double-lumen catheter were undergoing the following nursing: understanding vascular conditions before the patient to implement deep double-lumen venous catheter, implement ECG monitoring, strict aseptic technique dursing implement catheter. Cleaning catheters with normal saline before puncture, catheter was fixed by holding platform and non-adhesive dressings. Observed the local if bleeding, pollution. In the end of dialysis, be washed with normal saline and then sealed tube with heparin saline. Psychological guidance and health education for the patients. Results Thirty six casese were successed implement catheter and 2 cases were not. After change venous they got successed. One male case occurred irritability, sweating, difficulty breathing, tachycardia during implement catheter and after treatment the symptoms disappeared. The total retention time for this group were 228 months and an average were 6.5 (2-22) months, maximum was 12 months. Conclusion Standardized nursing interventions can improve hemodialysis patients with deep double-lumen venous catheter.
[Key words] Deep double-lumen venous catheter; Care; Hemodialysis; Nursing quility
维持性血液透析患者需要稳定可靠的血管通路。自体动-静脉内瘘是目前最为理想的血管通路[1]。但对于不能建立自体动-静脉内瘘的患者或有心血管疾病、做过多次内瘘术、不能行腹膜透析的、甚至还包括畏惧反复血管穿刺的患者，应用带涤沦套长期留置双腔导管，可以作为一种较理想的血管通路，是一种安全、有效的方法。如何尽量提高长期双腔深静脉置管的成功率、延长置管时间，一直是临床医护人员值得探讨的问题。本科对此进行了探讨，现总结如下：
1 资料与方法
1.1 一般资料
本科在2004年8月～2007年12月共有34例行永久性双腔导管留置术38例次，其中，男17例，女17例，年龄16～82岁，平均（56±30）岁；34例患者中31例患者术前已经带有临时双腔静脉导管，除2例患者从未做过内瘘手术外，其余均至少做过1次内瘘手术。