中国血液净化

中国血液净化 ›› 2018, Vol. 17 ›› Issue (04): 268-271.doi: 10.3969/j.issn.1671-4091.2018.04.015

• 护理研究 • 上一篇    下一篇

48 例钝针扣眼穿刺法在血液透析患者动静脉内瘘中的实施与效果分析

王婧1,矫健梅1,彭影1,王越媛1,王滢1,于洪梅1,荆艳辉1   

  1. 1. 哈尔滨医科大学附属第二医院第六住院部血液净化中心
  • 收稿日期:2017-10-09 修回日期:2018-01-02 出版日期:2018-04-12 发布日期:2018-04-12

Implement and effect analysis of buttonhole puncture to arteriovenous fistulas in 48 hemodialysis patients

  • Received:2017-10-09 Revised:2018-01-02 Online:2018-04-12 Published:2018-04-12

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摘要： 【摘要】目的探讨对自体动静脉内瘘的钝针扣眼穿刺法实施方法与效果分析，为临床提供指导和借鉴。方法回顾在哈尔滨医科大学附属第二医院应用扣眼穿刺法穿刺动静脉内瘘的48 例透析患者，总结隧道形成、钝针穿刺的方法及技巧，分析在穿刺过程中疑难问题的处理方法。结果48 例患者中，有43 例患者通过扣眼穿刺法使用钝针穿刺；有2 例患者内瘘栓塞，在对侧肢体质量新行动静脉内瘘手术后，改为绳梯穿刺法；有3 例患者发生感染，其中1 例感染症状消失后改为绳梯穿刺法；2 例患者假隧道形成，改为绳梯穿刺法。结论扣眼穿刺法的要点主要包括隧道形成、锐针穿刺更换为钝针穿刺时机、钝针穿刺方法、去痂方法。如以往已形成假性动脉瘤的患者应用扣眼穿刺法时，需避开瘤体建立隧道。钝针穿刺中断使用，如需重新启用，需用锐针沿原隧道穿刺几次后再改为钝针。当穿刺部位发生感染时，不得在感染部位穿刺，需每日3 次碘伏消毒感染部位，当感染症状消失后可继续使用；当发生钝针穿刺困难时，勿盲目进针，需分析穿刺困难原因后，再行钝针穿刺；一旦发生皮下血肿，停止血肿部位穿刺，更换穿刺点；发生渗血时，及时分析渗血原因并进行干预。

关键词: 钝针, 扣眼穿刺法, 动静脉内瘘, 血液透析

Abstract: 【Abstract】Objective To explore the procedure and the effect of blunt needle puncture to autogenous arteriovenous fistulas in order to provide a guidance for clinical practice. Methods We retrospectively summarized 48 hemodialysis patients treated with buttonhole puncture to arteriovenous fistulas for blood access, and analyzed the tunnel formation, the technique of blunt needle puncture and the management of obstacles during puncture. Results Blood access was successfully performed in 43 of the 48 patients using buttonhole puncture method of blunt needles. Two of them had embolisms in fistulas and underwent another arteriovenous fistula surgery in the contralateral limb. Ladder puncture was then used. Infections occurred in 3 patients; the symptoms disappeared after the change to ladder puncture in one cases, and pseudo-tunnel formation was found in 2 cases and ladder puncture was then used. Conclusion The critical techniques for buttonhole puncture include tunnel formation, the time for the replacement of sharp needle puncture to blunt needles
puncture, procedures for blunt needle puncture, and taking off the scars. In patients with pseudo-aneurysm on fistulas, buttonhole puncture should be carefully manipulated to establish a tunnel far from the pseudo-aneurysm. When blunt needle puncture is interrupted and has to be reused, the original tunnel should be punctured several times with a sharp needle and then a blunt needle is used for the puncture. When infection occurs at the puncture site, local treatment with iodophor is used 3 times daily and this site can be used until the infection disappears completely. When obstacles happen during blunt needle puncture, the puncture must be stopped to explore the causes before continuing the manipulation. When hematoma forms, the puncture site must be changed. When bleeding at the puncture site occurs, intervention and investigation of the bleeding cause must be immediately conducted.

Key words: Blunt needle, Buttonhole puncture, Arteriovenous fistula, Hemodialysis