hemodialysis arteriovenous shunt

1. Acute renal failure without urine or oliguria for more than 2 days, urea nitrogen greater than 90mg% or creatinine greater than 6mg% and obvious uremia symptoms. 2. Chronic renal failure, serum creatinine 6 ~ 10mg%, endogenous creatinine clearance rate of less than 10ml / min and moderate uremia symptoms. Treatment of diseases: chronic renal failure, acute renal failure Indication 1. Acute renal failure without urine or oliguria for more than 2 days, urea nitrogen greater than 90mg% or creatinine greater than 6mg% and obvious uremia symptoms. 2. Chronic renal failure, serum creatinine 6 ~ 10mg%, endogenous creatinine clearance rate of less than 10ml / min and moderate uremia symptoms. Surgical procedure (1) External arteriovenous shunt It can be used for a long time, easy to operate, no need for puncture; but it is prone to embolism in the long-term, with a catheter, convenient life, easy bleeding and infection. 1. Incision and exposure: In the place where the 5cm radial artery beats above the forearm wrist joint, the longitudinal incision is about 2cm long. The subcutaneous tissue and fascia are cut and separated, and the radial artery is exposed for 2cm long and is pulled by silk thread. Then choose a small incision about 2 cm parallel to the superficial vein adjacent to the radial artery. The subcutaneous tissue was dissected and separated, and the subcutaneous vein was exposed, separated by about 2 cm, and pulled with a silk thread. 2. Silicone shunt catheter trial: cut and separate the subcutaneous tissue so that it can satisfactorily bury the curved portion of the silicone shunt catheter. After the silicone arteriovenous shunt catheter was properly matched, the heparin solution (50 mg/ml) was perfused in the lumen, and the end of the catheter was clamped with a forceps. 3. Place the arterial catheter: firstly connect the distal end of the radial artery, and lift the traction line at the proximal end to temporarily block the blood flow. A small opening was made in the wall of the radial artery, and the two walls were retracted with a nylon thread. A silicone shunt catheter was inserted into the iliac artery, and the silicone shunt catheter was ligated with a wire and fixed to the vessel wall. The "u" shaped portion of the silicone shunt conduit is buried in the subcutaneous tissue that is sneaked apart, and a small opening is made in the skin at the appropriate location to pull the end of the silicone tube out. 4. Place the venous catheter: the distal end of the separated vein is ligated, and the proximal end is lifted with a wire to block the blood flow. A small opening was made in the vein wall, another silicone shunt catheter was inserted into the vein, and a heparin saline solution was injected into the catheter to observe whether it was unobstructed. In the same manner as the arterial treatment, the u-bend portion of the catheter is buried in the subcutaneous tissue that is sneaked apart, and the catheter is pulled out of the skin by pitting the hole in place. 5. Switch on the catheter and suture: After confirming that the arteriovenous and venous shunts are unobstructed, connect the two tubes, and the arterial blood can flow into the vein. The pulse can be touched at the proximal end of the vein. Auscultation has a murmur and cat asthma, indicating blood flow. unobstructed. The skin incision was sutured with silk thread and gently wrapped with a dressing. (B) in vivo arteriovenous shunt In vivo arteriovenous shunt, also known as subcutaneous arteriovenous shunt, is suitable for chronic long-term dialysis. In vivo arteriovenous shunt can be treated with lateral vascular anastomosis, end-to-end anastomosis and end-to-side anastomosis, but the lateral anastomosis is most reasonable and used together. When the flow is insufficient, the end-side or even end-to-end anastomosis is used. This type of surgery can maintain a long period of blood circulation, no catheter, easy to move, not easy to bleeding and infection; but high surgical requirements, slow blood flow, dialysis using a blood pump, is also a deficiency. 1. Incision and exposure: a 4 cm long incision is made 3 to 5 cm above the anterior wall wrist joint, the subcutaneous connective tissue is separated, the fascia is cut, the radial artery is exposed, and it is separated from the surrounding tissue by a length of about 4 to 5 cm. The ends are surrounded by a ribbon for a week, and the tension is gently lifted to temporarily block the blood flow. The same method is used to treat the superficial subcutaneous vein near the radial artery, but care should be taken to ligature its branches. 2. Cut the arteries and veins: Pull the traction bands on the veins and veins to each other, so that the two blood vessels are close together, and the arteries cannot be twisted or angled. The artery was pulled up with a vein hook, and the artery wall was cut with a knife about 7 mm long, taking care not to damage the posterior wall of the artery. The vein is also an isometric incision at the corresponding location. 3. Arteriovenous lateral anastomosis: first fix and draw with 7-0 or 9-0 non-invasive nylon suture at the distal and proximal ends of the incision of the arteriovenous and venous wall. Note that ligation should be outside the vessel wall. A needle pull line is sewed in the middle of the arteriovenous wall incision, and is drawn to both sides to make the posterior wall of the two blood vessels clear. Use the mosquito clamp to gently dilate the entrance and exit of the arteriovenous vein, and suture the posterior wall of the vascular anastomosis with one end of the proximal fixation line. The distal end is ligated to one end of the distal fixation line and knotted outside the vessel wall. Then use the other end of the distal fixation line to suture the anterior wall of the anastomotic and venous anastomosis. When suturing the anterior wall, the traction line in the middle of the vessel wall can be pulled up to make the anterior wall of the vessel clear, and the posterior wall is not injured when suturing. . After the front wall is sewn, it is ligated to the other end of the proximal fixation line. Then remove the pull wire and the fixed wire. 4. Check blood flow and suture: open the arteriovenous vein and gently press to stop bleeding. The vein should be pulsated immediately, and the cat can be swollen, indicating that the blood flow is smooth, and the arteriovenous fistula shunt is completed. Suture the subcutaneous tissue and skin incision, gently wrap the externally sterilized gauze, do not press too tight, so as not to affect the blood flow.

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