Dinwiddie Lesley C, Ball Lynda, Brouwer Deborah, Doss-McQuitty Sheila, Holland Janet
Nephrology Nurse & Vascular Access Consultant, Cary, North Carolina 27518, USA.
Semin Dial. 2013 May-Jun;26(3):315-22. doi: 10.1111/sdi.12069. Epub 2013 Mar 5.
This article describes cannulation events, especially problems, common and rare, minor and major, to aid the nephrologist (and mid-level providers e.g. nurse practitioner and physician's assistant) in decision-making to prevent or treat cannulation-related adverse outcomes. The usual management, potential outcomes, nephrologist intervention, and prevention are discussed and include: assessment of arteriovenous (AV) access and readiness for cannulation; initial cannulation of both arteriovenous fistulas and grafts; needle size and adequacy; needle direction and potential for recirculation; limited cannulation sites/buttonhole; pain and fear of pain; prevention of bleeding; management of infiltrations/extravasations; prevention and management of "one-site-itis"; prevention and management of infection. It concludes with the importance of the medical director as the leader of the continuous quality improvement (CQI) team in preventing/reducing cannulation-related adverse events.
本文描述了动静脉内瘘穿刺事件，尤其是各种问题，包括常见和罕见的、轻微和严重的问题，以帮助肾病学家（以及中级医疗人员，如执业护士和医师助理）在决策时预防或治疗与穿刺相关的不良后果。文中讨论了常规管理、潜在结果、肾病学家的干预措施和预防方法，包括：动静脉（AV）通路评估及穿刺准备；动静脉内瘘和移植物的首次穿刺；针头尺寸及适用性；进针方向和再循环可能性；穿刺部位受限/钮孔穿刺法；疼痛及对疼痛的恐惧；出血预防；渗漏/外渗处理；“单点炎症”的预防和处理；感染的预防和处理。文章最后强调了医疗主任作为持续质量改进（CQI）团队领导者在预防/减少与穿刺相关不良事件方面的重要性。
