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 Wysłany: Pią 23:25, 04 Mar 2011 Temat postu: The application of plasma exchange therapy and nur |
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The application of plasma exchange therapy and nursing
Nutritional supplement. 4. Common complications and care (1) hypovolemia, hypotension. Because cardiopulmonary bypass, coupled with the reduction of plasma plasma protein loss, intraoperative blood can occur humiliated, low blood pressure, patients, dizziness, sweating, nausea, vomiting, decreased blood pressure. Thus, in operation, vital signs should be closely observed. When the slow flow velocity space volume depletion, early to give improved replacement fluid, and added blood volume. (2) high blood volume, congestive heart failure. Since the replacement fluid protein concentration is too high, the plasma colloid osmotic pressure,[link widoczny dla zalogowanych], causing high-m capacity, or replacement of excessive fluid supplement, too fast, decompensation of heart and kidney function in patients, may cause congestive heart failure, pulmonary edema Therefore, the input substitution fluid, to control speed, pay attention to changes in vital signs. (3) Allergic reactions: substitution fluid containing foreign protein, anti-A, anti-B antibodies, and other allergens, when patients with urticaria, chest tightness, shortness of breath right, should consider the possibility of allergic reaction, you must slow down the input speed or stop the importation of replacement fluid, and with anti-histamine agents and hormones, warmth and other symptomatic treatment. (4) low calcium response: substitution fluid containing anticoagulant citrate, and calcium chelate, can reduce the concentration of serum calcium, with patients with mild perioral numbness, if not in time, and thus appear to tremor muscle cramps, hand-foot-pumping take hold, but also place a variety of arrhythmias. If patients had perioral numbness, immediately enter the blood containing citrate slow down, when symptoms, intravenous calcium gluconate. (5) infections: indwelling catheters, arteriovenous short circuit can cause failure of Practical Nursing acidosis and subacute bacterial endocarditis, and the reduction in immunoglobulin complement, hormones and immune inhibitors, more susceptible to infection. Therefore,[link widoczny dla zalogowanych], strict aseptic technique, indwelling catheter not too long, as little as possible with arteriovenous short circuit, if necessary, give gamma globulin to prevent severe infection. (6) bleeding tendency: Plasma exchange loss of many coagulation factors, coupled with the destruction of platelets,[link widoczny dla zalogowanych], heparin, should be taken to avoid bleeding. Therefore, the amount of intraoperative heparin must master, if necessary infusion of platelets or clotting factors. Plasma exchange in order to reduce costs, while improving the biocompatibility of the same patients were treated with the replacement device, reusable, our approach is: (1) Cleaning method: replacement of anti-seepage termination device artery, vein side open,[link widoczny dla zalogowanych], opening simultaneously in dialysis are red 3O minutes, and then, the dialysis zone after the end of the block filled with anti-seepage, the other end of anti-seepage, blood District dynamic and static side open decompression, the reverse osmosis 3O minutes until the venous trap no blood, no fiber, the appearance of cleaning up. Reperfusion of 2% formalin lO00ml ~ drug use. (2) replacement device reuse pre-hedging methods: the replacement of devices installed in the dialysis machine, filtering out the pipe was half-open state, a continuous pre-washed with normal saline 5GOCml, flow 15Cml / min, and finally adding 2Ging 500ml saline pre-washed heparin , put away after use. We tried 3 times reuse the above method and found no adverse reactions. With oneself, pulp Man cabinet, in a bow OOO Cs blood cell separator plasma exchange in the care Shanxi Tumor Hospital Yuping Zhang v-disease (1]. C8-300O our hospital blood cell separator into Q'PE treatment of multiple myeloma with hyperviscosity syndrome Tour and achieved good effect. PE of care is to obtain the treatment success and prevent certain serious complications the key. Clinical data and results of the past 3 years, the hospital treatment of multiple myeloma application of PE in 5 cases, all male, aged 35-52 years. A total of 2PE19 cases, and each exchange capacity 600--2000 ml. the total maximum 1 of 8000 ml, in 1 patient in the PE with melphalan and cyclophosphamide treatment before 3 months, symptoms gradually increased not only the husband relief but after using this method by reducing the viscosity of plasma, changing the micro Central Finland, the chemotherapy played a role, the symptoms were relieved after 5 cases of PE symptoms and signs and laboratory tests were obtained was sui. How C ~ - 3900 blood cell separator (Yao Wai Travonal product) is the use of arms, venipuncture, closed continuous separation, with the PE program four procedures. separation of plasma from the start,[link widoczny dla zalogowanych], while transfusion of T-tube at the open-infusion, add equal amount of constant replacement fluid flow rate per minute for the entire K 35-5O each other up, centrifugal speed l6OO r / min, blood and anticoagulant ratio of 1I: 1, the end of the exchange lasted 1.5-2 hours. Care for a recess, 0 care (-) Psychological care: the different state of mind based on the patient, Explanation of work to do to explain the necessity and safety of treatment, the machine
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