How To Evaluate Hemodialysis Patients? These 5 Aspects Are Very Important
Jan 11, 2023
If hemodialysis patients want to have good hemodialysis, they must do a good job in hospital treatment management and out-of-hospital nursing safety.
The number of hemodialysis patients in China is increasing year by year. According to statistics in 2022, the number of hemodialysis patients in China will be nearly 900,000 by 2021, an increase of 3.2 times in ten years. Dialysis patients are treated in the hospital dialysis center 2-3 times or even more times a week, each treatment time (hospital time) is about 4-5 hours, and the rest of the time is outside the hospital. Some patients leave the hospital after dialysis and stay at home When their self-care ability is poor, and the supervision and supervision of doctors and nurses are lacking, complications such as hyperkalemia, internal fistula failure, fractures caused by falls, and catheter infection are prone to occur, which is particularly unfavorable to the disease. Therefore, doing a good job in daily assessment is of great significance for hemodialysis patients. It can help patients get an objective and scientific assessment, make a detailed and scientific treatment plan and adjust and modify the treatment plan in time when the condition changes, so that patients can receive scientific and effective treatment. treat.
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This article describes the safety assessment of patients, hoping to help more dialysis patients with kidney disease and their families. Next, we will share the following five aspects.
1. General condition of dialysis patients
The basic situation of hemodialysis patients is the basis of all disease analyses. We need to carry out regular questionnaire analyses of personal self-care situations, usually once a month, but we need to conduct a brief situation assessment before each dialysis.
The evaluation of a single dialysis session is mainly to observe the patient's physical strength, distinguish walking, wheelchair, and flat car into the hemodialysis room at a glance, the patient's gait, and whether he needs to be supported; Feels good; check the patient's ultrafiltration volume in recent times; ask about sleep conditions, etc.
Long-term regular systematic assessment, including the patient's physical strength, lying position, appetite, drinking water control, sleep, urine output (residual renal function), defense, bleeding, and medication within a cycle, etc.
2. Evaluation of vascular access
1) Central venous catheter
In addition to the evaluation of the central venous catheter every time it goes on and off the machine, the content includes the integrity of the dressing, the condition of the catheter port (whether there is bleeding, whether there is inflammation), the integrity of the temporary catheter suture, and the skin around the catheter. Heat, pain, local skin itching at the catheter port, etc.; evaluate whether the patency of the catheter is good when on the machine and whether the patient has undergone regular urokinase thrombolysis; monitor the blood flow, venous pressure, and arterial pressure of each dialysis session.
The central venous catheter needs to be systematically evaluated once a month, including clarifying the position and depth of the catheter, whether the puncture point is intact, whether there is redness, swelling, exudate, bleeding, surrounding ecchymosis, suture breakage, etc.; consult the patient Dialysis blood flow in the past month, evaluate the catheter access status of the patient, no blood return in arterial cavity withdrawal, no blood return in venous cavity withdrawal, blood flow rate, arterial pressure, whether the patient has undergone monthly urokinase thrombolysis Treatment maintains catheter function.
2) Autologous arteriovenous fistula/graft artificial vascular fistula
For autogenous arteriovenous fistula and graft artificial vascular fistula, each dialysis treatment needs to be fully evaluated before puncturing on the machine. The evaluation includes blood pressure before the machine, whether there is bleeding, internal fistula tremor condition, local skin condition at the puncture section, whether there is redness, swelling, heat, pain, or ulceration, inquiry about the last time when the needle was pulled out for hemostasis after getting off the machine, and confirm the rope ladder to replace the needle eye for puncture; monitor the patient's blood flow, arterial pressure, and venous pressure after getting on the machine and transmembrane pressure, if there is insufficient blood flow, low arterial pressure or high venous pressure, and there is no improvement after needle adjustment or supplementation, it is necessary to report to the responsible physician.
For arteriovenous fistulas, it is recommended to conduct access follow-up visits once a month. Access nurses and access doctors may conduct functional assessments together, mainly by ultrasonographic examination of fistula blood flow, evaluation of stenosis, thrombus, etc., according to the recent puncture and machine The blood flow pressure situation, update the clear puncture plan every month. For some internal fistulas with high venous pressure and insufficient blood flow, timely surgical intervention is required.
3. Assessment of dry weight
Dry weight refers to the optimal target weight determined according to the patient's medical history and physical examination results. When the patient reaches this weight during dialysis, he is in a relatively comfortable state, that is, at the end of dialysis, there is no water and sodium retention, normal blood pressure, no discomfort complaints, no edema, and Body cavity effusion, no pulmonary congestion, no jugular venous distention, and cardiothoracic ratio within the ideal range. Dry weight is not constant. Dry weight is generally evaluated once a month. At present, general physical examination combined with medical history is commonly used to determine the dry weight in clinical practice. Other methods for the more accurate evaluation of dry weight include bioelectrical impedance analysis, online blood volume monitoring, and measurement of inferior vena cava diameter.
The accuracy of dry weight is directly related to the quality of dialysis of patients. Dynamic evaluation of the dry weight of patients to avoid errors is one of the key factors to reduce complications of dialysis patients so that patients can achieve comfortable dialysis with fewer complications and no subjective discomfort experience. It is high-quality dialysis. Clinical medical staff should pay attention to the patient's dry weight, manage the dry weight well, and effectively avoid the patient's water retention or excessive dehydration.
4. Nutritional status assessment
Malnutrition and protein energy depletion are important complications in hemodialysis patients due to decreased nutrient intake (loss of appetite, acidosis, gastrointestinal discomfort, depressive states, encephalopathy, etc.), hypercatabolism (associated diseases, inflammatory states, dialysis Membrane biocompatibility, acidosis, endocrine disorders, etc.), the incidence of malnutrition in hemodialysis patients is very high.
Nutritional assessment can be carried out through weekly dialysis for dietary education, paying attention to the patient's dietary status. Systematic reviews are generally done once a quarter, and the main content includes biochemical examination and screening of nutritional indicators such as creatinine, blood urea nitrogen, albumin, transferrin, ALB, etc.; body composition; measurement of anthropometric indicators such as BMI, Upper arm circumference, skinfold thickness, etc.; nutritional intake questionnaires such as diet records, 24-hour diet review, cholesterol intake, etc.; comprehensive evaluation systems such as quality of life evaluation.
For nutritional assessment, factors such as the patient's age, physiological needs, and primary disease should be considered. The first step is to fully evaluate the nutritional status, that is, to correctly understand one's nutritional status. Only when the nutritional status is accurately grasped can the next step be better formulated. Nutritional Therapy Program.
5. Patient Safety Assessment
1) Fall risk assessment
Due to the increasing number of elderly patients undergoing hemodialysis, it is also important to prevent patients from falling and falling off the bed. This requires training on relevant knowledge for dialysis patients, family members, and escorts, and classifies dialysis patients into high-risk, medium-risk, and low-risk falls and falls. For high-risk groups and middle-risk groups, we need to focus on and evaluate patients’ gait, drug use, blood pressure, and auxiliary tools every time they undergo dialysis, and use guardrails and additional tools such as wheelchairs correctly. We systematically evaluate the population once a month; low-risk groups can be systematically evaluated quarterly, but we also need to do an excellent job in daily education on falls and falls.
2) Unplanned extubation (needle) evaluation
Hemodialysis is inseparable from the puncture of the arteriovenous fistula and the central venous catheter useer. Whether it is internal fistula or catheter, unplanned extubation is an important safety nursing content during and between dialysis. This requires dialysis patients and their family members to maintain vascular access. During dialysis, avoid turning over at will and involving the dialysis catheter, so as not to cause the puncture needle or the dialysis catheter to come out.
For unplanned extubation assessment work, before the dialysis catheter is put on the machine, it is necessary to check whether the suture of the temporary catheter, especially the temporary femoral vein catheter, is in good condition, whether the patient’s clothes are loose, whether the patient and his family have awareness of the safety protection of the dialysis catheter, and long-term management Be sure to check whether the cuff is appropriate; patients with internal fistula should mainly strengthen inspections during dialysis, properly fix the dialysis tubing and puncture needle, and strengthen safety education or warning education to prevent needles from falling out.
Depending on the patient’s condition, a systematic assessment is performed once every 1 to 3 months, and the risk level is scored. Medium and high-risk groups need more systematic health education, strengthen inspections during dialysis, strengthened follow-up during dialysis intervals, and strengthened safety awareness of patients and their families in maintaining vascular access.
Finally, to think about the daily assessment of hemodialysis patients, we need to clarify a few questions: What is the assessment of dialysis patients? When to do the assessment? How often is the reassessment? …To formulate dialysis patient assessment, we need to clarify what content, including some record requirements and operating procedures, etc. The above five aspects are the content of the patient safety assessment we propose. Hemodialysis centers need to conduct monthly, quarterly, and annual quality control to control quality data and ensure the safety of dialysis patients inside and outside the hospital. In addition, there are many other assessments that we can do, including the assessment of the quality of life, anxiety and depression status of dialysis patients, assessment of daily living ability, assessment of pressure sore risk, assessment of adverse reactions of dialysis, and so on.
Hemodialysis work is not mechanical on-board and off-board get-off work. Adhering to a cautious and independent work attitude and critical thinking, assessment is the first step and a key step in effectively identifying and reducing patient safety risks. Doing a good job in the daily assessment and continuous periodic assessment of hemodialysis patients, taking effective preventive measures to reduce the occurrence of risks, and ensuring the safety of dialysis patients are the unshirkable sacred responsibility of every hemodialysis nurse.
for more information:ali.ma@wecistanche.com
