After years of clinical application, with increasing proficiency in operation and continuous improvement in technology, continuous blood purification (CBP) has successfully treated many critically ill patients. During the treatment process, nursing staff need to observe nursing from multiple aspects to ensure the safe and smooth progress of the treatment.
What are the advantages of CBP?
1. It is not suitable for moving patients, especially those with critical illness, unstable vital signs, or those who are not suitable for moving due to the use of a ventilator.
2. Slowly and continuously eliminate water from the human body, which is more in line with the physiological state of the human body.
3. It can maintain hemodynamic stability well, with small volume fluctuations, better fluid balance, minimal negative impact on hemodynamic stability, and is not limited by hypotension.
4. High solute clearance rate, which can effectively remove large molecule toxins, cytokines, inflammatory factors, and tumor debris from the blood.
5. Providing nutritional and medication therapy as needed is beneficial for improving the prognosis of critically ill patients.
Nursing of CBP
1. Nursing during the treatment process
1. Monitoring of the condition
During the treatment of critically ill patients, their body temperature, heart rate, blood pressure, respiration, and blood oxygen saturation should be closely monitored, and continuous electrocardiogram monitoring should be carried out to timely detect and handle various abnormal situations, observe the efficacy, and monitor changes in blood electrolytes and renal function. Closely monitor and prevent the occurrence of dialysis related complications such as hypotension, hypoglycemia, and coagulation.
2. Management of replacement fluid
According to the patient's extracellular fluid electrolyte composition, configure according to the same method. Based on biochemical results, add electrolytes such as potassium, sodium, calcium, magnesium, etc. according to medical advice; Clearly label to avoid confusion with other liquids; Adhere to the principle of precise medication use, strictly follow the verification system, and achieve three verifications and seven verifications; Strictly follow aseptic procedures, prepare and use immediately to prevent bacterial contamination; Replace it promptly and do not let the liquid go empty. Once the replacement fluid runs out, the balance scale will sound an alarm, the replacement fluid pump and ultrafiltration pump will stop rotating, and the treatment will automatically terminate; Monitor the input of replacement fluid to ensure that it is input at the correct speed. To maintain smooth vascular access, deep vein indwelling catheters should be prevented from blockage, contamination, dislodgement, and bleeding.
3. Strengthen basic care
Due to the long course of treatment, it is necessary to strengthen basic care, do a good job in oral care, and avoid infection; Keep the respiratory tract unobstructed, promptly remove phlegm, and use methods such as humidification, nebulization, patting the back, and suctioning to remove respiratory phlegm to prevent lung infection; Keep the bed unit clean, frequently turn over, massage regularly, and replace it in a timely manner to prevent bedsores from occurring.
Due to the large amount of fluid input during the treatment process, the patient's body temperature often drops. If the patient experiences chills or cold hands and feet, it is necessary to adjust the heating level and increase insulation measures to make the patient comfortable; The input of a large amount of replacement fluid is more likely to cause heat source reactions, so nurses should carefully inspect and perform aseptic operations when preparing and replacing replacement fluid, and pay attention to differentiation.
Due to the fact that pain, anxiety, tension, and noise generated by medical equipment are daily psychological stressors faced by critically ill patients, nurses should pay special attention to the psychological care of patients.
2、 Treatment records and complication management
1. Keep good treatment records
Accurately record and summarize various inflow and outflow data, vital signs, and disease changes, providing a basis for setting machine parameters and clinical treatment. Write nursing documents correctly and accurately record relevant treatment data, such as hourly blood glucose levels and half-hour blood pressure monitoring.
2. Observation and prevention of complications
Bleeding: The use of anticoagulants in CBP treatment can significantly increase or worsen bleeding. Therefore, it is necessary to closely monitor the bleeding situation of drainage fluid, feces, wounds, gums, etc., and record them in detail. When detected early, adjust the use of anticoagulants or use heparin free techniques to avoid serious complications caused by this.
Coagulation: Pay attention to whether the blood distribution at both ends of the filter is uniform, whether the fiber color of the filter changes, whether there is blood stratification in the pipeline, closely monitor the venous pressure, transmembrane pressure (TMP) value and fluctuation range, whether there is progressive elevation, and make records to determine whether the filter is clotting. If there is suspected coagulation, flush the tube with isotonic saline or replacement fluid. If there is severe coagulation, replace the filter and blood pipeline. Therefore, in carrying out various nursing operations, the principle of aseptic technique should be strictly followed.
3、 Continuous blood purification nursing
Currently, CBP has become a key supportive therapy for critically ill patients, but it can only be used as an adjuvant treatment, and the treatment of primary diseases still needs to be strengthened. The severity of a patient's condition before receiving CBP treatment has a significant impact on their prognosis, and human factors may also increase the risk of prognosis. Its core technology is to eliminate pathogenic mediators, maintain internal environment stability, improve immune dynamics abnormalities, rebuild internal stability balance, achieve the goal of maintaining and supporting important organ function, and prevent functional failure.
As blood purification nurses responsible for this technical operation, in order to safely implement this treatment, they should have rich experience in various aspects of CBP and maintain good clinical thinking ability at a certain level. When critically ill patients undergo CBP treatment, nurses need to have a high sense of responsibility, rich nursing experience, strong emergency response and rescue capabilities, solid specialized blood purification skills, and should do every nursing job well.