The clinical application of color Doppler ultrasound in guiding the puncture of new internal fistula in deep arteriovenous / 中国实用护理杂志

ABSTRACT

Objective:To investigate the clinical value of color Doppler ultrasound guidance in the puncture of new internal fistula in deep arteriovenous of hemodialysis patients.Methods:Selected thirty patients with arteriovenous fistula not less than 5 mm deep in the Department of Hemodialysis Room of Wuhan First Hospital, and they were divided into observation group and control group by the method of random number generator in IBM SPSS Statistics 22.0 software, with 15 patients in each group. The control group was treated with conventional blind puncture by experienced nurses (849 times), while the observation group was treated with color Doppler ultrasound guided puncture (855 times). By comparing two groups of deep arteriovenous fistula in new fistula patients within 6 months of the one-time success rate of puncture, the incidence of adverse events such as subcutaneous hematoma, bleeding, pain, interruption or postponement of treatment, and accidental injury to arteries caused by puncture errors of internal fistula, and the patient′s satisfaction with the puncture and dialysis results was evaluated to observe the advantage of color Doppler ultrasound guidance in clinical application of deep arteriovenous new fistula puncture.Results:The success rate of one-time puncture for internal fistula puncture in observation group was 98.95% (846/855), which was significantly higher than that in control group 81.27% (690/849), and the difference was statistically significant ( χ2 = 149.753, P < 0.01). The incidence of subcutaneous hematoma, bleeding, pain, interruption or delayed treatment in observation group respectively was 0.58% (5/855), 0.94% (8/855), 0.47% (4/855) and 0, however, in control group was 17.20% (146/849), 2.47% (21/849), 2.12% (18/849) and 1.06% (9/849), respectively. There were significant differences between the two groups ( χ2=145.557, 6.022, 7.875, Fisher′s exact test, P < 0.01 or 0.05). The incidence of arterial injury was extremely low in clinical practice, with 0 in observation group and 0.12 %(1/849) in control group, and the difference was not statistically significant ( P>0.05). The total incidence of adverse events caused by internal fistula puncture errors in the two groups was 1.99% (17/855) and 22.97% (195/849), respectively, and the difference was statistically significant ( χ2=172.126, P < 0.01). The average rank of satisfaction in observation group was 1 261.25, which was higher than control group 440.86, and the difference was statistically significant ( Z=-38.107, P < 0.01). Conclusions:Color Doppler ultrasound guidance in the puncture of new internal fistula in deep arteriovenous of hemodialysis patients has important clinical application value. It can significantly improve the success rate of one-time new internal fistula puncture, reduce the occurrence of adverse events due to puncture failure, and reduce patient′s pain, which is worthy of clinical promotion.