According to the puncture plan diagram drawn according to the blood vessel access conditions, select a suitable puncture point for needle insertion, the needle insertion angle is ＞25°, and the angle is lowered after seeing blood return. While pushing the indwelling needle hose part, gently remove the needle core. After the puncture is successful, properly fix it, apply a transparent dressing on the outside, and connect the heparin cap at the tail of the indwelling needle to the fistula needle (sharp needle). Strengthen observation during dialysis to prevent slippage. The steps are: puncture V-pull out the needle core-fix-puncture A-pull out the needle core-fix-hemostatic clamp V-remove the heparin cap-connect the anticoagulant syringe-release the hemostatic clamp-absorb air and inject the first dose of anticoagulant-hemostatic clamp again clamp the vein. When drawing blood on the machine, clamp the artery, remove the heparin cap-connect the artery-release the hemostatic clamp-draw blood-connect the vein-release the hemostatic clamp (the hemostatic clamp is made of plastic, disposable, and is specially used to clamp the dialysis indwelling needle).
Although the dialysis catheter can be left in the human body for 72 hours, everyone knows that the average blood flow of the fistula is a high-speed blood flow of 500-1000ml/min. If it is left in the patient's body and taken home, the nursing safety of the catheter between dialysis is a big problem. The risk of dialysis catheter retention lies in unplanned needle removal, bleeding, infection, coagulation, etc. Once it falls off, it will be very dangerous. Therefore, it is recommended to pull it out and discard it after each use. But it is definitely a blessing for CRRT patients. If the patient is hospitalized within 72 hours and continues to dialysis, it can be considered to continue to use it the next day. Then, after the dialysis is over, 10mL of normal saline is injected, and then the tube is sealed with heparin diluent. After getting off the machine, cover it with sterile gauze and wrap it with elastic bandage for fixed protection.
The dialysis indwelling needle puncture to establish an internal fistula buttonhole tunnel described in this article requires the removal of the indwelling needle half an hour before the next dialysis (>48 hours), and after pressing to stop bleeding, puncture the original puncture point with a blunt needle to start hemodialysis. After the dialysis is over, the blunt needle is removed and conventional pressing is performed to stop bleeding. After routine scab removal before each puncture, blunt needle puncture can be used. This method is much more convenient and faster than sharp needle buttonhole puncture to establish a tunnel. The use of sharp needle puncture to establish a tunnel requires more than 8 punctures by a designated person (the "three same principles", i.e., the same puncture point, the same angle, and the same depth).