CRRT tube related care mainly includes the following aspects:
Maintenance goals: prevent tube removal, infection, blockage, and insufficient blood flow. This includes secure fixation. The dressing is generally changed every 48 to 72 hours. If it is contaminated, it should be changed immediately. At the same time, pay attention to frequently observe whether the patient's skin at the catheter insertion site has redness, swelling, pain, heat, bleeding, and purulent secretions, and strictly abide by the principle of aseptic operation.
Prevent air embolism: ensure that the tube clamp is tightly closed to prevent air from mixing into the tube.
Special tube for special use: CRRT deep vein catheterization should be used for special tubes and should not be used for infusion, blood drawing, etc. in non-emergency situations. It is recommended to seal the tube once every 24 to 72 hours, and the frequency of sealing should be increased for hypercoagulable and special patients.
Monitoring during treatment: including close observation of patient vital signs, treatment parameters, extracorporeal circulation input and output, machine pressure values, and record them every hour. During the treatment, timely early warning should be carried out according to the changes in pressure data to avoid machine alarms. When the machine alarms, the cause should be actively found and the alarm should be lifted in time to minimize the risk of unplanned machine removal.
Post-CRRT care: At the end of normal treatment, the blood return rate should be reduced to ≤100ml/min, and 0.9% sodium chloride injection should be used for blood return throughout the whole process; when the treatment is unplanned or for patients with heart function impairment, the blood return rate should be reduced according to the patient's heart function status; when there is blood coagulation in the pipeline, bubble machine alarm, blood pump stoppage, and the alarm cannot be lifted for a long time during treatment, manual blood return without monitoring should be avoided, because the risk of thromboembolism is relatively high.
Catheter care: First, the lumen is flushed with normal saline in a pulsed manner, and then the sealing liquid is injected into the lumen according to the catheter volume in a bullet-like manner, the catheter clamp is clamped, and the heparin cap is covered; secondly, the catheter pipeline is fixed by the high-lift platform method; thirdly, observe whether there is redness, swelling, and exudation at the puncture site, and treat it in time; finally, inform the patient of the importance of protecting the catheter.
In summary, the care related to the CRRT tube set involves multiple aspects, including maintenance goals, prevention of air embolism, dedicated tube use, monitoring during treatment, post-CRRT care, and catheter care, to ensure the safety and effectiveness of CRRT treatment.