so Y TE HA GIANGB~~DAKHOA TiNH

S6VJ1/QB-BV

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Ha Giang, ngay 08 thang 6 ndm 2017

QUYETDINHV~ vi~c ban hanh htr6ng din quy trinh kY thu~t"LQc mau chu kY b~ng kY thu~t Th~n nhfln tao

(Th~n nhan tao chu ky, Th§m tach mau, Hemodialyse - HD)"

GIA.M DOC B:¢NH VI:¢N DA KHOA TiNH HA GIANG

Can cu Quyet dinh s6 494-QB-SYT, ngay 25/5/2015 cua Sa Y ts Ha GiangvS viec ban hanh Quy dinh phan cong, phan d.p vS T6 chirc b9 may va cong chirc,vien chirc, hop d6ng theo Nghi dinh s6 68/NI)-CP cua Sa Y ts tinh Ha Giang;

Can cu Quy chS Benh vien, ban hanh kern theo Quyet dinh s61895/19971BYT -QB, ngay 19/09/1997 cua B9 Truong B9 Y tS;

Theo dS nghi cua Truong phong KHTH va tnrong khoa HSTC&CB.

QUYETDINH:

Di~u 1. Nay ban hanh kern theo Quyet dinh nay "Huang din quy trinh kYthuat "L(Jc mdu chu kj bdng kY thuq.t Thq.n nhiin tflo (Thq.n nhiin tao chu kj,Thizm tach mdu, H emodialyse - HD)"

Di~u 2. "Huang din quy trinh kYthuat LQcmau chu ky bang kYthuat Thannhan tao (Than nhan tao chu ky, Tham tach mau, Hemodialyse - lID)" la tai lieuhuang din vS tlnrc hanh chuyen man ky thuat duoc ap dung tai Benh vien Dakhoa tinh Ha Giang.

Di~u 3. Quyet dinh co hieu hrc kS ill ngay ky.Di~u 4. Truong phong KHTH, Truong khoa HSTC&CB chiu trach nhiem

thi hanh Quyet dinh nay~

NO'i nhiin:- Sa Y tiHa Giang;- BHXH tlnh Ha Giang;- Ban Giam d6c;- Website Benh vien- Liru: VT - KHTH.

QUY TRINH KY THU~T"LQC MAu CHU KY BANG KY THU~T T~ NIlAN T~O

(Th~n nhiin t(Jo chu IcY, Tham tach mdu, Hemodia/yse -HD)"(Ban hanh theo Quyet dinh s6rJ..2 j /QD-BV ngay~himg 6 ruim 2017)

I.D~CUONG:- Ngiroi benh suy th~ giai doan cu6i phai diSu tri thay the, bao g6m th~

nhan tao, loc mang bung, ghep than. Trong d6 than nhan tao duoc ap dung ph6biSn nhat,

- Than nhan tao la thiet l~p vong tuk hoan ngoai co th€ c6 hru hrong mauill 200 - 400 ml/phut thai gian keo dai ill 4 - 8h. Vi c6 nhieu khau 10' thuat va thoigian theo d5i dai nen c6 r~t nhieu nguy co do v~y nhat thiSt phai chuan h6a cacbuoc, xay dung thanh quy trinh ch~t che d€ tranh cac bien clnrng c6 th€ xay ratrong buoi lee.

II. CHi DJNH:- Ngiroi benh suy than giai doan cuoi phai diSu tri thay thS khi mire loc cAu

th~ (MLCT) :::;15 mIl phut/ 1.73 m2. 0 Ngiroi benh dai thao dirong c6 th€ chidinh som hall.

- Ngoai ra, ky thuat than nhan tao ap dung d€ loc mau trong cac tnrong hopkhac: chi dinh loc mau c~p ciru, ngf de)c...

- LQc mau chy IcY 1 tuk ~ 12 gio (m6i lk loc mau it nh~t 4 gio, tuk 3 lk,cach ngay).

ill. CHONG cat DJNH:1. Tim mqch: truy tim rnach, r6i loan nhip tim, nh6i mau co tim va benh

mach vanh, suy tim toan be).2. RBi loan dong mdu va chiiy mdu: chi la chong chi dinh nrong d6i, c6

th€ cung ph6i hop loc mau va thay mau.3. Toan trang: Nguoi benh dang s6t cao, suy ki~t do ung thirIV. cAc BUaC TIEN IIANH:1. Chuan hi, khiYi dpng may:- M& h~ thong mroc, quan sat hoat de)ng tom be) h~ thong mroc, thao bo

phAn mroc u dong, kiem tra hru hrong va de) dan di~n cua h~ thong mroc- Ki€m tra may than, hru hrong 500 ml/phut, khong con ch~t sat trung,

kiem tra de) dan dien dich loc, kiem tra cac bao de)ng an toan cua may th~- Ki€m tra h~ thong oxy, di~n, va cac thiSt bi khac2. Bdc sy kiBm tra tinh trang NgU'ui h?nh trutrc khi /pc mdu- Tinh trang lam sang c~ lam sang cua Ngiroi benh trong 24h tnroc d6:

l)i~n tim, film XQ tim phoi , tinh trang tim mach hien tai.- Cac thuoc va diSu tri gk day nhat: cac chi dinh, cac thay d6i liSu hrong thuoc,- Cac chi s6 sinh h6a thong thuong va cac xet nghiem gk nhat:• l)i~n giai d6, Canxi, Phosphos

• pH, C02, Acid Uric• Hemoglobin, Hematocrit• Protein mau• Tinh trang dong mau• Men tim• Nhom mau Rh va SlJ ngung kSt b~t tlnrong• TiSn su di irng- Cac chi dinh cho buci 19C:• Cac xet nghiem tnroc va sau 19C• Thai gian 19C• Luu hrong (van t6c) mau• Sieu 19C (rut can)• Thuoc chong dong, liSu hrong va each dung• Qua 19C- Cac chi dinh theo doi diSu tri:• Trong buoi 19C• KSt thuc buoi 19C3. Chuan bj Nguoi b?nh Ioc mdu chu kY- Y ta chuan bi:• Can Ngiroi benh: Khong quen tnr bi (gifiy dep, qufin ao ... )NSu nghi ngo co th~ can lai nhieu lfinGhi chinh xac can nang cho Nguoi benh• Do huyet ap, mach N guoi benh a tu thS dimg, nam• Cac thong s6 duoc ghi chep cc1nthan vao s6 theo doi Ngiroi benh- Ngiroi benh trai ga, nam len giuong chuan bi 19C mau- Tay FAV cua Nguoi benh phai duoc sat trung cAn th~, rQng rai.4. N6i vong tuan hoan ngoai co th~- Tu thi Nguoi benh va chudn bi choc tay:• Ngiroi benh phai duoc nfun dung tu thS, thuan lei, n~m hoac mra nam,

giuong cao vira phai• May 19C th~ da s~n sang, khong co mot bao dQng nao.- Cac buac chudn bi dung C1;l:

• Mo hop vo trung dung cac dung cu loc mau, tranh nhiSm trung• L~p qua 19C: Ki~m tra d6i chien ten tu6i Ngiroi benh tranh nham 1§n.

Du6i hoi th~t ky, d~ t6c dQ born nr 90 - 120 ml/phut d6ng thai v6 nhetay vao qua 19C dam bao cho khi khong con trong qua 19C, khi conkhoang 300 ml dich thi quay vong dich trong qua 19C voi Heparin, cacrau cua duong day phai diroc xa nra sach

• Y ta va Ngiroi benh deo khftu trang• Chuan bi gang• Chuan bi gac da th~m ch~t sat trung

• D~t kim tren khay dung kim vo trung• Chuan bi cac 6ng dS Ifty mau ben canh khay• Di gang vo trung• Lfty sang vo bung• Nang cao tay Ngiroi benh• Trai sang diroi tay Nguci benh• Ngiroi benh d~t tay xuong• Chuan bi bang dinh• Sat trung lai tay Nguoi benh bang mieng gac dfl tham chftt sat trung• Garo.- Choc FA V:• Xac dinh bang ddu ngon tay dirong di mach mau (FA V)• Choc FA V: kim "dQng mach" huang v6 phi a mieng n6i, kim "tinh

mach" huang len cao (ngiroc kim dQng mach)• C6 dinh kim bang bang dinh vo trung.• Thong kim bang each mo nut sau do siSt chat lai ngay• Dong khoa kim lai• Tlnrc hien Ifty benh pham.- Chu011g trinh loc mdu va theo dOiNguai benh:• D~t chuang trinh loc mau:• Phai d~t chuang trinh truce khi n6i yang tudn hoan vao Nguoi benh• Thai gian lQCmau• S6 can rut• Li6u Heparin tftn cong, duy tri.• Ki~m tra hoat dQng born Heparin.• D~ theo d6i t6t FA V: BQc lQtay d~ quan sat diroc r6- N6i vong tudn hoan:• Cac clurc nang cua may dfl sful sang.• Kep dirong day "dQng mach",• N6i duong day "dong mach" voi kim "dong rnach" cua Nguoi benh.• Mo kep a kim "dQng mach" sau do mo kep a day "dong mach".• KiSm tra barn mau dang a vi tri 0 ml/phut sau do cho born mau chay,

mau Ngiroi benh se duoc hut theo born, mroc muoi sinh ly trong day vaqua lQC bi dAy v6 tui dung mroc thai, mau dang ddn trong yang tukhoan - tftn cong li6u Heparin - khi mau dSn bdu xanh (bdu tinh mach).DUng born mau.

• Kep dirong day "tinh mach", kiem tra xem co khi trong yang tuk hoankhong.

• N6i duong "tinh mach" voi kim "tinh mach" cua Ngiroi benh,• Khi n6i cac ddu day nho sat trung cac diSm n6i.• Cho born tang ddn t6c dQ 100ml / phut,

• Ki6m tra ap hrc dQng mach tinh mach tren man hinh.• Tang t6c dQ mau len tir tir,• Chi dinh liSu Heparin duy tri.• Barn nut Dialyse.• Ki6m tra cac den bao an toan cua may.• Ki6m tra dirong day tren ga, c6 dinh duong day van ga, khong d6 day

quet, quet tren dat, tranh virong phai.5. Theo do; huBi loc mduCac tieu chi theo d5i trong buci Ioc mau:- Huyet ap, mach cua Nguoi benh tirng gio.- Ki6m tra ap hrc dQng mach, tinh mach, ap hrc xuyen mango- Theo doi nong dQ dich loc (thanh phan Na+ va Bicarbonat).- Theo d5i duong huyet a Ngiroi benh ti6u dirong,- Toan trang trang Ngiroi benh.- Tat ca cac dau hieu phai ghi chep day duo6. Trii mdu vJ cho Nguai h?nh - kit thsu: huBi loc:- Tra mau lai mau cho Nguoi benh la dua toan bQ mau a vong tuan hoan

van co th6 Nguoi benh va k6t thuc buoi lee.- Tren man hinh thai gian la 0.00 -> k6t thuc buoi Ioc mau,- Tra mau cho Nguoi benh:• Dirng bom mau, kep kim "dong mach" va day "dong mach"• Thao kim "dong mach" voi duong day "dong mach", n6i dirong day

"dQng mach" voi dich NaCl 0.9 % chai 500ml, mo kep dirong "dongmach", cho born mau chay voi t6c dQ thap, mroc muoi se dAy mau tU nrvan co th6 Nguoi benh d6n khi qua loc, dirong day sach mau. Trang thaigian tra mau v6 nhe van qua lQCva kep nhe van dirong day d6 trach maut6n dong trong vong tuan hoan

• Tra lai mau a kim "dong mach" cho Ngiroi benh bang born tiem co mrocmuoi sinh ly

• Dirng born mau khi vong tuan hoan da: sach mau.- K6t thuc bu6i loc:• Kep kim "tinh mach" va duong day"tinh rnach"• Dau hai dau day lai va cho qua lee van tui• Rut kim FA V ra khoi tay Ngiroi benh, ep vao diem choc 15 - 20 phut.7. Theo diJisau huBi locSau khi loc cac tham s6 can phai then doi:- Huyet ap, mach a cac tu th6 dirng, nam- Cac dau hieu cua cao hoac tut huy6t ap- Can Nguoi benh: Can luc k6t thuc phai bang can kho- Dau hieu cua Nguoi benh do rut can qua hoac rut khong du- Ghi cac chi s6 van s6 theo doi, ghi r5 cac sai sot so voi protocol.

8. Y td lau may va rira may theo chuang trinh, chuan bi ca loc tiip theoV. TAl BIEN - XirTRI:1. Tut huyit dp: T~t sieu IQc, bu hru hrong tu5.n hoan2. Chupt rut: Bu dich NaCI 0,9% hoac muoi iru truong3. Bu8n non, non: Xu tri theo nguyen nhan. Vi du: do tut huyet ap, hQi

chirng mftt can bang, phan irng mang IQc4. Dau dau5. Dau nguc, dau lung6. Sat, ret run: do qua IQc bAn, mroc khong dat chftt hrong7.Hpi chieng mat din bdng8. Phiin ung vUimang loc9. Loan nhip tim10. Co gi~t11. Tan mdu12. Ttic mach do khi13. Cdc biin chtmg khdc do thu thu~t, ...VI. TAl L~U THAMKHAO:1. Nguyin Nguyen KhOi, Tran Van Chat (2004) "Thgn nhdn tao" B~nh

hoc nQi khoa, Nha xuat ban Y hoc, Tr. 250 - 260.2. Donald, LL (2002) "Pre - end - stage renal disease and dialysis programs:

The view of the manager" Hemodialysis Technology, Karger, P311-317.3. Eric Delmas (1997) "Procedure de mise en ouvre d'une dialyse" L'epuration

extra - Renale, ISBN: 2- 84204- 013- 9, ISSN: 1275- 3289, P54 - 60.4. Suhail Ahmad (2009) "Complications of Hemodialysis" Manual of

Clinical dialysis, Springer, P59 - 76.