目的: 探讨钝针扣眼穿刺在自体动静脉内瘘长期使用过程中出现的相关问题及干预方法与效果,为血液透析临床护理提供指导和借鉴。方法: 回顾皖南医学院第一附属医院弋矶山医院选用扣眼穿刺法进行动静脉内瘘穿刺267例血透患者,总结扣眼假隧道形成的原因、扣眼点去痂方法及技巧,分析在扣眼穿刺过程中内瘘感染的因素及防治方法。结果: 267例患者中,采用动静脉两针均为钝针穿刺189例,动脉穿刺或静脉穿刺一针采用钝针穿刺78例;扣眼重建隧道17例。2019年7至9月和2019年10至12月分别采用一次性16号无菌圆钝针头、一次性12号无菌斜面锐针头进行针眼湿敷后去痂,两种方法渗血发生比较差异无统计学意义(P＞0.05);但去痂难的程度经过统计前者高于后者,差异有统计学意义(P＜0.001),感染发生次数前者高于后者,差异有统计学意义(P＜0.05)。结论: 对于扣眼穿刺出现假隧道形成、去痂不易时通过换用锐针进行原扣眼隧道再建方法以及采用一次性12号灭菌斜面针头进行针眼湿敷后去痂处理,能提高血管穿刺成功率,避免穿刺处感染,应用于血液透析患者长期血管通路的维护有一定临床价值,值得推广。

Objective: To explore the related problems and intervention methods of blunt needle buttonhole technique in the long-term of autologous arteriovenous fistula puncture and analysis its effect, so as to provide guidance and reference for clinical nursing in hemodialysis. Methods: Clinical data of 267 hemodialysis patients who received arteriovenous fistula puncture with the blunt needle buttonhole technique in yijishan hospital, the First Affiliated Hospital of Wannan Medical College were reviewed. Reasons for the formation of the buttonhole false tunnel, the methods and skills of removing the scab at the buttonhole point were summarized, and risk factors of the internal fistula infection during the buttonhole puncture were analyzed to provide prevention methods. Results: Among the 267 patients, 189 patients underwent blunt needle puncture with both arterial and venous needles, and 78 patients underwent blunt needle puncture with only one needle of arterial puncture or venous puncture. Tunnel reconstruction with buttonhole was performed in 17 cases. From July to September 2019 and October to December 2019, a disposable No.16 sterile round blunt needle and a disposable No. 12 sterile beveled sharp needle were respectively used to remove the scabs after wet compressing the punctured sites. There was no statistical difference in the occurrence of bleeding between the two methods(P＞0.05); However, the degree of difficulty in removing scabs was statistically higher in the former than in that the latter (P＜0.001), and the frequency of infection was statistically higher in the former than that in the latter (P＜0.05). Conclusion: When false tunnel formed and scab hard to remove in buttonhole puncture, reconstruction of the original buttonhole tunnel with sharp needle and remove the scab after wet compression of the puncture hole by using disposable No.12 sterilized inclined needle can improve the success rate of vascular puncture and avoid infection at the puncture site. It has certain clinical value in the maintenance of long-term vascular access in hemodialysis patients and is worth of popularizing.