GGG

1. DR. MOHAMMED KAMAL
NEPHROLOGY SPECIALIST
NEW MANSOURA GENERAL HOSPITAL (INTERNATIONAL)
CARE OF VASCULAR ACCESS
‫الدموي‬ ‫الغسيل‬ ‫بوصالت‬ ‫العناية‬

2. ‫اص٘بء‬‫جِغخ‬َ‫ٗو‬ ْ‫٣ز‬ ١ٌُِٞ‫ا‬ َ٤‫اُـغ‬‫أُش٣غ‬ ْ‫جغ‬ ٖٓ ّ‫اُذ‬
‫عذت‬ ْ‫٣ز‬ ٝ ٢‫أُظل‬ ٢‫ك‬ ‫ُ٤ٔش‬ ١ٌُِٞ‫ا‬ َ٤‫اُـغ‬ ‫جٜبص‬ ٢ُ‫ا‬
ٚ‫ر٘و٤ز‬ ‫ثؼذ‬ ‫أُش٣غ‬ ٠ُ‫ا‬ ّ‫اُذ‬ ‫ُزؼ٤ذ‬ ّٞٔ‫اُغ‬ ٝ ‫اُضائذح‬ َ‫اُغٞائ‬

3. TYPES OF VASCULAR
ACCESS
1. AV Fistula
ٚ٣‫اُٞس٣ذ‬ ‫اُشش٣بٗ٤خ‬ ‫اُٞطِخ‬
2. Central Venous catheter
‫أُشًض٣خ‬ ١ٞٓ‫اُذ‬ َ٤‫اُـغ‬ ‫هغطشح‬(‫ٝاُذائٔخ‬ ‫أُإهزخ‬)
3. Synthetic Graft
ٚ٣‫اُٞس٣ذ‬ ‫اُشش٣بٗ٤خ‬ ٢‫اُظ٘بػ‬ ‫اُٞطِخ‬(٢‫اُظ٘بػ‬ ‫اُٞس٣ذ‬)

4. ‫الدموي‬ ‫الغسيل‬ ‫وصالت‬
‫الناصور‬(‫الفستوال‬)‫الوريدية‬ ‫الشريانية‬.
‫الصناعية‬ ‫الوصلة‬–‫الوريدية‬ ‫الشريانية‬
‫الدموي‬ ‫الغسيل‬ ‫قسطرة‬

5. NATIVE AV FISTULA
‫الشريانية‬ ‫الوريدية‬ ‫الوصلة‬

6. •َٔ‫ػ‬ ْ‫٣ز‬‫اُٞس٣ذ٣خ‬ ‫اُٞطِخ‬‫اُشش٣بٗ٤خ‬٢‫اُز‬ ‫اُزساع‬ ٢‫ك‬٠ِ‫ػ‬ ١ٞ‫رذز‬‫أٝسدح‬‫طبُذخ‬
٢‫ك‬ ‫رِق‬ ٖٓ ٕٞٗ‫٣ؼب‬ ٖ٣‫اُز‬ ٠‫أُشػ‬ ٢‫ك‬ ‫اٗشبؤٛب‬ َٜ‫اُغ‬ ٖٓ ‫ُ٤ظ‬ ‫ُٝزُي‬ ‫اُـشع‬ ‫ُٜزا‬
١‫اُغٌش‬ ٠‫ٓشػ‬ ‫خبطخ‬ ‫اُذٓٞ٣خ‬ ‫االٝػ٤خ‬
•‫رشثط‬‫ٓجبششح‬ ٕ‫ثبُشش٣ب‬ ‫أُش٣غ‬ ‫ٝس٣ذ‬‫ٝال‬‫اٗشبئٜب‬ ٖٓ ٖ٣‫شٜش‬ َ‫هج‬ ‫اعزخذآٜب‬ ٌٖٔ٣
‫جبٛضح‬ ٌٕٞ‫ُز‬
•َ‫األكؼ‬ ‫اُطج٤ؼ٤خ‬ ٚ٣‫اُٞس٣ذ‬ ‫اُشش٣بٗ٤خ‬ ‫اُٞطِخ‬ ‫رؼزجش‬ٍٞ‫أط‬ ‫ٓذح‬ ّٝ‫رذ‬ ‫أٜٗب‬ ‫د٤ش‬
‫ػشػخ‬ َ‫ٝاأله‬ ّ‫اُذ‬ ‫رذكن‬ ‫ٗبد٤خ‬ ٖٓ ‫ًلبءح‬ َ‫ٝاألكؼ‬‫ٓؼبػلبد‬ ‫ُذذٝس‬

7. SYNTHETIC AV GRAFT
‫الصناعية‬ ‫الوريدية‬ ‫الشريانية‬ ‫الوصلة‬

8. ٝ ٕ‫ثبُشش٣ب‬ ‫اُٞس٣ذ‬ َ‫ُٞط‬ ‫اٗجٞثخ‬٢‫ك‬ ‫كوط‬ ‫ُ٤ظ‬ ٝ ‫أ٣ؼب‬ ‫اُلخذ‬ ٢‫ك‬ ‫ٝػؼٜب‬ ٌُٖٔٔ‫ا‬ ٖٓ
ٕ‫أ‬ ‫ثؼذ‬ ‫أًضش‬ ٝ‫أ‬ ٖ٤‫أعجٞػ‬ ٍ‫خال‬ َٔ‫ُِؼ‬ ‫جبٛضح‬ ٌٕٞ‫ر‬ ٝ ‫اُزساع‬ّ‫اُزٞس‬ ‫٣ٜذأ‬‫ٌُٜ٘ب‬
‫ػشػخ‬ ‫أًضش‬ ٝ ‫ُِزجِط‬ ‫ػشػخ‬ ‫أًضش‬ ‫ألٜٗب‬ ‫اُطج٤ؼ٤خ‬ ‫اُٞطِخ‬ ٖٓ ‫ػٔشا‬ ‫أهظش‬
‫ُالُزٜبثبد‬‫اُجٌز٤ش٣خ‬

9. CENTRAL VENOUS CATHETER

10. Double lumen non
tunneled non cuffed
catheter
Double lumen tunneled
cuffed catheter

11. CARE OF THE
AVF AND GRAFT
‫اُٞس٣ذ٣خ‬ ‫اُشش٣بٗ٤خ‬ ِٚ‫ثبُٞط‬ ‫اُؼ٘ب٣خ‬ ‫ً٤ل٤خ‬

12. • Patient education
• Maturation
• cannulation
• complications

13. ‫للمريض‬ ‫تعليمات‬CARE
•٢ُ‫اُخب‬ ٕٞ‫ٝاُظبث‬ ‫ثبُٔبء‬ ‫خبطخ‬ ‫اُل٤غزٞال‬ ‫ٓ٘طوخ‬ ٢‫ٝك‬ ‫ػبٓخ‬ ‫ُِجِذ‬ ‫اُ٤ٞٓ٤خ‬ ‫اُ٘ظبكخ‬
ٚ‫ٝرشوو‬ ‫اُجِذ‬ ‫جلبف‬ ‫٣غجت‬ ‫ال‬ ٠‫دز‬ ‫اٌُبٝ٣خ‬ ‫أُٞاد‬ ٖٓ.
•ٟ‫األخش‬ ‫اُ٤ذ‬ ‫ٝػغ‬ ‫طش٣ن‬ ٖ‫ػ‬ ‫ٝرُي‬ ‫ٓغزٔشح‬ ‫ثظلخ‬ َٔ‫رؼ‬ ‫اُل٤غزٞال‬ ٕ‫أ‬ ٖٓ ‫اُزأًذ‬
ٚ‫ٝرذكو‬ ّ‫اُذ‬ ٕ‫ثغش٣ب‬ ‫ُزذظ‬ ‫ػِ٤ٜب‬.
•‫ػِ٤ي‬ ‫طٞرٜب‬ ٢‫ك‬ ‫ػؼق‬ ١‫ثأ‬ ‫شؼٞسى‬ ‫ٝػ٘ذ‬ ‫أُٔ٤ض‬ ‫اُل٤غزٞال‬ ‫طٞد‬ ‫ٝعٔبع‬ ‫ٓالدظخ‬
‫اُطج٤ت‬ ‫ثاثالؽ‬.
•‫٣ٞٓ٤ب‬ ‫خل٤لخ‬ ‫رٔش٣٘بد‬ َٔ‫ػ‬ ‫أٛٔ٤خ‬‫ُِزساع‬‫اُطج٤ت‬ ‫ئسشبداد‬ ‫ثارجبع‬ ‫اُل٤غزٞال‬ ‫ثٜب‬ ٢‫اُز‬
ُٞٔ٘‫ٝا‬ ‫اُزلزخ‬ ٢ِ‫ػ‬ ‫األٝسدح‬ ‫ٓغبػذح‬ ‫ٜٓ٘ب‬ ‫اُـشع‬ ‫اُزٔش٣٘بد‬ ٙ‫ٝٛز‬.
•ّ‫ػذ‬‫صو٤ِخ‬ ‫أش٤بء‬ ‫سكغ‬ ٝ‫أ‬ َٔ‫د‬ ٢‫ك‬ ‫اُل٤غزٞال‬ ‫ثٜب‬ ٢‫اُز‬ ‫٣ذى‬ ّ‫اعزخذا‬.
•‫اُشذ٣ذح‬ ‫اُجشٝدح‬ ٝ‫أ‬ ‫ُِذشاسح‬ ‫اُل٤غزٞال‬ ‫رؼشع‬ ّ‫ػذ‬.

14. •‫اُل٤غزٞال‬ ‫ثٜب‬ ٢‫اُز‬ ‫اُ٤ذ‬ ٢ِ‫ػ‬ ‫ٓزٌأ‬ ُّٞ٘‫ا‬ َ‫ٓض‬ ‫اُل٤غزٞال‬ ٢ِ‫ػ‬ ‫اُؼـط‬ ّ‫ػذ‬.
•‫اُل٤غزٞال‬ ‫ثٜب‬ ٢‫اُز‬ ‫اُ٤ذ‬ ٢‫ك‬ َ٤ُ‫ٓذب‬ ‫ئػطبء‬ ٝ‫أ‬ ّ‫د‬ ‫ػ٤٘خ‬ ‫أخز‬ ٝ‫أ‬ ‫اُؼـط‬ ‫ثو٤بط‬ ‫اُغٔبح‬ ّ‫ػذ‬.
•‫اُششثبد‬ َ‫ٓض‬ ‫اُل٤غزٞال‬ ‫كٞم‬ ‫ػ٤وخ‬ ‫ٓالثظ‬ ‫ُجظ‬ ّ‫ػذ‬.
•‫رغزط٤غ‬‫ثؼذ‬ ‫اُٞطِخ‬ ٖٓ ‫اُؼٔبد‬ ‫سكغ‬4-6‫ٗض٣ق‬ ‫ٛ٘بى‬ ٌٖ٣ ُْ ٕ‫ا‬ ‫اُجِغخ‬ ‫اٗزٜبء‬ ٖٓ ‫عبػبد‬
‫اُجشح‬ ‫هششح‬ ‫اصاُخ‬ ٝ‫أ‬ ‫اُجشح‬ ٕ‫ٌٓب‬ ‫دي‬ ‫رج٘ت‬ ٝ
•‫كٞسا‬ ‫اُطج٤ت‬ ‫ئثالؽ‬ ٢ِ‫ػ‬ ‫اُذشص‬‫األػشاع‬ ‫رِي‬ ٖٓ ١‫أ‬ ‫ٝجٞد‬ ‫ػ٘ذ‬:
.1ٕ‫ٌٓب‬ ٍٞ‫د‬ ‫اُزٜبة‬ ٝ‫أ‬ ‫ادٔشاس‬‫اُل٤غزٞال‬
.2‫ٗض٣ق‬ٕ‫ٌٓب‬ ٖٓ‫اُؼِٔ٤خ‬
.3ّ‫ػذ‬ٕ‫ٌٓب‬ ٢‫ك‬ ٚٗ‫ٝعش٣ب‬ ّ‫اُذ‬ ‫ثزذكن‬ ‫اإلدغبط‬‫اُل٤غزٞال‬
.4‫ثشٝدح‬‫ثٜب‬ ٢‫اُز‬ ‫ُِ٤ذ‬ ‫ثبألطشاف‬ َ٤ٔ٘‫ر‬ ٝ‫أ‬‫اُل٤غزٞال‬0
.5ٖٓ ‫ش٤ئ‬ ١‫ا‬ ٝ‫ا‬ ‫طذ٣ذ٣خ‬ ‫اكشاصاد‬ ١‫ا‬ ‫خشٝط‬‫اُٞطِخ‬

15. • Patient education
• Maturation
• Cannulation
• complications

16. MATURATION
AVF
• Cannulation before two weeks of age should be avoided.
• Cannulation between two to four weeks may be attempted but
only if the fistula is considered mature.
• Cannulation after four weeks of maturation may be safe, if the
fistula is mature.
Independent of the age of the fistula, clinical examination prior to
cannulation is very important, given that some fistulas require up
to six months to mature.

17. Grafts
 Grafts can be cannulated for hemodialysis
earlier than fistulas.
 Grafts can usually be cannulated within weeks.
 Some times within days of surgery

18. CANNULATION
• Direction of needles ‫االثش‬ ٙ‫ارجب‬
• First cannulation: rules, experienced
hands
• Techniques :
1. Rope Ladder
2. Butttonhole
• Follow rules of infection control during
needle insertion

19. TECHNIQUES
Rope Ladder

31. • Patient education
• Maturation
• Cannulation
• complications

32. COMPLICATIONS
• Hemmorrhage
• Malfunction
• Infection
• Steal syndrome
• Aneurysm and Pseudoaneurysm
• Venous Hypertension

37. CARE OF HD
VENOUS
CATHETER
‫اُذٓٞ٣خ‬ ‫ثبُوغطشح‬ ‫اُؼ٘ب٣خ‬

38. Predialysis

39. oَ٤‫ؿغ‬‫ٌٓبكذخ‬ ‫ٝهٞاػذ‬ ‫ُزؼِ٤ٔبد‬ ‫طجوب‬ ‫اُذٓٞ٣خ‬ ‫اُوغطشح‬ ‫ٓغ‬ َٓ‫اُزؼب‬ َ‫هج‬ ١‫األ٣ذ‬
ٟٝ‫اُؼذ‬
o‫اسرذاء‬‫ٓالثظ‬ ٢‫ٝاه‬
o‫اسرذاء‬‫ٓؼؤخ‬ ‫هلبصاد‬
o‫اسرذاء‬‫ٝأُٔشػخ‬ ‫أُش٣غ‬ ٖٓ ٌَُ ٚ‫ُِٞج‬ ‫ٓبعي‬
o‫ًشق‬‫االُزٜبثبد‬ ‫آصبس‬ ٖٓ ‫خِٞٛب‬ ٖٓ ‫ٝاُزأًذ‬ ‫ج٤ذا‬ ‫اُوغطشح‬ ٕ‫ٌٓب‬ ‫ٝكذض‬ ‫اُوغطشح‬
‫ٓجبششح‬ ‫اُطج٤ت‬ ‫رجِ٤ؾ‬ ْ‫٣ز‬ ‫ٝجذد‬ ٕ‫ٝئ‬
‫ثبُٞدذح‬ ‫ُِزٔش٣غ‬ ‫رؼِ٤ٔبد‬

40. o‫سكغ‬‫شبػ‬ ٢‫ك‬ ‫ٝٝػؼٜٔب‬ ‫اُذٓٞ٣خ‬ ‫اُوغطشح‬ ٢‫ُطشك‬ ٖ٤ًٔ‫اُذب‬ ٖ٤‫اُـطبئ‬ْ‫ٓؼو‬
o-‫ا‬ ٕ‫ٌٓب‬ ْ٤‫رؼو‬‫خ‬‫ج٤ذا‬ ‫رضج٤زٜب‬ ٕ‫ٌٝٓب‬ ‫ُِجِذ‬ ‫اُوغطشح‬ ‫زشام‬
o10%ٕٝ‫ثٞك٤ذ‬ٖ٣‫أ٣ٞد‬
o2%ٖ٣‫ًِٞسٌٛغ٤ذ‬
o70%ٍٞ‫ًذ‬‫ٓخلق‬
oٖٓ ‫ٓب٣وشة‬ ‫عذت‬2ٖ٣‫اُٜ٤جبس‬ ‫آصبس‬ ‫الصاُخ‬ ‫ٜٓ٘ب‬ ‫ٝاُزخِض‬ ‫طشف‬ ًَ ٖٓ ّ‫د‬ ْ‫ع‬
o‫ِٓخ‬ ٍِٞ‫ثٔذ‬ ‫اُوغطشح‬ ٢‫طشك‬ ‫ًال‬ ٖ‫دو‬0,9%ٖ‫ٝاُذو‬ ‫اُغذت‬ ‫ػِٔ٤خ‬ ‫ٝرٌشاس‬
ٝ‫أ‬ ٍٞ‫دخ‬ ‫٣ٔ٘غ‬ ‫ُؼبئن‬ ‫ٝجٞد‬ ‫ال‬ ٚٗ‫ٝأ‬ ‫ج٤ذا‬ َٔ‫رؼ‬ ‫اُوغطشح‬ ٕ‫أ‬ ٖٓ ‫ُِزأًذ‬ ‫ثبُززبثغ‬
َ٤‫اُـغ‬ ‫جِغخ‬ ‫أص٘بء‬ ‫ٜٓ٘ب‬ ّ‫اُذ‬ ‫خشٝط‬.
o‫اُجِغخ‬ َ٤‫رٞط‬
o‫اُجِغخ‬ ‫ٓذح‬ ٍ‫طٞا‬ ْ‫ٓؼو‬ ‫ثشبػ‬ ‫ُِجِذ‬ ‫اُوغطشح‬ ‫اخزشام‬ ٕ‫ٌٓب‬ ‫رـط٤خ‬ ٖٓ ‫اُزأًذ‬

41. POST DIALYSIS

42. •َ٤‫ؿغ‬ٟ‫األ٣ذ‬
•‫اسرذاء‬‫أُالثظ‬ ٢‫ٝاه‬
•‫اسرذاء‬‫اُولبصاد‬‫أُؼؤخ‬
•‫اسرذاء‬‫ٝأُش٣غ‬ ‫أُٔشػخ‬ ٖٓ ٌَُ ٚ‫اُٞج‬ ‫ٓبعي‬
•‫رشط٤ت‬‫اُجِغخ‬
•ٖ٣‫اُٜ٤جبس‬:
.1ٖ‫دو‬ ْ‫٣ز‬ ‫اُجِغخ‬ ‫رشط٤ت‬ ٖٓ ‫االٗزٜبء‬ ‫ثؼذ‬1000-5000‫طشف‬ ًَ ٢‫ك‬ ‫ٝدذح‬
•‫ؿٔظ‬‫ُٔذح‬ ٖ٣‫اُج٤زبد‬ ٢‫ك‬ ٖ٤‫اُـطبئ‬3-5ّ‫ثادٌب‬ ‫اُوغطشح‬ ٢‫طشك‬ ‫ؿِن‬ ْ‫ص‬ ‫دهبئن‬
ْ٤‫رؼو‬‫اُوغطشح‬ ٍٞ‫د‬ ‫أُ٘طوخ‬
•ْ‫أُؼو‬ ‫ثبُشبػ‬ ‫ُِجِذ‬ ‫اُوغطشح‬ ‫اخزشام‬ ٕ‫ٌٓب‬ ‫رـط٤خ‬.
•ٍ‫أُ٘ض‬ ٢‫ك‬ ‫ثبُوغطشح‬ ‫االػز٘بء‬ ‫ً٤ل٤خ‬ ٍٞ‫د‬ ‫ُِٔش٣غ‬ ‫رؼِ٤ٔبد‬ ‫اػطبء‬

43. CARE ( PATIENT EDUCATION)
•‫دبكظ‬‫ٗظ٤لب‬ ٝ ‫جبكب‬ ‫ُِجِذ‬ ‫اُوغطشح‬ ‫اخزشام‬ ٕ‫ٌٓب‬ ٠ِ‫ػ‬,‫أُبء‬ ‫ٓالٓغخ‬ ‫ٓٔ٘ٞع‬
‫اُوغطشح‬ ٕ‫ٌُٔب‬.
•‫اُوغطشح‬ ٢٘‫ص‬ ٝ‫أ‬ ‫ثشذ‬ ّٞ‫رو‬ ٝ‫أ‬ ‫اُجِذ‬ ‫رذي‬ ٕ‫أ‬ ‫ٓٔ٘ٞع‬
•‫اُوغطشح‬ ٕ‫ٌٓب‬ ٍٞ‫د‬ ‫دبدح‬ ‫أدٝاد‬ ّ‫رغزخذ‬ ‫ال‬
•‫ٛٞاء‬ ‫٣ذخِٜب‬ ‫ال‬ ٢ً ‫ُِوغطشح‬ ٖ٤ًٔ‫اُذب‬ ٖ٤‫اُـطبئ‬ ‫ٗضع‬ ‫ٓٔ٘ٞع‬
•‫اُجِغخ‬ ٢‫ُزِو‬ ‫اُٞدذح‬ ‫ٓج٤ئي‬ َ‫هج‬ ّ‫االعزذٔب‬ َ‫٣لؼ‬.
•‫دبكظ‬ٚ‫ٓـِو‬ ٙ‫اُوغطش‬ ٠ِ‫ػ‬.
•‫ٌٓبٜٗب‬ ٖٓ ‫عوطذ‬ ٝ‫ا‬ ٙ‫اُوغطش‬ ‫اٌٗغشد‬ ‫ئرا‬..‫ثطج٤جي‬ َ‫ٝارظ‬ ‫ٌٓبٜٗب‬ ٠ِ‫ػ‬ ‫اػـط‬
ٙ‫ٓجبشش‬.
‫ُِٔش٣غ‬ ‫رؼِ٤ٔبد‬

44. THANK YOU