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Safety Monitors in Hemodialysis 203
The Blood Circuit
‫الدم‬ ‫دائرة‬
The blood (extracorporeal) circuit (Fig. 13.9) monitors pressures in the arterial and
venous blood lines, and the integrity of the circuit for the presence of air and blood
leaks. The four main blood circuit monitors (Fig. 13.10) are the arterial pressure
monitor, venous pressure monitor, air-foam detector, and blood-leak detector.
‫(الشكل‬ )‫الجسم‬ ‫(خارج‬ ‫الدم‬ ‫دائرة‬ ‫تراقب‬
13.9
‫الدائرة‬ ‫وسالمة‬ ، ‫والوريدي‬ ‫الشرياني‬ ‫الدم‬ ‫خطوط‬ ‫في‬ ‫الضغط‬ )
‫لوجود‬
‫هواء‬
‫و‬
‫(الشكل‬ ‫الرئيسية‬ ‫األربعة‬ ‫الدموية‬ ‫الدورة‬ ‫مراقبة‬ ‫أجهزة‬ .‫الدم‬ ‫تسرب‬
13.10
‫مراقبة‬ ‫جهاز‬ ‫هي‬ )
‫قياس‬ ‫جهاز‬ ، ‫الشرياني‬ ‫الضغط‬
.‫الدم‬ ‫تسرب‬ ‫وكاشف‬ ، ‫الهوائية‬ ‫الرغوة‬ ‫كاشف‬ ، ‫الوريدي‬ ‫الضغط‬
The blood-leak detector acts as a blood-circuit alarm but is entirely incorporated
within the dialysate circuit and has already been described. The machinery responds
to blood-circuit alarms by activating an audible alarm, a visual alarm, stopping the
blood pump, and engaging the venous line clamp to stop the blood flow through the
blood circuit.
‫وصفه‬ ‫تم‬ ‫وقد‬ ‫الديالة‬ ‫دائرة‬ ‫في‬ ‫بالكامل‬ ‫مدمج‬ ‫ولكنه‬ ‫الدم‬ ‫لدائرة‬ ‫إنذار‬ ‫كجهاز‬ ‫الدم‬ ‫تسرب‬ ‫كاشف‬ ‫يعمل‬
‫ت‬ .‫بالفعل‬
‫وإيقاف‬ ، ‫مرئي‬ ‫وإنذار‬ ، ‫مسموع‬ ‫إنذار‬ ‫تنشيط‬ ‫طريق‬ ‫عن‬ ‫الدموية‬ ‫الدائرة‬ ‫إلنذارات‬ ‫اآللة‬ ‫ستجيب‬
.‫الدموية‬ ‫الدورة‬ ‫عبر‬ ‫الدم‬ ‫تدفق‬ ‫إليقاف‬ ‫الوريدي‬ ‫الخط‬ ‫مشبك‬ ‫وإشراك‬ ، ‫الدم‬ ‫مضخة‬
Additional areas to monitor in the blood circuit are blood flow rate, heparin
therapy, and normal saline supply.
‫وإمداد‬ ، ‫الهيبارين‬ ‫وعالج‬ ، ‫الدم‬ ‫تدفق‬ ‫معدل‬ ‫هي‬ ‫الدموية‬ ‫الدورة‬ ‫في‬ ‫مراقبتها‬ ‫يجب‬ ‫التي‬ ‫اإلضافية‬ ‫المجاالت‬
.‫الطبيعي‬ ‫الملحي‬ ‫المحلول‬
Arterial Pressure Monitor—Pre-Blood Pump
‫الدم‬ ‫ضغط‬ ‫مراقبة‬ ‫جهاز‬
-
‫الدم‬ ‫قبل‬ ‫ما‬ ‫مضخة‬
The arterial pressure monitor measures the pressure in the arterial blood line between
the patient’s arterial access and the blood. With the blood pump set to blood flow
rates greater than 200 mL/min to as high as 450 mL/min, the pressure in this blood
tubing segment is commonly subatmospheric to negative. This portion of the blood
circuit can be a source of air entry into the blood circuit and is considered a high-
risk area.
‫ضبط‬ ‫مع‬ .‫والدم‬ ‫الشرايين‬ ‫وصول‬ ‫بين‬ ‫الشرياني‬ ‫الدم‬ ‫خط‬ ‫في‬ ‫الضغط‬ ‫الشرياني‬ ‫الضغط‬ ‫مراقبة‬ ‫جهاز‬ ‫يقيس‬
‫م‬ ‫على‬ ‫الدم‬ ‫مضخة‬
‫من‬ ‫أكبر‬ ‫دم‬ ‫تدفق‬ ‫عدالت‬
200
‫إلى‬ ‫دقيقة‬ / ‫مل‬
450
‫هذا‬ ‫في‬ ‫الضغط‬ ‫يكون‬ ، ‫دقيقة‬ / ‫مل‬
‫الدموية‬ ‫الدورة‬ ‫من‬ ‫الجزء‬ ‫هذا‬ ‫يكون‬ ‫أن‬ ‫يمكن‬ .‫سلبي‬ ‫إلى‬ ‫الجوي‬ ‫الغالف‬ ‫تحت‬ ً‫ة‬‫عاد‬ ‫الدم‬ ‫أنابيب‬ ‫من‬ ‫الجزء‬
.‫الخطورة‬ ‫عالية‬ ‫منطقة‬ ‫ويعتبر‬ ‫الدموية‬ ‫الدورة‬ ‫إلى‬ ‫الهواء‬ ‫لدخول‬ ‫ا‬ً‫مصدر‬
204 Safety Monitors in Hemodialysis
Saline
Arterial
Pressure
Blood
Heparin
Venous
pressure
Ultrasonic
pump
ml/min
350
pump air detector
Venous line
clamp
From Patient To Patient
Blood (Extracorporeal) Circuit. (From Pittard J: Hemodialysis Nursing, Training
Manual, 7th ed., version 7.0. Santa Monica, CA, 2003, with permission.)
NORMAL WARNING ALARM
POWER
RESET
MUTE
Blood Circuit Monitors. (From Pittard J: Hemodialysis Nursing, Training
Manual, 7th ed., version 7.0. Santa Monica, CA, 2003, with permission.)
The arterial pressure monitor is leak-free with adjustable high/low limits (Fig.
13.11), which reads negative and positive pressures in millimeters of mercury
(mm Hg; 10% accuracy). This monitor requires a filter to prevent viruses, bacteria,
or blood from being refluxed back into the arterial pressure monitor. This filter is
essential, as viral hepatitis has been transmitted by contamination of air devices.
‫(الشكل‬ ‫للتعديل‬ ‫قابلة‬ ‫منخفضة‬ / ‫عالية‬ ‫حدود‬ ‫مع‬ ‫التسرب‬ ‫من‬ ‫خالي‬ ‫الشرياني‬ ‫الضغط‬ ‫مراقبة‬ ‫جهاز‬
13.11
‫دقة‬ ‫؛‬ ‫زئبق‬ ‫(مم‬ ‫الزئبق‬ ‫من‬ ‫بالمليمترات‬ ‫واإليجابية‬ ‫السلبية‬ ‫الضغوط‬ ‫تقرأ‬ ‫والتي‬ ، )
10
.)٪
‫جهاز‬ ‫إلى‬ ‫أخرى‬ ‫مرة‬ ‫االرتجاع‬ ‫من‬ ‫الدم‬ ‫أو‬ ‫البكتيريا‬ ‫أو‬ ‫الفيروسات‬ ‫لمنع‬ ‫ا‬ً‫ح‬‫مرش‬ ‫الشاشة‬ ‫هذه‬ ‫تتطلب‬
‫طريق‬ ‫عن‬ ‫الفيروسي‬ ‫الكبد‬ ‫التهاب‬ ‫ينتقل‬ ‫حيث‬ ، ‫ًا‬‫ي‬‫ضرور‬ ‫المرشح‬ ‫هذا‬ ‫يعد‬ .‫الشرايين‬ ‫ضغط‬ ‫مراقبة‬
.‫الهواء‬ ‫أجهزة‬ ‫تلوث‬
AIR BLOOD ARTERIAL VENOUS
DETECTOR LEAK PRESSURE PRESSURE
MINOR
290
200
100
0
PRIME OVERRIDE
–100
–200
–300
500
400
300
200
100
0
–50
Figure 13.9
Figure 13.10
Safety Monitors in Hemodialysis 205
ARTERIAL
PRESSURE
ARTERIAL
PRESSURE
290
200
100
0
–100
–200
–300
WITHIN LIMITS
290
200
100
0
–100
–200
–300
LOW LIMIT ALARM
Excess negative pressure
violated low limit
Arterial Pressure. (From Pittard J: Hemodialysis Nursing, Training Manual,
7th ed., version 7.0. Santa Monica, CA, 2003, with permission.)
These filters or fluid barriers are called isolators and/or transducer filters/
protectors. They protect the monitor from blood contamination and the spread of
infection between patients. The pressure monitor lines must be unclamped and patent
during dialysis. Some blood lines have collapsible pillow-shaped segments, which
can initiate a false alarm.
‫تحمي‬ ‫أنها‬ .‫الطاقة‬ ‫محول‬ ‫واقيات‬ / ‫مرشحات‬ ‫أو‬ / ‫و‬ ‫عوازل‬ ‫السوائل‬ ‫حواجز‬ ‫أو‬ ‫المرشحات‬ ‫هذه‬ ‫تسمى‬
ُ‫م‬ ‫غير‬ ‫الضغط‬ ‫مراقبة‬ ‫خطوط‬ ‫تكون‬ ‫أن‬ ‫يجب‬ .‫المرضى‬ ‫بين‬ ‫العدوى‬ ‫وانتشار‬ ‫الدم‬ ‫تلوث‬ ‫من‬ ‫الشاشة‬
‫وأن‬ ‫حكمة‬
‫تكون‬
‫ظاهرة‬
‫والتي‬ ، ‫وسادة‬ ‫شكل‬ ‫على‬ ‫للطي‬ ‫قابلة‬ ‫أجزاء‬ ‫على‬ ‫الدم‬ ‫خطوط‬ ‫بعض‬ ‫تحتوي‬ .‫الكلى‬ ‫غسيل‬ ‫أثناء‬
.‫ًا‬‫ب‬‫كاذ‬ ‫ا‬ً‫إنذار‬ ‫تطلق‬ ‫أن‬ ‫يمكن‬
During set-up, priming, and rinsing of the dialyzer, the high-low limits are
opened. As soon as the dialysis treatment is initiated, the dialysis personnel must set
the low, or negative, pressure limit just below the reading at the desired blood flow.
Upper and lower monitor limits should be set within 50–100 mm Hg of actual
reading to detect problems. Newer machine models will automatically adjust the
high/low limits approximately 50 mm Hg above and below the actual pressure.
‫عالج‬ ‫بدء‬ ‫بمجرد‬ .‫والمنخفضة‬ ‫العالية‬ ‫الحدود‬ ‫فتح‬ ‫يتم‬ ، ‫الغسيل‬ ‫لجهاز‬ ‫والشطف‬ ‫والتجهيز‬ ‫اإلعداد‬ ‫أثناء‬
‫س‬ ‫أو‬ ‫منخفض‬ ‫ضغط‬ ‫حد‬ ‫تعيين‬ ‫الكلى‬ ‫غسيل‬ ‫موظفي‬ ‫على‬ ‫يجب‬ ، ‫الكلى‬ ‫غسيل‬
‫عند‬ ‫القراءة‬ ‫من‬ ‫بقليل‬ ‫أقل‬ ‫لبي‬
‫حدود‬ ‫في‬ ‫والسفلية‬ ‫العلوية‬ ‫الشاشة‬ ‫حدود‬ ‫تعيين‬ ‫يجب‬ .‫المطلوب‬ ‫الدم‬ ‫تدفق‬
50
-
100
‫الفعلية‬ ‫القراءة‬ ‫من‬ ‫زئبق‬ ‫مم‬
‫بحوالي‬ ‫ًا‬‫ي‬‫تلقائ‬ ‫المنخفضة‬ / ‫العالية‬ ‫الحدود‬ ‫ضبط‬ ‫على‬ ‫األحدث‬ ‫الماكينات‬ ‫طرز‬ ‫تعمل‬ .‫المشكالت‬ ‫الكتشاف‬
50
‫ال‬ ‫الضغط‬ ‫من‬ ‫وأدنى‬ ‫أعلى‬ ‫زئبق‬ ‫مم‬
.‫فعلي‬
Setting the low arterial limit close to the actual pressure, about 50 mm Hg below
that pressure, will detect early drops in blood pressure with arteriovenous (AV)
fistulas. Some units limit the minimum arterial limit to –100 mm Hg.
‫الحد‬ ‫تحديد‬ ‫إن‬
‫حوالي‬ ، ‫الفعلي‬ ‫الضغط‬ ‫من‬ ‫بالقرب‬ ‫المنخفض‬ ‫الشرياني‬
50
، ‫الضغط‬ ‫هذا‬ ‫من‬ ‫أقل‬ ‫زئبق‬ ‫مم‬
( ‫الوريدية‬ ‫الشريانية‬ ‫النواسير‬ ‫مع‬ ‫الدم‬ ‫ضغط‬ ‫في‬ ‫مبكرة‬ ‫انخفاضات‬ ‫عن‬ ‫سيكشف‬
AV
‫الوحدات‬ ‫بعض‬ ‫تحدد‬ .)
‫عند‬ ‫للشريان‬ ‫األدنى‬ ‫الحد‬
-
100
.‫زئبق‬ ‫ملم‬
The greater the vacuum, the greater the risk of air entering this tubing segment
from any crack, improperly glued or fitted joint, sample port, saline infusion line,
or the patient’s access. It is advisable to set the high limit just below zero, which
will pick up a disruption of the arterial blood line from the fistula needle.
Figure 13.11
206 Safety Monitors in Hemodialysis
‫تم‬ ‫مفصل‬ ‫أو‬ ، ‫صدع‬ ‫أي‬ ‫من‬ ‫هذا‬ ‫األنابيب‬ ‫جزء‬ ‫إلى‬ ‫الهواء‬ ‫دخول‬ ‫خطر‬ ‫زاد‬ ، ‫الفراغ‬ ‫زاد‬ ‫كلما‬
‫لصقه‬
‫أو‬ ‫ا‬
.‫المريض‬ ‫وصول‬ ‫أو‬ ، ‫الملحي‬ ‫المحلول‬ ‫ضخ‬ ‫خط‬ ‫أو‬ ، ‫العينة‬ ‫منفذ‬ ‫أو‬ ، ‫صحيح‬ ‫غير‬ ‫بشكل‬ ‫تركيبها‬
ُ‫ي‬
‫نصح‬
‫إل‬ ‫سيؤدي‬ ‫والذي‬ ، ‫الصفر‬ ‫من‬ ‫بقليل‬ ‫أقل‬ ‫مرتفع‬ ‫حد‬ ‫بتعيين‬
‫م‬ ‫الشرياني‬ ‫الدم‬ ‫خط‬ ‫في‬ ‫خلل‬ ‫حدوث‬ ‫ى‬
‫إبر‬ ‫ن‬
‫ة‬
.‫الناسور‬
Arterial Pressure Monitoring
‫الشرايين‬ ‫ضغط‬ ‫مراقبة‬
The usual causes of a low-limit arterial pressure alarm are a drop in blood pressure
(only with AV fistulas), a kink in the arterial blood line between the access and blood
pump, malpositioned arterial needle or problem with arterial access, and a clotted
arterial line. The circuit should always be checked for air bubbles.
‫ا‬ ‫مع‬ ‫(فقط‬ ‫الدم‬ ‫ضغط‬ ‫انخفاض‬ ‫هي‬ ‫الحد‬ ‫منخفض‬ ‫الشرياني‬ ‫الضغط‬ ‫إنذار‬ ‫لجهاز‬ ‫المعتادة‬ ‫األسباب‬
‫لناس‬
‫و‬
‫ر‬
‫الشرا‬ ‫وإبرة‬ ، ‫الدم‬ ‫ومضخة‬ ‫الوصول‬ ‫بين‬ ‫الشرياني‬ ‫الدم‬ ‫خط‬ ‫في‬ ‫والتواء‬ ، )‫الوريدي‬ ‫الشرياني‬
‫ذ‬ ‫يين‬
‫الوضع‬ ‫ات‬
‫ب‬ ‫الدائرة‬ ‫فحص‬ ‫ا‬ً‫م‬‫دائ‬ ‫يجب‬ .‫الشرايين‬ ‫خط‬ .‫والتخثر‬ ، ‫الشرياني‬ ‫الوصول‬ ‫في‬ ‫مشكلة‬ ‫أو‬ ‫الخاطئ‬
‫ا‬ً‫ث‬‫ح‬
‫ع‬
‫فقاعات‬ ‫ن‬
.‫الهواء‬
The usual causes of a high-limit arterial pressure alarm are bloodline separation
(only if the upper limit is set below 0 mm Hg), the saline infusion line is unclamped,
an increase in patient’s blood pressure, a leak in the circuit between the patient and
monitor, and torn blood tubing in the pump segment. It is important to check for
leaking blood.
‫الح‬ ‫كان‬ ‫إذا‬ ‫(فقط‬ ‫الدم‬ ‫ساللة‬ ‫فصل‬ ‫هي‬ ‫الحد‬ ‫عالي‬ ‫الشرياني‬ ‫الضغط‬ ‫إلنذار‬ ‫المعتادة‬ ‫األسباب‬
‫األ‬ ‫د‬
‫م‬ ‫أقل‬ ‫على‬
‫ن‬
0
‫الدائرة‬ ‫في‬ ‫وتسرب‬ ، ‫المريض‬ ‫دم‬ ‫ضغط‬ ‫في‬ ‫وزيادة‬ ، ‫محكم‬ ‫غير‬ ‫الملحي‬ ‫التسريب‬ ‫وخط‬ ، )‫زئبق‬ ‫مم‬
‫بين‬
‫ومراقبة‬ ‫المريض‬
‫وتمزق‬
.‫الدم‬ ‫تسرب‬ ‫من‬ ‫التحقق‬ ‫المهم‬ ‫من‬ .‫المضخة‬ ‫جزء‬ ‫في‬ ‫الدم‬ ‫أنابيب‬
Safety Monitors in Hemodialysis 207
The appropriate response to pressure alarms is to, first, mute the audible alarm;
second, investigate the problem; third, correct the problem; and fourth, restart the
blood pump by pressing the reset/restart button. Do not restart the blood pump until
the problem is corrected for patient safety. Failure to correct the problem will cause
the alarm to reoccur.
‫المسموع‬ ‫اإلنذار‬ ‫صوت‬ ‫كتم‬ ، ً‫ال‬‫أو‬ ، ‫هي‬ ‫الضغط‬ ‫إلنذارات‬ ‫المناسبة‬ ‫االستجابة‬
‫؛‬ ‫المشكلة‬ ‫من‬ ‫تحقق‬ ، ‫ًا‬‫ي‬‫ثان‬ ‫؛‬
‫ال‬ .‫التشغيل‬ ‫إعادة‬ / ‫الضبط‬ ‫إعادة‬ ‫زر‬ ‫على‬ ‫بالضغط‬ ‫الدم‬ ‫مضخة‬ ‫تشغيل‬ ‫أعد‬ ، ‫ا‬ً‫ع‬‫وراب‬ ‫؛‬ ‫المشكلة‬ ‫تصحيح‬ ، ‫ا‬ً‫ث‬‫ثال‬
‫تصحيح‬ ‫عدم‬ ‫سيؤدي‬ .‫المريض‬ ‫سالمة‬ ‫أجل‬ ‫من‬ ‫المشكلة‬ ‫تصحيح‬ ‫يتم‬ ‫حتى‬ ‫الدم‬ ‫مضخة‬ ‫تشغيل‬ ‫بإعادة‬ ‫تقم‬
.‫اإلنذار‬ ‫تكرار‬ ‫إلى‬ ‫المشكلة‬
Venous Pressure Monitor
‫الوريدي‬ ‫الضغط‬ ‫مراقبة‬ ‫جهاز‬
The venous pressure monitor, located postdialyzer, monitors pressure at the venous
drip chamber, the segment between the drip chamber and the patient’s venous access,
and the added intra-access pressure. The resistance to the blood flow entering the
venous access causes the pressure to be positive (Fig. 13.12), above 0 mm Hg.
‫والجزء‬ ، ‫الوريدي‬ ‫التنقيط‬ ‫حجرة‬ ‫في‬ ‫الضغط‬ ‫يراقب‬ ، ‫الغسالة‬ ‫بعد‬ ‫الموجود‬ ، ‫الوريدي‬ ‫الضغط‬ ‫مراقبة‬ ‫جهاز‬
‫المريض‬ ‫ووصول‬ ‫التنقيط‬ ‫حجرة‬ ‫بين‬ ‫الموجود‬
‫الداخل‬ ‫الدم‬ ‫تدفق‬ ‫مقاومة‬ .‫اإلضافي‬ ‫الداخلي‬ ‫والضغط‬ ، ‫الوريدي‬
‫(الشكل‬ ‫ًا‬‫ب‬‫موج‬ ‫الضغط‬ ‫يكون‬ ‫أن‬ ‫إلى‬ ‫يؤدي‬ ‫الوريد‬ ‫إلى‬
13.12
‫فوق‬ ، )
0
.‫زئبق‬ ‫مم‬
The venous pressure monitor’s structure and standards are similar to those
described for the arterial pre-blood pump monitor. This pressure monitor requires
protection by a filter or transducer fluid barrier.
.‫الشرياني‬ ‫الدم‬ ‫مضخة‬ ‫مراقبة‬ ‫لجهاز‬ ‫الموصوفة‬ ‫لتلك‬ ‫مماثلة‬ ‫الوريدي‬ ‫الضغط‬ ‫مراقبة‬ ‫جهاز‬ ‫ومعايير‬ ‫هيكل‬
.‫الطاقة‬ ‫محول‬ ‫سائل‬ ‫حاجز‬ ‫أو‬ ‫مرشح‬ ‫بواسطة‬ ‫الحماية‬ ‫هذا‬ ‫الضغط‬ ‫مراقبة‬ ‫جهاز‬ ‫يتطلب‬
Venous Pressure Monitoring
‫الوريدي‬ ‫الضغط‬ ‫مراقبة‬
Causes of a high venous pressure alarm are a kink in the venous blood line between
the drip chamber and patient’s venous access, a clot in the venous drip chamber and/
or downstream to the patient, and a malpositioned venous needle or problem with
the venous access device.
‫هي‬ ‫الوريدي‬ ‫الدم‬ ‫ضغط‬ ‫ارتفاع‬ ‫أسباب‬
‫التواء‬
‫الوريدي‬ ‫والمدخل‬ ‫التنقيط‬ ‫غرفة‬ ‫بين‬ ‫الوريدي‬ ‫الدم‬ ‫خط‬ ‫في‬
‫مشكلة‬ ‫أو‬ ‫خاطئة‬ ‫وريدية‬ ‫وإبرة‬ ، ‫المريض‬ ‫إلى‬ ‫المصب‬ ‫أو‬ / ‫و‬ ‫الوريدي‬ ‫التنقيط‬ ‫حجرة‬ ‫في‬ ‫وجلطة‬ ، ‫للمريض‬
‫ف‬
.‫جهاز‬ ‫الوريدي‬ ‫الوصول‬ ‫ي‬
Causes of a low venous pressure alarm are blood line separation or disruption of
connections between the blood pump to and including the venous access; a kink in
the blood line postdialyzer and pre–venous drip chamber; a clotted dialyzer; and a
lowering of the blood-pump speed. Note that setting the low limit close to the
operating pressure of the venous drip chamber can alert to a disruption of the blood
circuit between the blood pump and venous access site. With a disruption of the
circuit, the venous pressure will drop to 0 mm Hg.
‫ذلك‬ ‫في‬ ‫بما‬ ‫الدم‬ ‫مضخة‬ ‫بين‬ ‫الوصالت‬ ‫انقطاع‬ ‫أو‬ ‫الدم‬ ‫خط‬ ‫فصل‬ ‫هي‬ ‫الوريدي‬ ‫الضغط‬ ‫انخفاض‬ ‫أسباب‬
‫جهاز‬ ‫؛‬ ‫المسبق‬ ‫الوريدي‬ ‫التنقيط‬ ‫وغرفة‬ ‫الدموي‬ ‫الديال‬ ‫بعد‬ ‫ما‬ ‫تحليل‬ ‫جهاز‬ ‫في‬ ‫التواء‬ ‫؛‬ ‫الوريدي‬ ‫الوصول‬
‫ضخ‬ ‫سرعة‬ ‫وخفض‬ ‫متخثر‬ ‫غسيل‬
‫التنقيط‬ ‫لحجرة‬ ‫التشغيل‬ ‫ضغط‬ ‫من‬ ‫بالقرب‬ ‫األدنى‬ ‫الحد‬ ‫تعيين‬ ‫أن‬ ‫الحظ‬ .‫الدم‬
‫مع‬ .‫الوريدي‬ ‫الوصول‬ ‫وموقع‬ ‫الدم‬ ‫مضخة‬ ‫بين‬ ‫الدموية‬ ‫الدورة‬ ‫في‬ ‫اضطراب‬ ‫حدوث‬ ‫إلى‬ ‫ينبه‬ ‫أن‬ ‫يمكن‬ ‫الوريدي‬
‫إلى‬ ‫الوريدي‬ ‫الضغط‬ ‫ينخفض‬ ، ‫الدائرة‬ ‫في‬ ‫اضطراب‬ ‫حدوث‬
0
.‫زئبق‬ ‫مم‬
208 Safety Monitors in Hemodialysis
VENOUS
PRESSURE
VENOUS
PRESSURE
500
400
300
200
100
0
–50
WITHIN LIMITS
500
400
300
200
100
0
–50
HIGH LIMIT ALARM
Excess negative pressure
violation upper limit
Venous Pressure. (From Pittard J: Hemodialysis Nursing, Training Manual,
7th ed., version 7.0. Santa Monica, CA, 2003, with permission.)
Figure 13.12

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  • 1. Safety Monitors in Hemodialysis 203 The Blood Circuit ‫الدم‬ ‫دائرة‬ The blood (extracorporeal) circuit (Fig. 13.9) monitors pressures in the arterial and venous blood lines, and the integrity of the circuit for the presence of air and blood leaks. The four main blood circuit monitors (Fig. 13.10) are the arterial pressure monitor, venous pressure monitor, air-foam detector, and blood-leak detector. ‫(الشكل‬ )‫الجسم‬ ‫(خارج‬ ‫الدم‬ ‫دائرة‬ ‫تراقب‬ 13.9 ‫الدائرة‬ ‫وسالمة‬ ، ‫والوريدي‬ ‫الشرياني‬ ‫الدم‬ ‫خطوط‬ ‫في‬ ‫الضغط‬ ) ‫لوجود‬ ‫هواء‬ ‫و‬ ‫(الشكل‬ ‫الرئيسية‬ ‫األربعة‬ ‫الدموية‬ ‫الدورة‬ ‫مراقبة‬ ‫أجهزة‬ .‫الدم‬ ‫تسرب‬ 13.10 ‫مراقبة‬ ‫جهاز‬ ‫هي‬ ) ‫قياس‬ ‫جهاز‬ ، ‫الشرياني‬ ‫الضغط‬ .‫الدم‬ ‫تسرب‬ ‫وكاشف‬ ، ‫الهوائية‬ ‫الرغوة‬ ‫كاشف‬ ، ‫الوريدي‬ ‫الضغط‬ The blood-leak detector acts as a blood-circuit alarm but is entirely incorporated within the dialysate circuit and has already been described. The machinery responds to blood-circuit alarms by activating an audible alarm, a visual alarm, stopping the blood pump, and engaging the venous line clamp to stop the blood flow through the blood circuit. ‫وصفه‬ ‫تم‬ ‫وقد‬ ‫الديالة‬ ‫دائرة‬ ‫في‬ ‫بالكامل‬ ‫مدمج‬ ‫ولكنه‬ ‫الدم‬ ‫لدائرة‬ ‫إنذار‬ ‫كجهاز‬ ‫الدم‬ ‫تسرب‬ ‫كاشف‬ ‫يعمل‬ ‫ت‬ .‫بالفعل‬ ‫وإيقاف‬ ، ‫مرئي‬ ‫وإنذار‬ ، ‫مسموع‬ ‫إنذار‬ ‫تنشيط‬ ‫طريق‬ ‫عن‬ ‫الدموية‬ ‫الدائرة‬ ‫إلنذارات‬ ‫اآللة‬ ‫ستجيب‬ .‫الدموية‬ ‫الدورة‬ ‫عبر‬ ‫الدم‬ ‫تدفق‬ ‫إليقاف‬ ‫الوريدي‬ ‫الخط‬ ‫مشبك‬ ‫وإشراك‬ ، ‫الدم‬ ‫مضخة‬ Additional areas to monitor in the blood circuit are blood flow rate, heparin therapy, and normal saline supply. ‫وإمداد‬ ، ‫الهيبارين‬ ‫وعالج‬ ، ‫الدم‬ ‫تدفق‬ ‫معدل‬ ‫هي‬ ‫الدموية‬ ‫الدورة‬ ‫في‬ ‫مراقبتها‬ ‫يجب‬ ‫التي‬ ‫اإلضافية‬ ‫المجاالت‬ .‫الطبيعي‬ ‫الملحي‬ ‫المحلول‬ Arterial Pressure Monitor—Pre-Blood Pump ‫الدم‬ ‫ضغط‬ ‫مراقبة‬ ‫جهاز‬ - ‫الدم‬ ‫قبل‬ ‫ما‬ ‫مضخة‬ The arterial pressure monitor measures the pressure in the arterial blood line between the patient’s arterial access and the blood. With the blood pump set to blood flow rates greater than 200 mL/min to as high as 450 mL/min, the pressure in this blood tubing segment is commonly subatmospheric to negative. This portion of the blood circuit can be a source of air entry into the blood circuit and is considered a high- risk area. ‫ضبط‬ ‫مع‬ .‫والدم‬ ‫الشرايين‬ ‫وصول‬ ‫بين‬ ‫الشرياني‬ ‫الدم‬ ‫خط‬ ‫في‬ ‫الضغط‬ ‫الشرياني‬ ‫الضغط‬ ‫مراقبة‬ ‫جهاز‬ ‫يقيس‬ ‫م‬ ‫على‬ ‫الدم‬ ‫مضخة‬ ‫من‬ ‫أكبر‬ ‫دم‬ ‫تدفق‬ ‫عدالت‬ 200 ‫إلى‬ ‫دقيقة‬ / ‫مل‬ 450 ‫هذا‬ ‫في‬ ‫الضغط‬ ‫يكون‬ ، ‫دقيقة‬ / ‫مل‬ ‫الدموية‬ ‫الدورة‬ ‫من‬ ‫الجزء‬ ‫هذا‬ ‫يكون‬ ‫أن‬ ‫يمكن‬ .‫سلبي‬ ‫إلى‬ ‫الجوي‬ ‫الغالف‬ ‫تحت‬ ً‫ة‬‫عاد‬ ‫الدم‬ ‫أنابيب‬ ‫من‬ ‫الجزء‬ .‫الخطورة‬ ‫عالية‬ ‫منطقة‬ ‫ويعتبر‬ ‫الدموية‬ ‫الدورة‬ ‫إلى‬ ‫الهواء‬ ‫لدخول‬ ‫ا‬ً‫مصدر‬
  • 2. 204 Safety Monitors in Hemodialysis Saline Arterial Pressure Blood Heparin Venous pressure Ultrasonic pump ml/min 350 pump air detector Venous line clamp From Patient To Patient Blood (Extracorporeal) Circuit. (From Pittard J: Hemodialysis Nursing, Training Manual, 7th ed., version 7.0. Santa Monica, CA, 2003, with permission.) NORMAL WARNING ALARM POWER RESET MUTE Blood Circuit Monitors. (From Pittard J: Hemodialysis Nursing, Training Manual, 7th ed., version 7.0. Santa Monica, CA, 2003, with permission.) The arterial pressure monitor is leak-free with adjustable high/low limits (Fig. 13.11), which reads negative and positive pressures in millimeters of mercury (mm Hg; 10% accuracy). This monitor requires a filter to prevent viruses, bacteria, or blood from being refluxed back into the arterial pressure monitor. This filter is essential, as viral hepatitis has been transmitted by contamination of air devices. ‫(الشكل‬ ‫للتعديل‬ ‫قابلة‬ ‫منخفضة‬ / ‫عالية‬ ‫حدود‬ ‫مع‬ ‫التسرب‬ ‫من‬ ‫خالي‬ ‫الشرياني‬ ‫الضغط‬ ‫مراقبة‬ ‫جهاز‬ 13.11 ‫دقة‬ ‫؛‬ ‫زئبق‬ ‫(مم‬ ‫الزئبق‬ ‫من‬ ‫بالمليمترات‬ ‫واإليجابية‬ ‫السلبية‬ ‫الضغوط‬ ‫تقرأ‬ ‫والتي‬ ، ) 10 .)٪ ‫جهاز‬ ‫إلى‬ ‫أخرى‬ ‫مرة‬ ‫االرتجاع‬ ‫من‬ ‫الدم‬ ‫أو‬ ‫البكتيريا‬ ‫أو‬ ‫الفيروسات‬ ‫لمنع‬ ‫ا‬ً‫ح‬‫مرش‬ ‫الشاشة‬ ‫هذه‬ ‫تتطلب‬ ‫طريق‬ ‫عن‬ ‫الفيروسي‬ ‫الكبد‬ ‫التهاب‬ ‫ينتقل‬ ‫حيث‬ ، ‫ًا‬‫ي‬‫ضرور‬ ‫المرشح‬ ‫هذا‬ ‫يعد‬ .‫الشرايين‬ ‫ضغط‬ ‫مراقبة‬ .‫الهواء‬ ‫أجهزة‬ ‫تلوث‬ AIR BLOOD ARTERIAL VENOUS DETECTOR LEAK PRESSURE PRESSURE MINOR 290 200 100 0 PRIME OVERRIDE –100 –200 –300 500 400 300 200 100 0 –50 Figure 13.9 Figure 13.10
  • 3. Safety Monitors in Hemodialysis 205 ARTERIAL PRESSURE ARTERIAL PRESSURE 290 200 100 0 –100 –200 –300 WITHIN LIMITS 290 200 100 0 –100 –200 –300 LOW LIMIT ALARM Excess negative pressure violated low limit Arterial Pressure. (From Pittard J: Hemodialysis Nursing, Training Manual, 7th ed., version 7.0. Santa Monica, CA, 2003, with permission.) These filters or fluid barriers are called isolators and/or transducer filters/ protectors. They protect the monitor from blood contamination and the spread of infection between patients. The pressure monitor lines must be unclamped and patent during dialysis. Some blood lines have collapsible pillow-shaped segments, which can initiate a false alarm. ‫تحمي‬ ‫أنها‬ .‫الطاقة‬ ‫محول‬ ‫واقيات‬ / ‫مرشحات‬ ‫أو‬ / ‫و‬ ‫عوازل‬ ‫السوائل‬ ‫حواجز‬ ‫أو‬ ‫المرشحات‬ ‫هذه‬ ‫تسمى‬ ُ‫م‬ ‫غير‬ ‫الضغط‬ ‫مراقبة‬ ‫خطوط‬ ‫تكون‬ ‫أن‬ ‫يجب‬ .‫المرضى‬ ‫بين‬ ‫العدوى‬ ‫وانتشار‬ ‫الدم‬ ‫تلوث‬ ‫من‬ ‫الشاشة‬ ‫وأن‬ ‫حكمة‬ ‫تكون‬ ‫ظاهرة‬ ‫والتي‬ ، ‫وسادة‬ ‫شكل‬ ‫على‬ ‫للطي‬ ‫قابلة‬ ‫أجزاء‬ ‫على‬ ‫الدم‬ ‫خطوط‬ ‫بعض‬ ‫تحتوي‬ .‫الكلى‬ ‫غسيل‬ ‫أثناء‬ .‫ًا‬‫ب‬‫كاذ‬ ‫ا‬ً‫إنذار‬ ‫تطلق‬ ‫أن‬ ‫يمكن‬ During set-up, priming, and rinsing of the dialyzer, the high-low limits are opened. As soon as the dialysis treatment is initiated, the dialysis personnel must set the low, or negative, pressure limit just below the reading at the desired blood flow. Upper and lower monitor limits should be set within 50–100 mm Hg of actual reading to detect problems. Newer machine models will automatically adjust the high/low limits approximately 50 mm Hg above and below the actual pressure. ‫عالج‬ ‫بدء‬ ‫بمجرد‬ .‫والمنخفضة‬ ‫العالية‬ ‫الحدود‬ ‫فتح‬ ‫يتم‬ ، ‫الغسيل‬ ‫لجهاز‬ ‫والشطف‬ ‫والتجهيز‬ ‫اإلعداد‬ ‫أثناء‬ ‫س‬ ‫أو‬ ‫منخفض‬ ‫ضغط‬ ‫حد‬ ‫تعيين‬ ‫الكلى‬ ‫غسيل‬ ‫موظفي‬ ‫على‬ ‫يجب‬ ، ‫الكلى‬ ‫غسيل‬ ‫عند‬ ‫القراءة‬ ‫من‬ ‫بقليل‬ ‫أقل‬ ‫لبي‬ ‫حدود‬ ‫في‬ ‫والسفلية‬ ‫العلوية‬ ‫الشاشة‬ ‫حدود‬ ‫تعيين‬ ‫يجب‬ .‫المطلوب‬ ‫الدم‬ ‫تدفق‬ 50 - 100 ‫الفعلية‬ ‫القراءة‬ ‫من‬ ‫زئبق‬ ‫مم‬ ‫بحوالي‬ ‫ًا‬‫ي‬‫تلقائ‬ ‫المنخفضة‬ / ‫العالية‬ ‫الحدود‬ ‫ضبط‬ ‫على‬ ‫األحدث‬ ‫الماكينات‬ ‫طرز‬ ‫تعمل‬ .‫المشكالت‬ ‫الكتشاف‬ 50 ‫ال‬ ‫الضغط‬ ‫من‬ ‫وأدنى‬ ‫أعلى‬ ‫زئبق‬ ‫مم‬ .‫فعلي‬ Setting the low arterial limit close to the actual pressure, about 50 mm Hg below that pressure, will detect early drops in blood pressure with arteriovenous (AV) fistulas. Some units limit the minimum arterial limit to –100 mm Hg. ‫الحد‬ ‫تحديد‬ ‫إن‬ ‫حوالي‬ ، ‫الفعلي‬ ‫الضغط‬ ‫من‬ ‫بالقرب‬ ‫المنخفض‬ ‫الشرياني‬ 50 ، ‫الضغط‬ ‫هذا‬ ‫من‬ ‫أقل‬ ‫زئبق‬ ‫مم‬ ( ‫الوريدية‬ ‫الشريانية‬ ‫النواسير‬ ‫مع‬ ‫الدم‬ ‫ضغط‬ ‫في‬ ‫مبكرة‬ ‫انخفاضات‬ ‫عن‬ ‫سيكشف‬ AV ‫الوحدات‬ ‫بعض‬ ‫تحدد‬ .) ‫عند‬ ‫للشريان‬ ‫األدنى‬ ‫الحد‬ - 100 .‫زئبق‬ ‫ملم‬ The greater the vacuum, the greater the risk of air entering this tubing segment from any crack, improperly glued or fitted joint, sample port, saline infusion line, or the patient’s access. It is advisable to set the high limit just below zero, which will pick up a disruption of the arterial blood line from the fistula needle. Figure 13.11
  • 4. 206 Safety Monitors in Hemodialysis ‫تم‬ ‫مفصل‬ ‫أو‬ ، ‫صدع‬ ‫أي‬ ‫من‬ ‫هذا‬ ‫األنابيب‬ ‫جزء‬ ‫إلى‬ ‫الهواء‬ ‫دخول‬ ‫خطر‬ ‫زاد‬ ، ‫الفراغ‬ ‫زاد‬ ‫كلما‬ ‫لصقه‬ ‫أو‬ ‫ا‬ .‫المريض‬ ‫وصول‬ ‫أو‬ ، ‫الملحي‬ ‫المحلول‬ ‫ضخ‬ ‫خط‬ ‫أو‬ ، ‫العينة‬ ‫منفذ‬ ‫أو‬ ، ‫صحيح‬ ‫غير‬ ‫بشكل‬ ‫تركيبها‬ ُ‫ي‬ ‫نصح‬ ‫إل‬ ‫سيؤدي‬ ‫والذي‬ ، ‫الصفر‬ ‫من‬ ‫بقليل‬ ‫أقل‬ ‫مرتفع‬ ‫حد‬ ‫بتعيين‬ ‫م‬ ‫الشرياني‬ ‫الدم‬ ‫خط‬ ‫في‬ ‫خلل‬ ‫حدوث‬ ‫ى‬ ‫إبر‬ ‫ن‬ ‫ة‬ .‫الناسور‬ Arterial Pressure Monitoring ‫الشرايين‬ ‫ضغط‬ ‫مراقبة‬ The usual causes of a low-limit arterial pressure alarm are a drop in blood pressure (only with AV fistulas), a kink in the arterial blood line between the access and blood pump, malpositioned arterial needle or problem with arterial access, and a clotted arterial line. The circuit should always be checked for air bubbles. ‫ا‬ ‫مع‬ ‫(فقط‬ ‫الدم‬ ‫ضغط‬ ‫انخفاض‬ ‫هي‬ ‫الحد‬ ‫منخفض‬ ‫الشرياني‬ ‫الضغط‬ ‫إنذار‬ ‫لجهاز‬ ‫المعتادة‬ ‫األسباب‬ ‫لناس‬ ‫و‬ ‫ر‬ ‫الشرا‬ ‫وإبرة‬ ، ‫الدم‬ ‫ومضخة‬ ‫الوصول‬ ‫بين‬ ‫الشرياني‬ ‫الدم‬ ‫خط‬ ‫في‬ ‫والتواء‬ ، )‫الوريدي‬ ‫الشرياني‬ ‫ذ‬ ‫يين‬ ‫الوضع‬ ‫ات‬ ‫ب‬ ‫الدائرة‬ ‫فحص‬ ‫ا‬ً‫م‬‫دائ‬ ‫يجب‬ .‫الشرايين‬ ‫خط‬ .‫والتخثر‬ ، ‫الشرياني‬ ‫الوصول‬ ‫في‬ ‫مشكلة‬ ‫أو‬ ‫الخاطئ‬ ‫ا‬ً‫ث‬‫ح‬ ‫ع‬ ‫فقاعات‬ ‫ن‬ .‫الهواء‬ The usual causes of a high-limit arterial pressure alarm are bloodline separation (only if the upper limit is set below 0 mm Hg), the saline infusion line is unclamped, an increase in patient’s blood pressure, a leak in the circuit between the patient and monitor, and torn blood tubing in the pump segment. It is important to check for leaking blood. ‫الح‬ ‫كان‬ ‫إذا‬ ‫(فقط‬ ‫الدم‬ ‫ساللة‬ ‫فصل‬ ‫هي‬ ‫الحد‬ ‫عالي‬ ‫الشرياني‬ ‫الضغط‬ ‫إلنذار‬ ‫المعتادة‬ ‫األسباب‬ ‫األ‬ ‫د‬ ‫م‬ ‫أقل‬ ‫على‬ ‫ن‬ 0 ‫الدائرة‬ ‫في‬ ‫وتسرب‬ ، ‫المريض‬ ‫دم‬ ‫ضغط‬ ‫في‬ ‫وزيادة‬ ، ‫محكم‬ ‫غير‬ ‫الملحي‬ ‫التسريب‬ ‫وخط‬ ، )‫زئبق‬ ‫مم‬ ‫بين‬ ‫ومراقبة‬ ‫المريض‬ ‫وتمزق‬ .‫الدم‬ ‫تسرب‬ ‫من‬ ‫التحقق‬ ‫المهم‬ ‫من‬ .‫المضخة‬ ‫جزء‬ ‫في‬ ‫الدم‬ ‫أنابيب‬
  • 5. Safety Monitors in Hemodialysis 207 The appropriate response to pressure alarms is to, first, mute the audible alarm; second, investigate the problem; third, correct the problem; and fourth, restart the blood pump by pressing the reset/restart button. Do not restart the blood pump until the problem is corrected for patient safety. Failure to correct the problem will cause the alarm to reoccur. ‫المسموع‬ ‫اإلنذار‬ ‫صوت‬ ‫كتم‬ ، ً‫ال‬‫أو‬ ، ‫هي‬ ‫الضغط‬ ‫إلنذارات‬ ‫المناسبة‬ ‫االستجابة‬ ‫؛‬ ‫المشكلة‬ ‫من‬ ‫تحقق‬ ، ‫ًا‬‫ي‬‫ثان‬ ‫؛‬ ‫ال‬ .‫التشغيل‬ ‫إعادة‬ / ‫الضبط‬ ‫إعادة‬ ‫زر‬ ‫على‬ ‫بالضغط‬ ‫الدم‬ ‫مضخة‬ ‫تشغيل‬ ‫أعد‬ ، ‫ا‬ً‫ع‬‫وراب‬ ‫؛‬ ‫المشكلة‬ ‫تصحيح‬ ، ‫ا‬ً‫ث‬‫ثال‬ ‫تصحيح‬ ‫عدم‬ ‫سيؤدي‬ .‫المريض‬ ‫سالمة‬ ‫أجل‬ ‫من‬ ‫المشكلة‬ ‫تصحيح‬ ‫يتم‬ ‫حتى‬ ‫الدم‬ ‫مضخة‬ ‫تشغيل‬ ‫بإعادة‬ ‫تقم‬ .‫اإلنذار‬ ‫تكرار‬ ‫إلى‬ ‫المشكلة‬ Venous Pressure Monitor ‫الوريدي‬ ‫الضغط‬ ‫مراقبة‬ ‫جهاز‬ The venous pressure monitor, located postdialyzer, monitors pressure at the venous drip chamber, the segment between the drip chamber and the patient’s venous access, and the added intra-access pressure. The resistance to the blood flow entering the venous access causes the pressure to be positive (Fig. 13.12), above 0 mm Hg. ‫والجزء‬ ، ‫الوريدي‬ ‫التنقيط‬ ‫حجرة‬ ‫في‬ ‫الضغط‬ ‫يراقب‬ ، ‫الغسالة‬ ‫بعد‬ ‫الموجود‬ ، ‫الوريدي‬ ‫الضغط‬ ‫مراقبة‬ ‫جهاز‬ ‫المريض‬ ‫ووصول‬ ‫التنقيط‬ ‫حجرة‬ ‫بين‬ ‫الموجود‬ ‫الداخل‬ ‫الدم‬ ‫تدفق‬ ‫مقاومة‬ .‫اإلضافي‬ ‫الداخلي‬ ‫والضغط‬ ، ‫الوريدي‬ ‫(الشكل‬ ‫ًا‬‫ب‬‫موج‬ ‫الضغط‬ ‫يكون‬ ‫أن‬ ‫إلى‬ ‫يؤدي‬ ‫الوريد‬ ‫إلى‬ 13.12 ‫فوق‬ ، ) 0 .‫زئبق‬ ‫مم‬ The venous pressure monitor’s structure and standards are similar to those described for the arterial pre-blood pump monitor. This pressure monitor requires protection by a filter or transducer fluid barrier. .‫الشرياني‬ ‫الدم‬ ‫مضخة‬ ‫مراقبة‬ ‫لجهاز‬ ‫الموصوفة‬ ‫لتلك‬ ‫مماثلة‬ ‫الوريدي‬ ‫الضغط‬ ‫مراقبة‬ ‫جهاز‬ ‫ومعايير‬ ‫هيكل‬ .‫الطاقة‬ ‫محول‬ ‫سائل‬ ‫حاجز‬ ‫أو‬ ‫مرشح‬ ‫بواسطة‬ ‫الحماية‬ ‫هذا‬ ‫الضغط‬ ‫مراقبة‬ ‫جهاز‬ ‫يتطلب‬ Venous Pressure Monitoring ‫الوريدي‬ ‫الضغط‬ ‫مراقبة‬ Causes of a high venous pressure alarm are a kink in the venous blood line between the drip chamber and patient’s venous access, a clot in the venous drip chamber and/ or downstream to the patient, and a malpositioned venous needle or problem with the venous access device. ‫هي‬ ‫الوريدي‬ ‫الدم‬ ‫ضغط‬ ‫ارتفاع‬ ‫أسباب‬ ‫التواء‬ ‫الوريدي‬ ‫والمدخل‬ ‫التنقيط‬ ‫غرفة‬ ‫بين‬ ‫الوريدي‬ ‫الدم‬ ‫خط‬ ‫في‬ ‫مشكلة‬ ‫أو‬ ‫خاطئة‬ ‫وريدية‬ ‫وإبرة‬ ، ‫المريض‬ ‫إلى‬ ‫المصب‬ ‫أو‬ / ‫و‬ ‫الوريدي‬ ‫التنقيط‬ ‫حجرة‬ ‫في‬ ‫وجلطة‬ ، ‫للمريض‬ ‫ف‬ .‫جهاز‬ ‫الوريدي‬ ‫الوصول‬ ‫ي‬ Causes of a low venous pressure alarm are blood line separation or disruption of connections between the blood pump to and including the venous access; a kink in the blood line postdialyzer and pre–venous drip chamber; a clotted dialyzer; and a lowering of the blood-pump speed. Note that setting the low limit close to the operating pressure of the venous drip chamber can alert to a disruption of the blood circuit between the blood pump and venous access site. With a disruption of the circuit, the venous pressure will drop to 0 mm Hg. ‫ذلك‬ ‫في‬ ‫بما‬ ‫الدم‬ ‫مضخة‬ ‫بين‬ ‫الوصالت‬ ‫انقطاع‬ ‫أو‬ ‫الدم‬ ‫خط‬ ‫فصل‬ ‫هي‬ ‫الوريدي‬ ‫الضغط‬ ‫انخفاض‬ ‫أسباب‬ ‫جهاز‬ ‫؛‬ ‫المسبق‬ ‫الوريدي‬ ‫التنقيط‬ ‫وغرفة‬ ‫الدموي‬ ‫الديال‬ ‫بعد‬ ‫ما‬ ‫تحليل‬ ‫جهاز‬ ‫في‬ ‫التواء‬ ‫؛‬ ‫الوريدي‬ ‫الوصول‬ ‫ضخ‬ ‫سرعة‬ ‫وخفض‬ ‫متخثر‬ ‫غسيل‬ ‫التنقيط‬ ‫لحجرة‬ ‫التشغيل‬ ‫ضغط‬ ‫من‬ ‫بالقرب‬ ‫األدنى‬ ‫الحد‬ ‫تعيين‬ ‫أن‬ ‫الحظ‬ .‫الدم‬ ‫مع‬ .‫الوريدي‬ ‫الوصول‬ ‫وموقع‬ ‫الدم‬ ‫مضخة‬ ‫بين‬ ‫الدموية‬ ‫الدورة‬ ‫في‬ ‫اضطراب‬ ‫حدوث‬ ‫إلى‬ ‫ينبه‬ ‫أن‬ ‫يمكن‬ ‫الوريدي‬ ‫إلى‬ ‫الوريدي‬ ‫الضغط‬ ‫ينخفض‬ ، ‫الدائرة‬ ‫في‬ ‫اضطراب‬ ‫حدوث‬ 0 .‫زئبق‬ ‫مم‬
  • 6. 208 Safety Monitors in Hemodialysis VENOUS PRESSURE VENOUS PRESSURE 500 400 300 200 100 0 –50 WITHIN LIMITS 500 400 300 200 100 0 –50 HIGH LIMIT ALARM Excess negative pressure violation upper limit Venous Pressure. (From Pittard J: Hemodialysis Nursing, Training Manual, 7th ed., version 7.0. Santa Monica, CA, 2003, with permission.) Figure 13.12