Practical Dialysis in the Year 2009

Practical Dialysis in the Year 2009 √ªŸ ∑Ë’ 3 · ¥ßº≈°“√·∑߇ âπ‡≈Õ◊ ¥·∫∫ Area √ªŸ ∑Ë’ 4 · ¥ßº≈°“√·∑߇ πâ ‡≈◊Õ¥·∫∫ Constant-site À√◊Õ Buttonhole Twardoski Z ‰¥â√“¬ß“π«‘∏’°“√·∑ß«‘∏’π’ȧ√—Èß·√°„π¬ÿ‚√ªμ—Èß·μàªï §.». 1977 ´÷Ëßπ“π¡“°°«à“ 30 ªï ·≈–μàÕ¡“¡’À≈“¬ª√–‡∑»‰¥âπ”‡∑§π‘§°“√·∑ßπ’ȉª„™â ¡’√“¬ß“π„πª√–‡∑» “∏“√≥√—∞Õ‡¡√‘°“ μ—Èß·μàªï §.». 1997 ·≈–μàÕ¡“°“√·∑ߥ⫬«‘∏’π’È¡’®”π«π‡æ‘Ë¡¡“°¢÷Èπ °“√·∑ߥ⫬«‘∏’π’È®–μâÕ߇¢â“„®À≈—° °“√·∑ß∑’Ë∂Ÿ°μâÕß ¡‘©–π—Èπ®–∑”„Àâ°“√·∑߇ªìπ·∫∫´È”„°≈â∑’ˇ¥‘¡ (area technique) ‚¥¬‰¡àμ—Èß„® „πÕ¥’μ ¡’·μà‡¢Á¡ª≈“¬·À≈¡∑”„ÀâÕ“®®–·∑ßæ≈“¥·≈–∑”„Àâ√àÕ߇ ’¬‰¥â„π∑’Ë ÿ¥ ªí®®ÿ∫—π¡’‡¢Á¡ª≈“¬∑àŸ ´÷Ë߇¡◊ËÕ  √â“ß√àÕß®“°‡¢Á¡ª≈“¬·À≈¡‰¥â ”‡√Á®·≈â« ®–‡ª≈’ˬπ‡ªìπ‡¢Á¡ª≈“¬∑Ÿà Õ¥‡¢â“√àÕ߇¢â“ àŸ‡ âπ‡≈◊Õ¥ 488

Work Instruction: Buttonhole Cannulation: New Insight 3. ¢Õâ ¥·’ ≈–¢âÕ‡ ¬’ ¢Õß°“√·∑߇ âπ¥«â ¬«∏‘ ’ Constant-site À√◊Õ Buttonhole 3.1 ¢Õâ ¥’ 1. ™à«¬„Àâ°“√·∑ßßà“¬¢÷Èπ ≈¥Õ“°“√μ√–Àπ° ”À√—∫欓∫“≈ºâŸ·∑ß·≈–ºâŸªÉ«¬ºâŸ∂Ÿ°·∑ß ‡π◊ËÕß®“°¡’√àÕßπ”∑“ß„π°“√·∑ßÕ¬Ÿà·≈â« 2. ≈¥Õ“°“√ª«¥¢≥–·∑߇ âπ 3. ≈¥°“√æ≈“¥∑’ËμâÕß·∑ß´È” ¡’√“¬ß“π«à“≈¥‰¥â∂÷ß 10 ‡∑à“ 4. ≈¥Õ“°“√·∑√°´âÕπÕ—π‡π◊ËÕß®“°°“√·∑ßæ≈“¥ À√◊Õ·∑ß∑–≈ÿ¥â“πÀ≈—ߢÕߺπ—߇ âπ‡≈◊Õ¥ À√◊Õ·∑߉¡à¡‘¥√Ÿ‡¢Á¡ ´÷Ëß®–∑”„Àâ‡≈◊Õ¥√—Ë«ÕÕ°®“°ºπ—߇ âπ‡≈◊Õ¥ ·≈–∑”„À⇰‘¥Õ“°“√∫«¡√Õ∫‡ âπ‡≈◊Õ¥ À√◊Õ¡’°âÕπ‡≈◊Õ¥√Õ∫‡ âπ‡≈◊Õ¥ æ∫«à“≈¥Õÿ∫—μ‘°“√≥剥â 100 ‡∑à“ 5. ‰¡àæ∫«à“¡’°“√μ‘¥‡™◊ÈÕ‡æ‘Ë¡¡“°¢÷Èπ Õ¬à“߉√°Áμ“¡„πªí®®ÿ∫—π‡√Ë‘¡æ∫«à“Õÿ∫—μ‘°“√≥å°“√ 쥑 ‡™◊ÕÈ æ∫‰¥â‰¡àπâÕ¬ ‚¥¬‡©æ“–∂Ⓣ¡ªà Æ∫‘ μ— μ‘ “¡¢πÈ— μÕπÕ¬à“߇§√àߧ√¥— 6. ‡π◊ËÕß®“°‡ªìπ°“√„™â‡¢Á¡ª≈“¬∑àŸ ·∑π‡¢Á¡ª≈“¬·À≈¡ ∑”„Àâ≈¥‚Õ°“ ∑’Ë∫ÿ§≈“°√∑“ß°“√ ·æ∑¬å®–∂°Ÿ ‡¢Á¡μ”μ—«‡Õß ‰¡àμâÕß¡’¡“μ√°“√摇»…„π°“√°”®—¥¢Õß¡’§¡ 7. ‡ªìπ∑’ËæÕ„®¢Õß欓∫“≈·≈–ºâŸªÉ«¬‡¡◊ËÕ‡∑’¬∫°—∫°“√·∑ߥ⫬«‘∏’ª°μ‘ 8. ºâŸªÉ«¬ “¡“√∂·∑߇Õ߉¥â ‡À¡“–°—∫°“√∑” home hemodialysis 3.2 ¢âÕ‡ ’¬ 1. μÕâ ß∑”√Õà ß„À‰â ¥¥â ’ ‡æÕË◊ ®–‰¥·â ∑߇ πâ ‰¥ßâ “à ¬ ∂“â ∑”√Õà ߉¡¥à ’ ºªŸâ «É ¬®–¡Õ’ “°“√ª«¥¢≥–·∑ß À“√àÕß 2. μâÕß¡’‡¢Á¡ª≈“¬∑àŸ ´÷Ëß¡’„πª√–‡∑»‰∑¬·≈â« ∂â“„™â‡¢Á¡ª≈“¬·À≈¡·∑ß√àÕß∑’ˉ¥â∑”‰«â·≈â« Õ“®®–æ≈“¥∑”„Àâ√àÕ߇ ’¬‰¥â 3. μâÕ߇ ’¬‡«≈“„π°“√°”®—¥ –‡°Á¥§√“∫πÈ”‡À≈◊ÕßÕÕ°°àÕπ ∂Ⓣ¡à°”®—¥ÕÕ°·≈–·∑ߺà“π  –‡°¥Á §√“∫πÈ”‡À≈Õ◊ ß®–∑”„À‡â °¥‘ °“√쥑 ‡™Õ◊È ‰¥â¢πÈ— μÕππ È’ ”§≠— ¡“° Õ¬“à ߉√°μÁ “¡¢π—È μÕπμÕà ‰ª„π°“√ ·∑߇¢â“√àÕß∑’Ë∑”‰«â·≈â«®–ßà“¬·≈–√àπ√–¬–‡«≈“°“√·∑ß‚¥¬√«¡‰¥â 4. ∂⓺ŸâªÉ«¬μâÕ߉ªøÕ°‡≈◊Õ¥∑’ËÀπ૬‰μ‡∑’¬¡Õ◊Ëπ™—Ë«§√“« ·≈–Àπ૬‰μ‡∑’¬¡π—Èπ‰¡à¡’ ª√– ∫°“√≥„å π°“√·∑ß·∫∫ButtonholeÀ√Õ◊ ‰¡¡à ‡’ ¢¡Á ª≈“¬∑àŸ„À·â ∑ß∑μ’Ë ”·Àπßà Õπ◊Ë ¥«â ¬«∏‘ ª’ °μÀ‘ “à ß®“°√Õà ß ‡æ◊ËÕ‰¡à∑”„Àâ√àÕ߇ ’¬‰ª ·≈–ªÑÕß°—𧫓¡º‘¥æ≈“¥∑’Ë®–∑”„À⇰‘¥°“√μ‘¥‡™◊ÈÕμ“¡¡“ 3.3 ºŸâ∑’ˇÀ¡“– ¡°∫— °“√·∑ߥ⫬«∏‘ ’ Constant-site À√◊Õ Buttonhole 1. „™â°—∫ºŸâªÉ«¬∑’Ë¡’‡ âπøÕ°‡≈◊Õ¥™π‘¥ AVF ‰¡à„Àâ„™°â ∫— ‡ âπøÕ°‡≈Õ◊ ¥™π‘¥ AVG 2. ‡À¡“–¡“° ”À√—∫ºŸâªÉ«¬∑’Ë¡’∫√‘‡«≥∑’Ë·∑߇ âπ®”°—¥ 3. ∫√‡‘ «≥∑®Ë’ –·∑߇ªπì Buttonhole ‰¡§à «√¡·’ º≈‡ªπì ¡“° À√Õ◊ ‡ªπì ∫√‡‘ «≥∑‡Ë’ §¬∂°Ÿ ·∑ß®π‡°¥‘ ·º≈‡ªìπ ·≈–§«√‡≈’ˬß∫√‘‡«≥ aneurysm ‡π◊ËÕß®“°∫√‘‡«≥‡À≈à“π’È®–∑”„À⇰‘¥√àÕß∂“«√¬“° ·≈–∫“ß §√—Èߪ“°·º≈®–¢¬“¬°«â“߬“°μàÕ°“√À“·π«¢Õß√àÕß∑’Ë∂Ÿ°μâÕß 489

Practical Dialysis in the Year 2009 4. μ—« AVF ‰¡à§«√Õ¬àŸ≈÷°‡°‘π‰ª ‚¥¬‡©æ“–∑’Ë∫√‘‡«≥μâπ·¢π ·≈–μ—« AVF ‰¡à§«√‡§≈◊ËÕπ‰À« ‰¥âÕ¬à“ßÕ‘ √–¡“° ®π∑”„À≡ࠓ¡“√∂μ√÷߇ âπ AVF „ÀâÕ¬Ÿà°—∫∑’ˉ¥â ´÷Ëß¡—°æ∫„πºâŸ ŸßÕ“¬ÿ∑’Ë¡’™—Èπ‰¢¡—π„μâ º‘«Àπ—ßπâÕ¬ ∑”„Àâ°“√∑”√àÕ߇ªìπ‰ª‰¥â¬“° 4. ‡∑§π§‘ °“√·∑ß AVF ¥«â ¬«∏‘ ’ Constant-site À√◊Õ Buttonhole 4.1 ‡∑§π§‘ ª√–°Õ∫¥â«¬ 2 ¢Èπ— μÕπ 1. ¢—ÈπμÕπ°“√ √â“ß√àÕß ”À√—∫°“√·∑߇ âπ (Establishing constant-sites) 2. ¢—ÈπμÕπ°“√·∑߇¢â“√àÕß∑’Ë‚μ·≈â« (Cannulating mature constant-sites) 4.2 ¢—πÈ μÕπ°“√ √â“ß√àÕß ”À√—∫°“√·∑߇ πâ (√Ÿª∑’Ë 5) 1. ‡≈◊Õ°μ”·Àπà߇ âπ∫√‘‡«≥∑’ˇªìπ‡ âπμ√ß∑’ˇ¢Á¡ “¡“√∂·∑ßΩí߇¢â“‰¥â 2 μ”·Àπàß ‚¥¬‡¡◊ËÕ ·∑߇¢Á¡øÕ°‡≈◊Õ¥·≈â« ª≈“¬‡¢Á¡®–Õ¬ŸàÀà“ß°—πÕ¬à“ßπâÕ¬ 2 π‘È« ‡æ◊ËÕÀ≈’°‡≈’ˬ߰“√‡°‘¥ recirculation „Àâ À≈’°‡≈’ˬßμ”·Àπàß aneurysm „ÀâÀ≈’°‡≈’ˬßμ”·Àπàß„°≈â¢âÕæ—∫ ·≈–§«√‡≈◊Õ°μ”·Àπàß∑’˺ŸâªÉ«¬ “¡“√∂ ·∑߇Õ߉¥â„πÕπ“§μ 2. ∑”§«“¡ –Õ“¥∫√‘‡«≥∑’Ë®–·∑߇ âπ ‚¥¬°”®—¥ ‘Ëߪπ‡ªóôÕπμà“ßÊ ·≈–≈â“ߥ⫬πÈ”¬“¶à“ ‡™◊ÈÕμ“¡ μŸ √¢ÕßÀπ૬‰μ‡∑’¬¡·μà≈–·Ààß √Ÿª∑Ë’ 5 · ¥ß¢—πÈ μÕπ°“√ √“â ß√àÕß ”À√—∫°“√·∑߇ âπ‡≈Õ◊ ¥ AVF ·∫∫ Constant-site À√◊Õ Buttonhole ®“°´“â ¬‰ª¢«“ (Establishing constant-site) 490

Work Instruction: Buttonhole Cannulation: New Insight 3. „™â‡¢Á¡ AVF ∑’Ë„™âÕ¬àŸ„πªí®®ÿ∫—π ´÷Ëß®–‡√’¬°«à“ 燢Á¡ª≈“¬§¡é ·∑߇¢â“‡ âπ ‚¥¬„ÀâÀπâ“μ—¥ Àß“¬¢÷Èπ·≈–∑”¡ÿ¡ 25 Õß»“°—∫º‘«Àπ—ß ¢≥–·∑ß„ÀâÀ“«‘∏’μ√÷߇ âπ‡≈◊Õ¥„Àâπ‘Ëß ‡æ◊ËÕ∑”„À⇠âπ‡≈◊Õ¥∑’Ë·∑ß μ÷ß·≈–ßà“¬μàÕ°“√·∑ß °“√μ√÷߇ âπ‡≈◊Õ¥μâÕß∑”‚¥¬‰¡à¥÷ß√—Èß„Àâ™—Èπº‘«Àπ—߇§≈◊ËÕπÕÕ°®“°‡ âπ‡≈◊Õ¥ ´÷Ëß ®–∑”„Àâ·π«¢Õß√àÕ߉¡àμ√ß·≈–∑”„Àâ¡’º≈μàÕ°“√·∑ß„π§√—ÈßμàÕÊ ‰ª 4. ‡¡◊ËÕ¡’‡≈◊Õ¥‰À≈¬âÕπ°≈—∫‡¢â“‡¢Á¡ ´÷Ëß· ¥ß«à“‡¢Á¡‡¢â“‡ âπ‡≈◊Õ¥·≈â« „Àâ≈¥¡ÿ¡¢Õ߇¢Á¡≈ß ·≈–¥—π‡¢Á¡„À⇢Ⓡ âπ®π‰¥âμ”·Àπàß 5. ¬÷¥‡¢Á¡ AVF ‡¢â“°—∫º‘«Àπ—ߥ⫬‡∑ª 6. „Àâ∑”°“√·∑ß∑’Ë μ”·Àπßà ‡¥¡‘ ¡ÿ¡‡∑à“‡¥¡‘ ·≈–§«“¡≈°÷ ‡∑à“‡¥‘¡ ‚¥¬§π·∑ß§π‡¥¡‘ ®”π«πª√–¡“≥ 6-8 §√—Èß ´÷Ëß®–∑”„Àâ¡’√àÕ߇°‘¥¢÷Èπ„π∫√‘‡«≥¥—ß°≈à“« (Õ¬à“߉√°Áμ“¡¡’√“¬ß“π ®“° ª√– ∫°“√≥å„π∫“ß·Ààß«à“Õ“®®–μâÕß∑”´È”∂÷ß 8-10 §√—Èß„πºâŸªÉ«¬∑’ˉ¡à‡ªìπ‚√§‡∫“À«“π ·≈– 10-12 §√—Èß„πºâŸªÉ«¬‚√§‡∫“À«“π)  ‘Ëß∑’Ë∫àß∫Õ°«à“πà“®–‡ª≈’ˬπ‡ªìπ‡¢Á¡ª≈“¬∑Ÿà‰¥â §◊Õ¡’·√ßμâ“π∑“π πâÕ¬¡“°¢≥–‡¢Á¡ºà“π™—Èπº‘«Àπ—ß ·≈–„™â·√ߥ—ππâÕ¬¡“°¢≥–·∑ߺà“π‡ âπ‡≈◊Õ¥ À√◊ÕÕ“®®–¥Ÿ°“√ ‡ª≈’ˬπ·ª≈ߢÕß√Õ¬‡¢Á¡®“°√Ÿªμ—« çVé ‡ªìπ çUé ·≈–‡ªìπ√°Ÿ ≈¡Ê „π∑’Ë ÿ¥ ·≈–º‘«Àπ—ß√Õ∫√Ÿ‡¢Á¡ ¥â“π∑’Ë „™â à߇≈◊Õ¥ÕÕ° (arterial site) ®–ππŸ ¢÷Èπ ·μà√Õ∫Ê √Ÿ‡¢Á¡ ¥â“π∑’Ë√—∫‡≈◊Õ¥‡¢â“ (venous site) ®–À¥μ—«≈߉ª 7. À≈ß— ®“°·∑߇ πâ AVF ®–¡π’ È”‡À≈Õ◊ ß·Àâß°√ß— À√◊Õ –‡°¥Á πÈ”‡À≈Õ◊ ß (Scab) μ‘¥Õ¬àŸ∑ªË’ “°·º≈ ´÷Ëß‚¥¬∑—Ë«‰ª·≈â«®–‡ªìπ —≠≠≈—°…≥å∫àß∫Õ°«à“‡æ‘Ëߺà“π°“√·∑ß¡“ ·≈–„ÀâÀ≈’°‡≈’ˬ߰“√·∑ß„π μ”·Àπßà „°≈‡â §¬’ ßπ’È·μ à ”À√∫— °“√·∑ßButtonhole®–μÕâ ß¡ÕßÀ“ ß‘Ë π·’È ≈–·∑ß∫√‡‘ «≥∑¡’Ë  ’ –‡°¥Á πÈ”‡À≈Õ◊ ßπ’È ¥—ßπ—Èπ®–μâÕß°”®—¥ –‡°Á¥πÈ”‡À≈◊Õß∑ÿ°§√—Èß °àÕπ®–·∑߇¢Á¡ ‡π◊ËÕß®“°∂â“·∑ߺà“π –‡°Á¥πÈ”‡À≈◊Õßπ’È®– ∑”„À⇰‘¥°“√μ‘¥‡™◊ÈÕ‰¥â „À⥫Ÿ ‘∏’°“√°”®—¥ –‡°Á¥πÈ”‡À≈◊Õß„πÀ—«¢âÕ∂—¥‰ª 4.3 ¢Èπ— μÕπ°“√·∑߇¢“â √Õà ß∑’Ë‚μ·≈«â (√Ÿª∑’Ë 6) 1. ¢π—È ·√° μÕâ ß°”®¥—  –‡°¥Á πÈ”‡À≈Õ◊ ß∑ª’Ë “°√Õà ß∫√‡‘ «≥ Constant site (¥«Ÿ ∏‘ °’ “√°”®¥— πÈ”‡À≈Õ◊ ß ∑’Ë·Àâß°√—ß∑’˪“°√àÕß Constant site ) 2. ∑”§«“¡ –Õ“¥∫√‘‡«≥∑’Ë®–·∑߇ âπ ‚¥¬°”®—¥ ‘Ëߪπ‡ªóôÕπμà“ßÊ ·≈–≈â“ߥ⫬πÈ”¬“¶à“ ‡™◊ÈÕμ“¡ μŸ √¢ÕßÀπ૬‰μ‡∑’¬¡·μà≈–·Ààß 3. „™â‡¢Á¡ AVF ™π‘¥ª≈“¬∑Ÿà (Buttonhole Needle Sets with anti-stick dull bevel) ¥—ß√ªŸ ∑’Ë 7 ‚¥¬„ÀâÀπâ“μ—¥Àß“¬¢÷Èπ √à«¡°—∫°“√¥÷ߺ‘«Àπ—ß∑’ˇÀπ◊ÕÕ¬Ÿà‡Àπ◊ÕμàÕ∫√‘‡«≥∑’Ë®–·∑ߢ÷Èπ æ√âÕ¡°—∫·∑ß ‡¢â“‰ª„π√àÕ߇¥‘¡∑’Ë‚μ·≈â« ∂â“æ∫«à“¡’·√߇ ’¬¥∑“π„Àâ§àÕ¬Ê À¡ÿπ‡¢Á¡‚¥¬„™â·√ߥ—ππâÕ¬¡“°Ê 4. ‡¡◊ËÕ¡’‡≈◊Õ¥‰À≈¬âÕπ°≈—∫‡¢â“μ—«‡¢Á¡ · ¥ß«à“‡¢â“‡ âπ·≈â« „Àâ≈¥¡ÿ¡‡¢Á¡≈ß·≈–¥—π‡¢Á¡‡¢â“ ‡ âπ™â“Ê ®πÕ¬àŸ„πμ”·Àπàß∑’ˇÀ¡“– ¡ 5. ¬÷¥‡¢Á¡ AVF °—∫º‘«Àπ—ߥ⫬ tape (À¡“¬‡Àμÿ °“√„™â‡¢Á¡ª≈“¬∑Ÿà„π°“√·∑ß„π¢—ÈπμÕππ’È®–≈¥°“√∑”„Àâ√àÕß∂°Ÿ μ—¥ºà“π¥â«¬‡¢Á¡ ª≈“¬§¡) 491

Practical Dialysis in the Year 2009 √ªŸ ∑Ë’ 6 · ¥ß¢È—πμÕπ°“√·∑߇¢“â √àÕß∑Ë’‚μ·≈â«  ”À√—∫°“√·∑߇ πâ ‡≈Õ◊ ¥ AVF ·∫∫ Constant-site À√◊Õ Buttonhole ®“°´â“¬‰ª¢«“ (Cannulating mature constant-site) √Ÿª∑Ë’ 7 · ¥ß‡¢¡Á ª≈“¬∑àŸ (Buttonhole Needle Sets with anti-stick dull bevel) 492

Work Instruction: Buttonhole Cannulation: New Insight 4.4 ¢πÈ— μÕπ°“√°”®—¥ –‡°¥Á π”È ‡À≈◊Õß (Scab) ∑ªË’ “°·º≈·∑߇ âπ ¡’¥â«¬°—πÀ≈“¬«‘∏’ 1. ∑”„Àâπ‘Ë¡·≈–°”®—¥ÕÕ°°àÕπ∑“¬“¶à“‡™◊ÈÕ «‘∏’π’ȇªìπ«‘∏’∑’Ë¥’∑’Ë ÿ¥ ∑”¥â«¬°“√∑”„Àâ –‡°Á¥ πÈ”‡À≈◊Õ߇°‘¥§«“¡™◊Èπ ‡æ◊ËÕ®–‰¥â‡™Á¥ª“¥ÕÕ°‰¥âßà“¬ Õ“®®–„™âºâ“°äÕ´¢π“¥ 2x2 π‘È« ™ÿ∫¥â«¬πÈ”‡°≈◊Õ  –Õ“¥ª√–§∫‰«â À√◊Õ∂â“¡’ alcohol-based gel °Á„™â·∑ππÈ”‡°≈◊Õ‰¥â ®“°π—Èπ„™âºâ“°äÕ´∂Ÿ‡Õ“ –‡°Á¥πÈ” ‡À≈◊Õß∑‘È߉ª À√◊Õ„™â forceps À√◊Õ tweezers ∑’˺à“π°“√∑”„Àâª√“»®“°‡™◊ÈÕ°”®—¥ –‡°Á¥πÈ”‡À≈◊ÕßÕÕ° ∂⓺⟪ɫ¬™à«¬ª√–§∫ –‡°Á¥πÈ”‡À≈◊Õߥ⫬πÈ” –Õ“¥À√◊Õ alcohol °àÕπ∑’Ë®–¡“øÕ°‡≈◊Õ¥°Á®–™à«¬∑”„Àâ πÈ”‡À≈◊Õß∑’Ë·Àâß°√—ßπ’Èπ‘Ë¡≈ß·≈–°”®—¥‰¥â‡√Á«¢÷Èπ ‰¡à§«√„™â‡¢Á¡·À≈¡‡¢’ˬ –‡°Á¥∑‘Èß ‡π◊ËÕß®“°Õ“®®–∑”„Àâ ‡°‘¥∫“¥·º≈¡’‡≈◊Õ¥ÕÕ° ·≈–μ‘¥‡™◊ÈÕ‰¥âßà“¬¢÷Èπ Õ¬à“߉√°Áμ“¡ª√– ∫°“√≥å∑’Ë¡Ÿ≈π‘∏‘‚√§‰μ √.æ. ß¶å ‰¡à  “¡“√∂°”®—¥ –‡°Á¥πÈ”‡À≈◊Õ߉¥âÀ¡¥¥â«¬«‘∏’π’È ·μà„™â‡¢Á¡Õ“°“»∑’Ë¡“°—∫¢«¥πÈ”‡°≈◊Õ ´÷Ëß sterile ·≈– ª≈“¬‰¡à·À≈¡¡“°‡ªìπμ—« –°‘¥§√“∫πÈ”‡À≈◊Õß∑‘Èß 2. ∑“¬“¶“à ‡™Õ◊È ·≈–°”®¥— ÕÕ°„π¿“¬À≈ß— «∏‘ π’ μ’È «—  –‡°¥Á πÈ”‡À≈Õ◊ ߬ߗ ·¢ßÁ ¥ß— ππ—È „À„â ™â forceps À√◊Õ tweezers ∑’˺à“π°“√∑”„Àâª√“»®“°‡™◊ÈÕ¥÷ß –‡°Á¥ÕÕ° „Àâ√–«—ßÕ¬à“„Àâ¡’‡≈◊Õ¥ÕÕ° À√◊Õ„™â‡¢Á¡ ·À≈¡‡¢’Ë¬μ—« –‡°Á¥πÈ”‡À≈◊Õß∑‘Èß ∂â“μ—« –‡°Á¥πÈ”‡À≈◊Õ߉¡àπ‘Ë¡Õ“®®–¡’°“√·μ°‡ªìπ™‘ÈπÊ ∑”„Àâ°”®—¥‰¥â ‰¡àÀ¡¥ ·≈–„μâ –‡°Á¥πÈ”‡À≈◊Õß¡—°¡’‡™◊ÈÕ‚√§ – ¡Õ¬Ÿà ¥—ßπ—Èπ§«√∑“¬“¶à“‡™◊ÈÕ´È” 3. ‰¡à·π–π”„Àℙ⇢Á¡∑àŸ∑’Ë®–·∑߇¢’ˬ –‡°Á¥πÈ”‡À≈◊ÕßÕÕ°®“°ª“°·º≈ ‡π◊ËÕß®“°®–∑”„Àâ ‡¢Á¡∑Ÿà¡’°“√ªπ‡ªóôÕπ¢Õ߇™◊ÈÕ‚√§  √ÿª«à“μâÕ߇√‘Ë¡¥â«¬°“√·∑ߥ⫬«‘∏’∑’˪°μ‘°àÕπ ‚¥¬‡≈◊Õ°μ”·Àπàß∑’Ë®–·∑ß„Àâ‡À¡“– ¡ ·∑ß ¥«â ¬§π‡¥¡‘ μ”·Àπßà ‡¥‘¡ ¡¡ÿ ‡¥¡‘ ≈°÷ ‡∑à“‡¥¡‘ ®π°«à“®–¡’√àÕ߇°‘¥¢÷Èπ ´÷Ëß„™â‡«≈“ª√–¡“≥ 6-12 §√—Èß ®÷߇°‘¥√àÕߢ÷Èπ ®“°π—Èπ„À⇪≈’ˬπ‡ªìπ‡¢Á¡ª≈“¬∑àŸ·≈–„™â«‘∏’¥—π·≈–À¡ÿπ‡¢Á¡‡¢â“‡ âπ μâÕß°”®—¥ –‡°Á¥πÈ” ‡À≈◊Õß∑’˪“°√àÕßÕÕ°°àÕπ∑ÿ°§√—Èß ‡¡◊ËÕ¡’√àÕß 2 √àÕß ”À√—∫„™â·∑߇¢Á¡ 2 ‡¢Á¡·≈â« ¢—ÈπμàÕ‰ª§◊Õ∑”√àÕß∑’Ë 3 ‡æ◊ËÕ„™â‡ªìπ back up °√≥’∂â“¡’ªí≠À“‡°‘¥¢÷Èπ°—∫ 2 √àÕß·√° 4.5 μ«— Õ¬“à ߺ⪟ «É ¬ √Ÿª∑’Ë 8 · ¥ßºŸâªÉ«¬√“¬Àπ÷Ëß∑’ˉ¥â√—∫°“√·∑ߥ⫬«‘∏’ Buttonhole μ‘¥μàÕ°—ππ“π 1 ªï ®–‡ÀÁπ«à“ ‰¡à‡°‘¥ aneurysm ·≈–¡’‡æ’¬ß√Õ¬·∑ß 2 ®ÿ¥‡∑à“π—Èπ∑’˪√“°ØÕ¬àŸ  à«π√Ÿª∑’Ë 9 · ¥ß°“√μ‘¥‡™◊ÈÕ∑’ˇ°‘¥°—∫ μ”·Àπàß√·Ÿ ∑߇¢Á¡ Buttonhole ´÷Ëßæ÷ß„À⧫“¡√–¡—¥√–«—ß 5. Õªÿ  √√§·≈–°“√·°â‰¢ 1. ªí≠À“∑’Ë ”§—≠§◊Õ ‰¡à¡’欓∫“≈¡◊Õ‡¥’¬«∑’Ë®–∑”√àÕß„À⺟âªÉ«¬μ‘¥μàÕ°—π 6-12 §√—Èß ‡π◊ËÕß®“°æ¬“∫“≈¢÷Èπ‡«√‰¡àμ√ß°—∫√Õ∫ºâŸªÉ«¬ ´÷ËßÀπ૬‰μ‡∑’¬¡μâÕß·°âªí≠À“π’ȇÕß Àâ“¡‡ª≈’ˬπºŸâ·∑ß π”√àÕß ·¡â®–¡’√“¬ß“π«à“ “¡“√∂ √â“ß√àÕ߉¥â ‚¥¬‰¡àμâÕß„™âºâŸ·∑ß§π‡¥‘¡°Áμ“¡ μâÕß·∑ßμ“¡·π«√àÕß ‡¥¡‘ Àâ“¡·∑ß„π∑‘»∑“ß„À¡à∑’˧‘¥«à“πà“®–¥’°«à“ ‡π◊ËÕß®“°Õ“®®–∑”„Àâ√àÕß∑’Ë°”≈—ß √â“߇ ’¬‰ª ·≈–∑”„Àâ √àÕß°«â“ߢ÷Èπ ∑”„Àâ¡’‡≈◊Õ¥ÕÕ°√Õ∫Ê ª“°·º≈‰¥â 493

Practical Dialysis in the Year 2009 √Ÿª∑’Ë 8 · ¥ß√Õ¬·∑߇¢Á¡·∫∫ Buttonhole 쥑 μ“¡π“π 1 ªï √Ÿª∑’Ë 9 · ¥ß°“√쥑 ‡™Õ◊È ∑Ë√’ ·Ÿ ∑߇¢Á¡ Buttonhole 494

Work Instruction: Buttonhole Cannulation: New Insight 2. °“√ √â“ß√àÕß∑’Ë¥’®–∑”„Àâ°“√·∑߇¢Á¡·∫∫ Buttonhole ª√– ∫§«“¡ ”‡√Á® √àÕß∑’Ë¥’®– μâÕßμ√ß  “¡“√∂ Õ¥‡¢Á¡ª≈“¬∑àŸ‡¢â“‰¥âßà“¬ „π∫“ߧ√—Èß®–‰¥â·π«√àÕß∑’Ë¡’·π«‡Õ’¬ß ∑”„Àâ Õ¥‡¢Á¡ª≈“¬ ∑Ÿà‡¢â“‰¥â¬“° ·≈–„π∫“ߧ√—ÈßμâÕß¡’°“√ Õ¥„ à„π∑‘»∑“ß∑’Ëæ‘ ¥“√  à«π„À≠à‡°‘¥‡π◊ËÕß®“°°“√‡≈◊Õ° μ”·Àπàß∑’ˉ¡à‡À¡“– ¡ À√◊Õ„π¢≥–·∑ߥ⫬‡¢Á¡ª≈“¬·À≈¡ ¡’°“√¥÷ß√—Èß™—Èπº‘«Àπ—ßÕÕ°Àà“ß®“° ‡ âπ‡≈◊Õ¥∑’ËÕ¬Ÿà„μ⺑«Àπ—ß ¥—ßπ—Èπ®–μâÕ߉¡à¥÷ß√—Èߺ‘«Àπ—ß¡“°‡°‘π‰ª ºŸâ∑”√àÕß À√◊ÕºâŸ∑’Ë√Ÿâ∑‘»∑“ߢÕß√àÕß §«√ ∫—π∑÷°∑‘»∑“ß≈ß„π∫—π∑÷°¢ÕߺŸâªÉ«¬ ‡æ◊Ëպ⟷∑ߧπÕ◊Ëπ “¡“√∂𔉪ªØ‘∫—μ‘μàÕ‰¥â À√◊Õ·®âß„À⺟âªÉ«¬∑√“∫ ·π«°“√·∑߇æ◊ËÕ®–‰¥âÕ∏‘∫“¬„ÀâºâŸ·∑߇ âπ∑à“πÕ◊ËπªØ‘∫—μ‘μ“¡‰¥â 3. „π¢≥–·∑ߥ⫬‡¢Á¡ª≈“¬∑àŸ ∂Ⓡ¢Á¡ºà“π™—Èπº‘«Àπ—ß·μà‰¡à “¡“√∂·∑ßμàÕ‰ª‰¥â ‡π◊ËÕß®“° À“·π«√àÕ߉¡àæ∫ ‰¡à§«√™Õπ‰™ª≈“¬‡¢Á¡‰ªμ“¡™—Èπ„μ⺑«Àπ—߇æ◊ËÕÀ“√àÕß „π°√≥’π’È„Àâ§ß∑‘»∑“߇¥‘¡‰«â ´÷Ëߧ«√‡ªìπ∑‘»∑“ß∑’Ë∂Ÿ°μâÕß‚¥¬ Õ∫∂“¡®“°ºâŸ‡§¬·∑߉¥â ¥®Ÿ “°∫—π∑÷° À√◊Õ Õ∫∂“¡®“°ºâŸªÉ«¬ ®“°π—Èπ „À⥗π‡¢Á¡‰ª„π∫√‘‡«≥„°≈⇧’¬ß∑—Èߴ⓬ ¢«“ ∫π ·≈–≈à“ß ‡æ◊ËÕÀ“·π«√àÕß „π¢≥–∑”μâÕß√—Èß™—Èπº‘«Àπ—ß ·≈–μ—«‡ âπ‡≈◊Õ¥„Àâπ‘Ëß ‰¡àμâÕß°≈—««à“®–∑”„À⇠âπ‡≈◊Õ¥·μ°·≈–∫«¡ ·≈–∂⓬—ßÀ“√àÕ߉¡àæ∫ „Àℙ⇢Á¡ ª≈“¬·À≈¡∑”√àÕß„À¡à 4. „π∫“ߧ√ßÈ— ¢≥–·∑߇¢“â √Õà ßæ∫«“à μÕâ ß¥π— ‡¢¡Á ∑‡Ÿà ¢“â ‡ πâ ‡≈Õ◊ ¥·√ß¡“° ´ßË÷ ®–∑”„Àºâ ªâŸ «É ¬‡®∫Á „π°√≥’π’ÈÕ“®®–μâÕ߇ª≈’Ë¬π¡“„™â‡¢Á¡ª≈“¬·À≈¡·∑ߺà“π√àÕßμ≈Õ¥ ‡æ◊ËÕªÑÕß°—π‰¡à„À⺟âªÉ«¬ª«¥ Õ¬à“߉√°Áμ“¡μâÕß√–«—߉¡à„Àâª≈“¬‡¢Á¡·À≈¡∑”≈“¬√àÕß∑’ˉ¥â∑”‰«â 5. „π∫“ߧ√—È߇¡◊ËÕ·∑ß Buttonhole ‰¥â 1 ‡¢Á¡·≈â« (¡—°‡ªìπ‡¢Á¡ venous site) ·≈–‡¢Á¡∂—¥‰ª μâÕ߇ ’¬‡«≈“π“π„π°“√À“√àÕß (¡—°‡ªìπ‡¢Á¡ arterial site) „π™à«ßπ’È μâÕß√–«—ß°“√‡°‘¥≈‘Ë¡‡≈◊Õ¥¿“¬„π‡¢Á¡ øÕ°‡≈◊Õ¥¥â“π vein ®÷ߧ«√„™âπÈ”‡°≈◊ÕÀ≈àÕ¿“¬„π‡¢Á¡øÕ°‡≈◊Õ¥¥â“π vein À√◊Õ‡√‘Ë¡„Àâ heparin load ‡¢â“  àŸ√à“ß°“¬∑—π∑’ ∑’ËÀπ૬‰μ‡∑’¬¡¡Ÿ≈π‘∏‘‚√§‰μ √.æ. ß¶å æ∫ªí≠À“π’È∫àÕ¬·≈–μâÕßÀ≈àÕ “¬¥â“π vein ¥â«¬ πÈ”‡°≈◊Õ∑ÿ°§√—Èß 6. „π°√≥’∂⓺ŸâªÉ«¬μâÕ߉ªøÕ°‡≈◊Õ¥∑’ËÕ◊Ëπ∑’ˉ¡à¡’ª√– ∫°“√≥å„π°“√·∑ß·∫∫ Buttonhole „À⺟âªÉ«¬π”‡¢Á¡ª≈“¬∑àŸ‰ª¥â«¬ ·≈–‡¢’¬π®¥À¡“¬· ¥ß«‘∏’°“√·∑߇¢Á¡ª≈“¬∑Ÿà ‡æ◊ËÕ„Àâ欓∫“≈ºŸâ≈߇¢Á¡ ∑”μ“¡ „π°√≥’∂â“欓∫“≈‰¡à “¡“√∂ªØ‘∫—쑉¥â „Àâ·∑ߥ⫬‡¢Á¡ª≈“¬·À≈¡μ“¡ª°μ‘ ·μà„ÀâÀà“ß®“° ∫√‘‡«≥√àÕß∑’Ë¡’Õ¬àŸÕ¬à“ßπâÕ¬ª√–¡“≥ 3/4 π‘È« ‡æ◊ËÕ‰¡à„À⇢Á¡ª≈“¬·À≈¡ºà“π·≈–∑”≈“¬√àÕß∑’Ë¡’Õ¬Ÿà ·≈– ∂â“°≈—∫¡“øÕ°‡≈◊Õ¥∑’ˇ¥‘¡ ·≈–‰¡à “¡“√∂·∑ߥ⫬‡¢Á¡ª≈“¬∑àŸ‰¥â „Àℙ⇢Á¡ª≈“¬·À≈¡π”‡¢â“√àÕ߇¥‘¡ ‰ª°àÕπ¥â«¬ºŸâ·∑ߧπ∑’ˇ§¬·∑ß·≈–®”∑‘»∑“ß√àÕ߉¥â ®π·πà„®«à“¡’√àÕß∑’Ë “¡“√∂≈ߥ⫬‡¢Á¡ª≈“¬∑àŸ‰¥â ·≈–∂â“μâÕ߉ª∑”À—μ∂°“√ angiogram À√◊Õ venogram À√◊Õ fistulogram „Àâ·∑߇ âπÀà“ß®“°√àÕß 3/4 π‘È« ‡™àπ°—π ∂â“√àÕ߉¡à‰¥â„™âÕ¬ÀàŸ ≈“¬Ê §√ßÈ— √Õà ßÕ“®®–∂°Ÿ ·∑π∑¥’Ë â«¬æß— º◊¥ ·≈–‰¡ à “¡“√∂„™ßâ “π‰¥â μÕâ ß √“â ß √àÕß„À¡à 495

Practical Dialysis in the Year 2009 ‡Õ° “√Õ“â ßÕß‘ 1. Vascular Access 2006 Work Group. Clinical practice guidelines for vascular access. Am J Kidney Dis 2006; 48 (Suppl 1): S176-S317. 2. Kronung G. Plastic Deformation of Cimino Fistula by Repeated Puncture. Dial Transplant 1984; 13: 635-6. 3. Twardowski ZJ, Kubara H. Different Sites vs. Constant Sites of Needle Insertion into Arteriovenous Fistulas for Treatment by Repeated Dialysis. Dial Transplant 1979; 8: 978-80. 4. Twardowski ZJ. Constant Site (Buttonhole) Method of Needle Insertion for Hemodialysis. Dial Transplant 1995; 24: 559-76. 5. Harper G. The buttonhole technique of fistula access: a personal experience. Home Hemodial Int 1997; 1: 41-2. 6. Peterson P. Fistula Cannulation: The Buttonhole Technique. Nephrol Nurses J 2002; 29: 195. 7. Toma S, Shinzato T, Fukui H. A time saving method to create a fixed puncture route for the buttonhole technique. Nephrol Dial Transplant 2003; 18: 2118-21. 8. Ball LK. Improving arteriovenous fistula cannulation skills. Nephrol Nurs J 2005; 32: 611-7. 9. Ball LK. The Buttonhol Technique for Arteriovenous Fistula Cannulation. Nephrol Nurs J 2006; 33 : 299-304. 10. Marticorena RM, Hinter J, Macleod S et al. The salvage of aneurismal fistulae utilizing a modified buttonhole cannulation technique and multiple cannulators. Hemodial Int 2006; 10: 193-200. 496

Index Index AB Acetate Ringerûs solution 73 backfiltration 437 adjuvant 179 backwash 17 air embolism 22 balancing system 28 air leak detector 24 bare stent 104 alpha fetoprotein 263 bicarbonate 73 aluminium intoxication 187 black blood syndrome 125 amino acid 303, 357 blood line 205 anaphylaxis 252 blood loss, hemolysis 187 androgen 169, 180 body surface area 232 anemia 148, 236 body surface area 202 aneurysm 486 branched-chain amino acids 358 angiotensin II 188 buttonhole 337, 486 anti-Xa activity 76 bypass 105 anticoagulant 74, 206 arterial pressure 22 C arterialization 117 arteriovenous fistula 90, 117, 229, 460, 484 C-reactive protein 166 arteriovenous graft 90, 119, 229, 460 calcimimetic 150 ascorbic acid 179 cardiac pulsatility 94 Association for the Advancement of Medical cardiomyopathy 144 catheter 229 Instrument 14 catheter related peritonitis 300 automated peritoneal dialysis 303, 366 central venous catheter 97, 114 automated reprocessing system 342 citrate 76 497

Practical Dialysis in the Year 2009 clearance 5, 70 dialyzer reprocessing 340 complication 240 dietary recall 362 conductivity 18, 27 diffusion 3, 67 conductivity meter 27 diffusive clearance 43 connectology 300 disinfection 18 constant-site 486 doppler 93 continuous ambulatory peritoneal dialysis 300 double lumen catheter 71, 114 continuous arteriovenous hemofiltration 66 dry weight 55, 231 continuous cyclic peritoneal dialysis 368 dynamic arterial pressure 475 continuous erythropoiesis receptor activator 172 dynamic venous pressure 475 continuous hemodiafiltration 69 continuous hemodialysis 68 E continuous hemofiltration 67 continuous renal replacement therapy 66 endothelin 178 convection 3, 67 endotoxin 14 creatinine 164 endovenectomy 105 creatinine clearance 164 enzyme-linked immunosorbent assay 270 cross-infection 348 equilibrated BUN 216 crust 486 equivalent renal clearance 80 erythropoiesis 165 D erythropoietic-stimulating agent 169 erythropoietin 165, 236 daily nutrient recommendations 219 european best practice guideline 14, 166 darbepoetin 171 extracellular compartment 198 Daugirdas natural logarithm formula 215 extracorporeal volume 208 deaeration 24 defibrillator 97 F deionization 16 delivered Kt/V 38 fatty liver 361 dextrose 356 feedback control 30 diabetes 148 fetuin-A 149 dialysate 2, 22, 72, 205 filtration fraction 83 dialysate proportioning 25 first-use syndrome 252 dialysate temperature 54 fixed ratio mixing 25 dialysis disequilibrium syndrome 207, 248, 254 flow sensor 28 dialyzer 72, 202 folate 187 498

Index G hyponatremia 254 hypoxemia 256 glucose 73 glucose degradation product 303 I grand mal seizure 178 icodextrin 303 H immunization 237 infection control nurse 346 hand washing 346 influenza vaccine 279 health care financing administration 260 insulin resistance 148, 360 hematocrit 31 intensified dialysis 217 hemodiafiltration 14, 436 interferon 264 hemodialysis 2, 34, 67, 114, 198, 212, 229, 240, intermittent hemodialysis 66 intimal hyperplasia 125 330 intradialytic hypertension 245 hemodialysis catheter 94, 460 intradialytic hypotension 240 hemodialysis unit 212 intradialytic parenteral nutrition 235, 352 hemofilter 72 iron deficiency 182 hemofiltration 67 iron status 183 hemoglobin 31, 164 isothermic 54 hemoglobinopathies 187 itching 256 hemolysis 250 hemorrhage 251 K heparin 75, 232 heparin pump 24 Kt/V 35 heparin-induced thrombocytopenia 76 high efficiency dialyzer 47 L high-efficiency HD 40 HIV antibody 278 L-carnitine 181 HomeChoice 371 lactate 73 homocysteine 151 Lactate Ringerûs solution 73 hypercatabolism 81 lamivudine 265 hyperkalemia 86 leakage testing 342 hypernatremia 254 left ventricular hypertrophy 145, 167 hyperparathyroidism 149, 187 low efficiency dialyzer 47 hyperphosphatemia 86, 149 low molecular weight heparin 76 hypertension 146 low-efficiency hemodialysis 40 499

Practical Dialysis in the Year 2009 M pediatric blood line 213 pegylated interferon 270 machine CRRT 78 percent of hypochromic red blood cell 184 malnutrition-inflammation-artherosclerotic syndrome percutaneous transluminal angioplasty 102 peripheral blood mononuclear cells 270 152, 189 peristaltic pump 24 mass transfer 3 peritoneal dialysis 200, 366 megaloblastic anemia 166 permanent pacemaker 97 metabolic alkalosis 255 physical examination 460 mid-arm muscle circumference 217 plasma refilling 242 multi organ dysfunction syndrome 66 polyphasic atrial waveform 94 mycobacterium 278 prescribed Kt/V 38 pretreatment 16 N priming volume 205 pseudoaneurysm 125 needle-stick injury 272 PTFE interposition 105 neuropathy 468 pulse augmentation 464 nightly intermittent peritoneal dialysis 369 pure red cell aplasia 188 normalized protein catabolic rate 216, 232 nursing diagnosis 315 R nursing intervention 315 nursing process 314 Reasonerûs 2A agar 15 nutrition 352 rebound hypoglycemia 361 recirculation 476, 477, 478 O recombinant immunoblot assay 270 refeeding syndrome 361 online hemodiafiltration 190, 436 renin angiotensin system 188 online monitoring 30 reserve volume 370 optical absorbance 31 resistivity 18 oxalosis 180 respiratory phasicity 94 oxidative stress 145, 152 restless legs syndrome 247 oxpentifylline 181 reticulocyte Hb content 184 reverse osmosis 16 P rope cannulation 337 Rope-ladder 486 P-Offset 471 paradoxical CSF acidosis 248 PD first policy 300 PD Night 371 500

S Index saline flush 77 transaminase 261 semipermeable membrane 2, 22, 67 transferrin saturation 183 serum ferritin 183 transmembrane pressure 6, 28, 67 servo controlled mixing 25 Transonic 480 sevelamer 149 trypticase soy agar 15 sieving coefficient 4, 50, 70 tuberculin skin test 278 single-pool Kt/V 35 twin catheter 114 skin fold thickness 217 slow continuous ultrafiltration 67 U sodium 72 sodium profiling dialysis 27 ultrafiltration 6, 67, 242 softener 16 ultrafiltration coefficient 48, 67 soluble transferrin receptor 184 ultrafiltration rate 83 staphylococcal vaccine 278 ultrapure water 15 static intra-access pressure 469, 470 ultrasound 92 statins 147, 181 urea reduction ratio 36 steal syndrome 128, 246 uremic toxin 34 stenosis 461 substitute fluid 436 V sudden death 246 vascular access 22, 71, 114, 212, 229, 276, 331, T 460 thermal energy balance 31 vascular calcification 149 thermoneutral 54 vascular refilling 31 thrombosis 98 venogram 92 tidal peritoneal dialysis 370 venous drip chamber 22 tidal volume 370 vitamin B 12 187 time average concentration 80 vitamin B6 187 total cell volume 341 vitamin E 181 total parenteral nutrition 353 vitamin 360 Z zinc protoporphyrin 184 501



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