New Frontiers in Dialysis

New Frontiers in Dialysis 388 ∏𵑠®‘√π—π∑å∏«—™  ‘√¿‘ “ ™â“ß»‘√‘°ÿ≈™—¬ ∏ππ— ¥“ µ√–°“√«π™‘ « —πµå  ‡ÿ ¡∏°ÿ≈ 1.3.7 „™Àâ ≈°— aseptic technique „π°“√‡µ√¬’ ¡ replacement fluid µ“à ßÊ µ“¡·ºπ°“√√°— …“ 1.3.8 §«√∑”·º≈∫√‡‘ «≥ exit site ∑°ÿ «π— ·≈–∑°ÿ §√ßÈ— ∑¡Ë’ °’ “√‡ª¬ï °™πÈ◊ 1.3.9 √–À«“à ß∑” CRRT §«√ ß— ‡°µ§“à PD (pressure drop) ∑‡’Ë æ¡‘Ë ¢π÷È Õ¬“à ß√«¥‡√«Á ´ß÷Ë · ¥ß∂ß÷ °“√‡°¥‘ clot „𵫗 °√Õß ‡√“Õ“®ª√∫— Õµ— √“ «à π√–À«“à ß pre-dilution ·≈– post-dilution ‡æÕË◊ ¬¥◊ Õ“¬°ÿ “√ „™ßâ “π¢Õßµ«— °√Õß 1.3.10 √–À«“à ß∑” CRRT §«√ ß— ‡°µ§“à TMP (transmembrane pressure) ∑‡Ë’ æ¡Ë‘ ¢πÈ÷ Õ¬“à ß√«¥‡√«Á ´ßË÷ · ¥ß∂ß÷ °“√‡°¥‘ membrane saturation ‡√“Õ“®ª√∫— filtration rate ‡æÕË◊ ¬¥◊ Õ“¬°ÿ “√„™ßâ “π¢Õßµ«— °√Õß À√Õ◊ ‡µ√¬’ ¡µ«— °√Õß¡“‡ª≈¬Ë’ π„À¡à 1.3.11 √–À«à“ß∑’Ë¡’°“√欓∫“≈ºŸâªÉ«¬∑”„À⺟âªÉ«¬‡§≈◊ËÕπ‰À« §«√¡’°“√≈¥ blood flow ≈ß ª√–¡“≥ 10 ∂ß÷ 20 ‡ªÕ√‡å ´πÁ µå ‡æÕË◊ ≈¥°“√‡°¥‘ alarm ®“°‡§√ÕË◊ ß À√Õ◊ °¥„Àªâ ¡Éÿ balance pump À¬¥ÿ ∑”ß“π°Õà π 2. ª≠í À“·≈–«∏‘ °’ “√·°‰â ¢∑ÕË’ “®®–‡°¥‘ ¢π÷È √–À«“à ß∑” CRRT ¡¥’ ß— µÕà ‰ªπ’È

Work Instruction: Machine Continuous Renal Replacement Therapy ∑«æ’ ß…å ª“®√’¬å ™≈∏ª‘ æß» å °ÿ≈ æß»∏√ §™‡ π’ Õππ— µå ‡™◊ÈÕ ÿ«√√≥ æ𑥓 ™Ëπ◊ ¡’»√’ ∏√’ –πÿ™ ‡æ™√√ÿßà 389

New Frontiers in Dialysis 390 ∏𵑠®‘√ππ— ∑∏å «™—  ‘√‘¿“ ™â“ß»‘√‘°ÿ≈™¬— ∏π—𥓠µ√–°“√«π™‘ « π— µå  ‡ÿ ¡∏°≈ÿ

Work Instruction: Machine Continuous Renal Replacement Therapy ∑«’æß…å ª“®√¬’ å ™≈∏‘ª æ߻堰≈ÿ æß»∏√ §™‡ π’ Õππ— µå ‡™◊ÈÕ «ÿ √√≥ æ𑥓 ™πË◊ ¡»’ √’ ∏’√–πÿ™ ‡æ™√√ÿàß 391 3. Work Instruction ‡√ÕË◊ ß°“√„™‡â §√Õ◊Ë ß PRISMA FLEX machine CRRT 1. Õªÿ °√≥∑å „’Ë ™√â «à ¡„π°“√·π–π” ®”π«π 2 ‡§√Õ◊Ë ß 1. ‡§√Õ◊Ë ß (CRRT) PRISMA FLEX ®”π«π 1 ‡§√Õ◊Ë ß 2. ‚ª√‡®§‡µÕ√å ®”π«π 2 SET 3. SET ∑¥≈Õß 4. πÈ”¬“∑„’Ë ™„â π°“√∑¥≈Õß 2.  «à πª√–°Õ∫¢Õ߇§√Õ◊Ë ß PRISMA FLEX 2. Status Light 1. Display 4. Replacement Solution Pump 3. Effluent Pump 6. Pinch Clamp 5. Dialysate Pump 8. Pre-blood Pump (PBP) 7. Blood Pump 10. Tubing Guides 9. Scales 12. Syringe Pump Assembly 11. Pressure Sensor Housing 14. Bar Code Reader 13. Syringe Pump Control Panel 16. Discharger Ring Guide 15. Blood Leak Detector (BLD) 18. Deaeration Chamber Support 17. Return Pressure Port

New Frontiers in Dialysis 392 ∏π‘µ ®√‘ π—π∑∏å «™—  √‘ ‘¿“ ™â“ß»√‘ °‘ ≈ÿ ™—¬ ∏ππ— ¥“ µ√–°“√«π‘™ « π— µå  ‡ÿ ¡∏°ÿ≈ 19. Air Bubble Detector 20. Return Line Clamp 21. Power Switch 22. Brake Pedal 23. Recessed Handles 24. Carrying Bar 25. Side hook 3. °“√ set-up ‡§√ÕË◊ ß 1. ‡¡Õ◊Ë ‡ª¥î ‡§√Õ◊Ë ßÀπ“â ®Õ®–· ¥ßµ“¡√ªŸ ¢“â ß≈“à ß 2. „À‡â ≈Õ◊ ° NEW PATIENT ‡æÕ◊Ë ∑”°“√√°— …“ „À‡â ≈Õ◊ ° CONTINUE 3. ‡§√Õ◊Ë ß®–„À„â  ™à Õ◊Ë ·≈–πÈ”Àπ°— ¢Õߧπ‰¢â 4. „À‡â ≈Õ◊ ° MODE °“√√°— …“ (PATIENT ID. & PATIENT WEIGHT) ∂“â ‰¡µà Õâ ß°“√„ ™à ÕË◊ §π‰¢„â À‡â ≈Õ◊ ° CONTINUE

Work Instruction: Machine Continuous Renal Replacement Therapy ∑«æ’ ß…å ª“®√¬’ å ™≈∏‘ª æ߻堰≈ÿ æß»∏√ §™‡ π’ Õπ—πµå ‡™ÕÈ◊  ÿ«√√≥ æ𥑠“ ™◊Ëπ¡’»√’ ∏’√–πÿ™ ‡æ™√√ßàÿ 393 5. Àπ“â ®Õπ®È’ –· ¥ß«∏‘ °’ “√„ à SET ‚¥¬¡¢’ πÈ— µÕπ 6. ‡§√ÕË◊ ß®–· ¥ßÀπ“â ®Õµ“¡√ªŸ ¢“â ß≈“à ß „À√â Õ µ“¡«¥’ ‚’ Õ∑®’Ë –𔇠πÕ ‡¡Õ◊Ë „ à SET ‡√¬’ ∫√Õâ ¬  °— §√Ÿà ·≈«â „À‡â ≈Õ◊ ° LOAD ‡æÕË◊ „™ßâ “π‡§√ÕË◊ ßµÕà ‰ª 7. Àπ“â ®Õπ®’È –· ¥ß√“¬≈–‡Õ¬’ ¥¢Õß SET ∑„’Ë ™â 8. Àπ“â ®Õπ®’È –· ¥ß«∏‘ °’ “√„ πà È”¬“‚¥¬¡¢’ π—È µÕπ ß“π ®“°ππ—È „À‡â ≈Õ◊ ° CONTINUE µ“¡«¥’ ‚’ Õ∑®’Ë –𔇠πÕ‡¡Õ◊Ë ∑”µ“¡¢π—È µÕπ·≈«â „À‡â ≈Õ◊ ° PRIME ‡æÕË◊ ‰≈à AIR ¿“¬„π SET

New Frontiers in Dialysis 394 ∏𵑠®‘√π—π∑∏å «™—  ‘√‘¿“ ™â“ß»√‘ °‘ ÿ≈™¬— ∏ππ— ¥“ µ√–°“√«π™‘ « π— µå  ÿ‡¡∏°ÿ≈ 9. ‡¡Õ◊Ë ‡§√Õ◊Ë ß· ¥ßÀπ“â ®Õπ„’È À√â Õ®π°√–∑ß—Ë ‰≈à 10. „À‡â ≈Õ◊ ° PRIME TEST AIR ¿“¬„π SET À¡¥ ®“°ππÈ— Àπ“â ®Õ®– · ¥ßµ“¡√ªŸ ¢“â ß≈“à ß 11. ‡§√Õ◊Ë ß®–∑”°“√µ√«® Õ∫°“√„ à SET «“à 12. ‡¡Õ◊Ë ‡§√Õ◊Ë ß· ¥ßÀπ“â ®Õπ·’È  ¥ß«“à ‡§√Õ◊Ë ßæ√Õâ ¡ ∂°Ÿ µÕâ ßÀ√Õ◊ ‰¡à „À√â Õª√–¡“≥ 5-10 π“∑’ ∑®Ë’ –„™ßâ “π·≈«â „À‡â ≈Õ◊ ° CONTINUE ®“°ππ—È ‡§√Õ◊Ë ß®–· ¥ßµ“¡√ªŸ ¢“â ß≈“à ß

Work Instruction: Machine Continuous Renal Replacement Therapy ∑«æ’ ß…å ª“®√’¬å ™≈∏‘ª æß» å °≈ÿ æß»∏√ §™‡ π’ Õππ— µå ‡™◊ÈÕ ÿ«√√≥ æ𥑠“ ™Ëπ◊ ¡»’ √’ ∏’√–π™ÿ ‡æ™√√ßÿà 395 13. „Àµâ ß—È §“à °“√√°— …“µ“¡ ORDER ∑À’Ë ¡Õ ß—Ë 14. Àπ“â ®Õπ®’È –· ¥ß¢Õâ ¡≈Ÿ ∑º’Ë „⟠™‰â ¥∑â ”°“√‡≈Õ◊ ° ‚¥¬„™Àâ π“â ®Õµ“¡√ªŸ ¢“â ß≈“à ß ‡¡ÕË◊ ‡√¬’ ∫√Õâ ¬·≈«â §“à ∑„Ë’ ™„â π°“√√°— …“‰«â „À‡â ≈Õ◊ ° CONTINUE „À‡â ≈Õ◊ ° ENTER ‡æÕ◊Ë ‰ª∑¢’Ë π—È µÕπµÕà ‰ª ‡æÕ◊Ë ¬π◊ ¬π— §“à ∑‡’Ë ≈Õ◊ °‰«â 15. Àπ“â ®Õπ®’È –· ¥ß«∏‘ °’ “√µÕà SET ‡¢“â °∫— 16. Àπ“â ®Õπ‡’È ªπì Àπ“â ®ÕÀ≈°— ¢Õ߇§√Õ◊Ë ß‚¥¬®– §π‰¢â ‚¥¬®–Õ∏∫‘ “¬µ“¡«¥’ ‚’ Õ ‡¡Õ◊Ë µÕà ‡ √®Á · ¥ß§“à º„⟠™‰â ¥∑â ”°“√‡≈Õ◊ °§“à ∑„’Ë ™„â π°“√√°— …“‰«â ‡√¬’ ∫√Õâ ¬„À‡â ≈Õ◊ ° START ‡æÕË◊ ∑”°“√√°— …“ ·≈–§“à ·√ß¥π— µ“à ß Ê 17. ‡¡ÕË◊ µÕâ ß°“√À¬¥ÿ °“√√°— …“„À‡â ≈Õ◊ ° STOP ∑Ë’ Àπ“â ®ÕÀ≈°— (√ªŸ „π¢Õâ 16)



Index A D access recirculation 56 daily dialysis 164 acute kidney injury 212 deionizer 21 air embolism 136 dialysis disequilibrium syndrome 133 ambulatory blood pressure monitoring 192 dialyzer preparation 298 androgen 112 dialyzer reaction 128 Andy Disc 339 dialyzer reprocessing 310 anemia 100 diffusion 2 antibiotic lock solution 64 double lumen catheter 44 Association for the Advancement of Medical E Instrument 19 EDTA titrimetric method 35 automated peritoneal dialysis 244 empty-bed contact time 31 arterio-venous fistula 50, 270 endotoxin 34 arterio-venous graft 50, 284 EPO-mimetic peptide 114 erythropoiesis-stimulating agent 107 B exit site infection 63 buttonhole needle cannulation 327 H C hand grip exercise 49 calcimimetics 153 health education 313 carbon filter 22 HEMO study 8 catheter related bacteremia 63 hemodiafiltration 198 catheter related infection 62 hemodialysis 2, 266, 282 colorimetric Method 36 hemofiltrate reinfusion 205 compression test 50 hyperparathyroidism 145 continuous erythropoietin receptor activator 114 hypertension 190 continuous flow peritoneal dialysis 247 continuous renal replacement therapy 218, I intradialytic hypotension 120 348, 378 iron storage 103 convection 3

New Frontiers in Dialysis 398 ∏𵑠®‘√ππ— ∑∏å «—™  √‘ ¿‘ “ ™“â ß»‘√‘°≈ÿ ™¬— ∏π—𥓠µ√–°“√«π‘™ « π— µå  ‡ÿ ¡∏°≈ÿ K S Kt/V 85 scab 334 softener 22 L static intra-access pressure 54 L-carnitine 112 long nighttime hemodialysis 165 T time average concentration of urea 84 M transmembrane pressure 362 multimedia filter 22 tunnel infection 63 muscle cramp 131 twin bag 343 two-bag formula 380 N nursing Care 289 U ultrafiltration 7 P urea kinetic model 85 patient monitoring 300 urea rebound 92 percent recovery 32 urea reduction ratio 83 percent solute rejection 32 urea-based hemodialysis adequacy 83 peritoneal dialysis 231, 338 uremic toxin 80 phosphate balance 181 phosphate binder 150 V plasmapheresis 358 vascular access 44, 305 pruritus 135 vitamin D 151 psychoneuroimmunology 320 W R water treatment 13 rate equation 94 renal osteodystrophy 145 reticulocyte count 103 reverse osmosis 21 RIFLE criteria 212

Index ∏π‘µ ®‘√ππ— ∑å∏«™—  √‘ ‘¿“ ™“â ß»√‘ °‘ ≈ÿ ™—¬ ∏ππ— ¥“ µ√–°“√«π‘™ « π— µå  ÿ‡¡∏°≈ÿ 399