What should I pay attention to when doing renal puncture needle puncture?

Although renal puncture is a small traumatic examination, patients and family members are still affected and worried. Preoperative psychological care, intraoperative cooperation, and postoperative comprehensive care all play a key role in the operation. The nursing experience of 45 patients in our department from March 2004 to October 2004 is summarized as follows.

1 Clinical data

Among the 45 patients, 25 were males and 20 were females, aged 13-48 years old, including 25 cases of nephrotic syndrome. There were 10 cases of simple hematuria, 8 cases of nephritis, and 2 cases of purpuric nephritis.

2 method

Prepare hemostasis and rescue medicines, escort the patient to the B-ultrasound room, locate under the B-ultrasound and puncture under the direct vision of the B-ultrasound, assist the patient to adopt a prone position, put a hard pillow under the abdomen, so as to turn the kidneys to the back and under local anesthesia During the operation, while comforting the patient, observe the patient's complexion, pulse, and breathing. If there is any abnormality, report it to the doctor in time. After the puncture operation is completed, local compression is performed for 15-30 minutes, and the patient is escorted back to the ward.

3 results

After the operation, only 2 cases of female patients had obvious gross hematuria, one of which was more serious. After absolute bed rest, hemostasis and other symptomatic treatments, the hematuria disappeared. Three patients developed urinary retention and urinate on their own after applying heat to the lower abdomen and massaging the bladder. 6 cases had mild backache, and passed the ball to the west quickly after a few hours. The postoperative complication rate was 26.6%, and it was reported that the complication rate was 47.7%.

4 Preoperative care

(1) It is very important to carry out preoperative care. Simply tell the patient the process of renal puncture, explain in detail the importance and cooperation of renal puncture, possible complications, and introduce successful examples of renal puncture, so that the transition will be changed from passive to active and timely To adjust the mental state. None of the 45 patients were nervous.

(2) Breathing training. The patient holds his breath for 10-20 seconds. It is not easy to shift during kidney puncture. The training started one week before the operation. The nurse in charge explained the purpose of breathing training to the patient, taught by precept and deeds, and allowed the patient to master it, and urged the patient to persist in training every day.

(3) Training to urinate in bed. Since the operation requires absolute bed rest for 24 hours, the bedpan is regularly placed 3 days before the operation to allow the patient to urinate in bed. This is the most difficult thing for many patients to do. The patient should be patiently and meticulously explained to the patient.

5 Postoperative care

(1) After returning to the ward, take a supine position with pillows, and measure blood pressure immediately. At the beginning, the test will be performed once every 15min, and the test will be performed continuously for 5 times. After that, the hundreds will be tested once every half an hour, three times in a row, and after it is stable, the test will be changed to once every hour, and the test will continue for 6 hours, depending on the situation.

(2) Observe the urination, leave three cups of urine to observe the color of the urine and send it for examination, encourage the patient to drink more water to achieve self-washing effect, and record the intake and output, observe whether there is gross hematuria, there is one female patient in this group of patients after surgery A small amount of blood clots appeared in bright red hematuria the next day, and I was given to Absolutely I am confused, and rational use of hemostatic drugs, the hematuria disappeared a week later.

(3) Under normal circumstances, stay in bed absolutely for 24 hours, and patients with gross hematuria can extend the time in bed, knowing that the hematuria has disappeared more than 3 times. Because of the bed rest, the nurses give more care while taking good care of life, so that the patient feels that the medical staff value him, which can increase the confidence in treatment. Tell the patient to move his limbs on the bed to assist in turning over and prevent back pain.

(4) There is no hematuria or other discomfort for 24 hours after the operation. You can get out of bed for light activities and avoid strenuous activities. There is still the risk of bleeding if there is no color.

(5) Pay attention to observe whether the puncture site has bleeding or swelling, and take care of the wound.

(6) Apply hemostatic drugs and antibiotics as prescribed by doctors, and strengthen patient inspections.

6 Summary

Although renal puncture is a minimally traumatic examination, the patient and family members do not know much about it. Before the operation, the patient and family members should be patient and meticulously explain to the patient and family members that the purpose of this examination is to confirm the diagnosis, determine the treatment plan, avoid blind medication, and provide better protection. The kidneys thus gain their understanding and cooperation, and the patients are proficient in preoperative breathing training and bed urination training, and have a good attitude. It is a guarantee to reduce complications when the condition is closely observed after the operation.

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