In this situation, we must carefully change the location of the catheter, pull it toward you, and to make follow-HS volume of circulating fluid. During the operation it is necessary to closely monitor the patient (subjective feeling, heart rate, blood pressure, BH skin condition, behavior). If you experience any complications (fever, hypotension, bleeding, etc.) to try to remove them without stopping the HS. Along with heparin in arterial line during HS infusion administered at a dose of 1.5-2.0 trental mg / kg in 500 ml of saline solution, and if necessary being symptomatic therapy. We should not make attempts rastrombirovaniya sorbent during HS saline as possible hemolysis. Silicone and PVC line is not recommended needle. Injections should be made through a special lock or a rubber segment. With some experience in the operation hemosorption easy to implement and is safe for the patient.
High biocompatibility biospecific sorbents virtually eliminates complications associated with connecting the extracorporeal circuit with a sorbent to vascular system of the patient. Reduced to a minimum the possibility of anafilaticheskih reactions, pulmonary edema, metabolic disorders, which are described for a number of dialysis membranes and some natural sorbents first generation. Complications of HS using a sorbent of this type can be associated mainly with the technique or methodological errors of the operation. 1. Complications due to technical errors: o defects in the catheterization of central and peripheral blood vessels; o depressurization perfusion system that untimely identification can cause significant blood loss; o occurrence air embolism in displacement of blood from massoobmennika air, in the process itself is a complication of HS may occur during veno-venous connection option when silicone tube slips out from under the roller pump, or lack of proper supervision by medical staff during the displacement of blood with air; o the risk of infection in patients with non-compliance with GS rules of asepsis and antisepsis. 2.
Complications associated with inadequacy of the methodology of the GS: o chills – the most frequent and quite serious complication of HS. Chills associated with pyrogenic reactions due to poor cleaning of the sorbent or pyrogenicity transfuznyh environments, rather easily cropped. There is also evidence of the role of large doses of heparin in the occurrence of this complication. Massive lipolysis induced by heparin superdozami, leading to consumption of calcium may be the reason for this; o collaptoid reaction – a common cause of this complication is hypovolemia and circulatory centralization. Sorption of vasoactive peptides with pressor leads to decentralization and circulatory hypotension; o massoobmennika thrombosis and extracorporeal systems are most commonly associated with the difficulty of correcting the system of regulation the state of aggregation of blood when not in use opportunities to influence the components of this complex system and for the prevention of thrombotic events only apply large doses of heparin. It should also be noted that it was in septic disease is sharply reduced primary target of action of heparin – antithrombin-III. So large doses of heparin does not facilitate the perfusion, but rather the contrary, contribute to the development of adverse reactions of heparin.
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