What to do with skin itching for hemodialysis patients?

In hemodialysis patients, skin itching is a common and intolerable symptoms, the incidence rate of 60% -90%. With the extension of dialysis time, the symptoms gradually increased, so that patients all day long anxiety, very painful, seriously affecting the quality of life of patients. The following details of hemodialysis patients with skin itching, how to deal with, improve the quality of life.

    First, the electrolyte metabolism caused by skin itching. Chronic renal failure patients are the most common, due to reduced phosphorus, blood phosphorus levels increased repeatedly, blood calcium levels decreased, thereby stimulating PTH (parathyroid hormone) secretion and lead to secondary hyperparathyroidism. Studies have shown that secondary hyperparathyroidism can cause skin itching, the increase can cause hypercalcemia, skin calcification and stimulate skin mast cells to release histamine, and thus increased PTH is considered to be an important cause of the disease.
    Responses:
    1, limit the intake of phosphorus in the diet, it is recommended that the best phosphorus content of less than 600 a l200 mg / d, to avoid eating soy products and animal offal.
    2, the application of active vitamin D calcium. Adjust the dialysate to the appropriate calcium concentration, to prevent hypercalcemia.
    3, change the way itch. Hand tapping, ground nails. Special attention to maintain the arterial and venous fistula arm side of the skin's integrity, so as to avoid fistula infection. If local infection, puncture should be avoided, and prescribed by the use of more than 100 state antibiotic ointment.
    Second, the retention of nitrogen metabolites lead to skin itching
    Nitrogen metabolites retention on the skin irritation and sebaceous glands and sweat glands atrophy, so that the skin appears to varying degrees of dry, scaling and cause itching. Skin looks like fish scales ringworm-like, skin itching unbearable, often scratching, and even scratch the skin and can not be alleviated. The main reason for the retention of nitrogen metabolism is: dialysis is not sufficient, the choice of low-flux dialyzer is also repeated multiple times and so on.
    Responses:
    1, reduce the number of times the low-pass dialyzer multiplex, increase the number of dialysis (3 times / w), conditions permit, the choice of medium flux dialyzer (ultrafiltration coefficient 15-30 mL / mmHg · h · m2) Dialysis.
    2, dialysis process, close observation of dialysis machine operation is normal, try to do early detection, early prevention, early treatment.
    3, the care operation should be standardized, the implementation of treatment attention to aseptic operation, to ensure the safety of dialysis treatment.
    4, lead the patient with cold water, ice towel wet compress to reduce itching, dry skin can be coated with skin lubricant and the use of cheese soap.
    Third, allergic reactions lead to skin itching
    Allergic reactions mainly due to heparin, softened vasodilator path plasticizer and disinfection dialyzer and brucine ethylene oxide and other dialysis patients can stimulate the spleen, bone marrow and skin hypertrophic cell proliferation, resulting in increased blood histamine concentration induced Skin itching.
    Responses:
    1, the use of antihistamines treatment to be alleviated.
    2, to encourage comfort patients, reduce patient tension.
    3, select a biocompatible dialyzer to reduce the ethylene oxide caused by allergic reactions.
    4, dialysis before the choice of saline full pre-multiplexing dialysis and piping, on the machine to do a good job of residual disinfectant testing to ensure the safety of dialysis treatment.
    5, such allergic reactions caused by itching and more accompanied by rash, to guide patients to avoid scratching and causing skin damage, can use some cool oil coated, to alleviate the symptoms.
   
    Health tips:
    1, psychological care: the patient due to skin itching and itching lead to self-image defects. So that patients are very anxious. With the symptoms increased day by day, affecting the quality of sleep at night, under the guidance of a doctor taking sedatives. So that the mood is too anxious. As HP combined with HD alone, the implementation of HD treatment costs increased, will give patients a certain psychological pressure, leading to dialysis patients with HP combined with HD treatment compliance is not high, it should be healthy guidance work to improve patient compliance. To ensure the smooth progress of treatment.
    2, to guide the daily life of patients to wear cotton, loose underwear. Bath water should not be too hot, generally with 40 ℃ warm water bath is appropriate. Avoid using alkaline soap and bath.
    3, in order to avoid dry skin caused by itching, local can be coated with moisturizing lubricant, while doing personal hygiene, ground bath, ground clothes. Should not drink, eat less irritating food.
   4, the correct guidance of patients taking phosphorus binding agent, regular blood tests the indicators to strengthen the nutrition of the missionary, improve patient compliance, delay the occurrence of long-term complications.