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Pubblicato il 25 giugno 2013

Pulsiossimetria in sala dialisi

Pulsiossimetria in sala dialisi

Pulsiossimetria in sala dialisi

Pulse Oximetry in the Dialysis Room

Marco Marano

Ambulatorio di Emodialisi CI.MA.SA., Gruppo Casa di Cura Maria Rosaria, Pompei

Corrispondenza a: Marco Marano; Ambulatorio di Emodialisi CI.MA.SA. srl, Gruppo Casa di Cura Maria Rosaria, Via Colle San Bartolomeo, 50; 80045 Pompei (NA); Tel. 0815359517 Fax 0818502821; mail: marco.marano@cimasadialisi.it

Abstract

La gestione degli eventi critici e le problematiche cliniche quotidiane dell’ambulatorio di emodialisi possono giovarsi dell’uso del pulsiossimetro. La saturazione pulsata di ossigeno (SpO2), il cosiddetto quinto segno vitale, può essere acquisita prima dell’inizio del trattamento emodialitico contemporaneamente alla misurazione della pressione arteriosa e ogni qualvolta, durante la dialisi,  si teme un deterioramento delle condizioni cliniche ed emodinamiche o si effettua la dialisi ad un paziente critico. Il pulsiossimetro fornisce informazioni anche su frequenza cardiaca e regolarità del ritmo cardiaco.  Rappresenta un insostituibile primo step diagnostico nei pazienti con dispnea escludendo, per valori elevati di SpO2, l’imbibizione dell’interstizio polmonare. Consente di valutare quando eseguire l’emogasanalisi, conferma la natura arteriosa del sangue prelevato dalla fistola arterovenosa, fornisce indicazioni su quando iniziare la ossigenoterapia e ne consente il monitoraggio. Infine può essere utilizzato per valutare la pulsazione arteriosa, e dunque la perfusione periferica, in particolare a valle delle fistole arterovenose, nella diagnostica differenziale bed-side del dolore alla mano.

Abstract

The use of pulse oximetry can improve the management of critical events and daily clinical problems in a haemodialysis unit. Blood oxygen saturation using pulse oximetry (SpO2), the so-called 'fifth vital sign', can be determined together with noninvasive blood pressure measurement, before haemodialysis treatment or when, during treatment, a patient's condition suddenly worsens. The pulse oximeter provides useful information on pulse rate and on heart rhythm. It can be considered a diagnostic first step for dyspnoea because normal-high values rule out interstitial pulmonary fluid. It is also a useful screening for blood gas analysis, providing confirmation of arterial blood from an arteriovenous fistula sample. It can indicate when oxygen therapy should be initiated and provides monitoring. Finally, it can be used to explore pulse blood flow distal to the arteriovenous fistula.

Tabella 1. Il pulsiossimetro nell’ambulatorio di emodialisi.
Misura parametri vitali: SpO2 e frequenza cardiaca
Diagnostica della dispnea “polmone asciutto”
Indicazione alla O2 terapia
Screening per l’emogasanalisi arteriosa (EGA)
Conferma idoneità per EGA del sangue prelevato dalla FAV o dalla linea arteriosa
Monitoraggio O2 terapia
Diagnostica differenziale dolore alla mano
×
Tabella 2. Ipotesi ischemica per il dolore alla mano lato FAV.
improbabile se SpO2 uguale ai due arti a paziente supino sia con gli arti distesi lungo il corpo sia sollevando l’arto con FAV di 30 cm
possibile se SpO2 uguale ai due arti
a paziente supino con gli arti distesi lungo il corpo		 ma SpO2 lato FAV ridotta rispetto al controlaterale
oppure non più rilevabile con arto sollevato di 30 cm
probabile

se

 (a paziente supino con arti lungo il corpo) SpO2 lato FAV non rilevabile o ridotta rispetto all’arto controlaterale
×

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Contenuti articolo
    release  1
    pubblicata il  25 giugno 2013 
    Da

    Marco Marano

    Ambulatorio di Emodialisi CI.MA.SA., Gruppo Casa di Cura Maria Rosaria, Pompei

    Corrispondenza a: Marco Marano; Ambulatorio di Emodialisi CI.MA.SA. srl, Gruppo Casa di Cura Maria Rosaria, Via Colle San Bartolomeo, 50; 80045 Pompei (NA); Tel. 0815359517 Fax 0818502821; mail: marco.marano@cimasadialisi.it

    Parole chiave: Emodialisi, Fistola arterovenosa, Pulsiossimetro, Saturazione d’ossigeno
    Key words: Arteriovenous fistula, Haemodialysis, Oxygen saturation, Pulse oximeter
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