"Slam Fight" in ICU Ward

On February 26, nurses at the Blood Purification Center in Guanggu District, Tongji Hospital, Wuhan City, Hubei Province were waiting for the aid supplies to be delivered. This "renal protection team" composed of more than 20 specialized nursing staff is responsible for blood purification and clearing of cytokine storms in patients with severe and critical neo-coronary pneumonia.

Since the night of New Year's Eve, Wu Jianjun, head nurse of the Blood Purification Center of Wuhan Tongji Hospital, and his team have never rested for more than a month.

On February 26th, the monitoring screen in the ICU ward of the Guanggu District of Wuhan Tongji Hospital.

On February 9, the Guanggu District of Wuhan Tongji Hospital was requisitioned as a new severe pneumonia hospital. In more than two days, more than 800 critically ill and critically ill patients were quickly filled here. On the day of the requisition, Jianjun Jian took the nurses to complete dialysis for more than 100 patients and transferred them back to the headquarters campus. It was already midnight.

On February 26, nurses at the Blood Purification Center in the Optics Valley of Wuhan Tongji Hospital pushed the blood purifier through three doors before entering the polluted area from the clean area.

Two days later, more than 40 nurses of the blood purification center were divided into two, and half of the "youngest and most capable" nurses returned to the Optics Valley Hospital to form a "renal protection team" and began to serve patients with new coronary pneumonia. Do dialysis. These patients were "stocks" two weeks ago. At that time, the policy of "receiving and receivables" had not yet been introduced. Many patients were delayed due to false negative results of nucleic acid tests, and they were only admitted to the hospital after their condition worsened.

On February 26, in the ICU ward of the Tongji Hospital in Wuhan, the "Kidney Guard Team" and the medical staff of the Shanghai Huashan Hospital medical team observed the changes in the signs of a patient with new coronary pneumonia during blood purification.

The work of the "Kids Protection Team" is to first screen patients with kidney disease damage and to intervene early to avoid kidney damage; second is to screen inflammatory cytokines. They found that many patients were at risk for a "cytokine storm". Patients with underlying diseases may experience multiple organ failures under the influence of the "cytokine storm", which may lead to death. Blood purification technology can protect the organs and save lives by removing inflammatory factors. The "New Coronavirus Pneumonia Diagnosis and Treatment Program (Trial Version 7)" issued by the National Health and Medical Commission on March 3 clearly proposed that "blood purification treatment" should be added to cytokine storms in severe and critically ill patients.

On February 26, in the ICU ward of Guanggu District, Wuhan Tongji Hospital, the head nurse, Jianjian Jun (second from right), was helping to debug the blood purifier.

With the current staffing of the team, dialysis for 10 patients a day is normal and full of work. After entering the ICU, the nurses first adjusted the blood purifier, and the doctors began to intubate the patient. These tasks became difficult and abnormal when wearing two or three layers of protective clothing. The work that could be completed in half an hour had to be completed. Do it for an hour. A patient uses a blood purifier for 8-10 hours, and the use time of protective clothing for medical staff is 6 hours, so two dial nurses are required to complete the blood purification of a patient. Some nurses even require a day Enter the ICU 3 times.

On February 26th, in the Guanggu District of Wuhan Tongji Hospital, nurses concentrated in the clean area to eat before preparing to enter the ward. After the outbreak, many of them lived in double rooms rebuilt in hospital wards, and have not returned home for a long time.

The ICU ward is the red zone in the red zone. The virus aerosol concentration in the room is very high. When performing close-range operations, secondary or even tertiary protection is required. The virus may be inhaled. This is also a state of high hypoxia, and every time they come out of the ICU, their entire body will be wet with sweat.

On February 26, a nurse at the medical team of Shanghai Huashan Hospital was resting in the ICU ward of Guanggu District, Wuhan Tongji Hospital. Six blood purification nurses in the medical team took over the ECMO equipment and cooperated with the "Kidney Team" treatment.

At the beginning of the epidemic, patients who require routine dialysis still go to the hospital two or three times a week, and the dialysis room is where people gather and the risk of transmission is high. Most dialysis patients are associated with underlying disease, and once infected, the mortality rate is extremely high. Health care professionals who operate dialysis also face great risks.

Constant news of infection and diagnosis by medical staff will have an impact on the mentality of front-line nurses. "To be honest, we are all scared. But hemodialysis treatment is the last resort to save the patient's life. Once done, the patient may live, but he will die if he does not do so." Jianjun Jian said.

In the early days of "City Closing", many supplies were not shipped in time, and the gowns were used up. Doctors and nurses could only wear work clothes or even patients' sick clothes. The situation did not improve until after the 15th of the first month. That is, during this period, batches of hospitals in Wuhan were requisitioned, and there was no place for dialysis patients. Once they have a fever, the hospital that could have gone to dialysis was not allowed to receive it, but could only go to the designated hospital for investigation. "During the investigation, because no dialysis was performed, many patients did not survive it." Jianjun Jian said. Later, the dialysis patient had a designated hospital, and with the entry of medical teams from other provinces, the situation improved.

On February 26, Wan Niu, a nurse of the Blood Purification Center, leaned on the corridor to wipe tears secretly in the Guanggu District of Wuhan Tongji Hospital. She and her 1-year-old child have not seen each other for more than 40 days.

He Fan, associate professor of nephrology at Tongji Hospital, said that at the beginning, the aid medical teams in the Optics Valley Hospital held a conservative attitude towards the application of blood purification technology to patients with new coronary pneumonia. Once, the Kidney Squad completed three blood purifications for a 74-year-old man. The old man who had had respiratory failure and had entered a coma gradually began to improve, and the inflammatory factors that were more than 30 times higher than normal levels returned to the normal range. One week later, the old man was transferred to hospital after getting serious. Since then, this treatment has been accepted by medical teams. In the next two weeks, 34 patients received nearly a hundred blood purifications, of which 10 have been discharged or transferred to a mild hospital.

According to the press conference of the State Council ’s joint prevention and control mechanism on February 29, the state sent medical teams in Hubei and Wuhan to dispatch more than 5,500 nurses in critical care, accounting for about 21% of the total number of nurses in the field. Nurses account for 3/4 of the total number of critical care staff. Most of the medical teams are doctors in the respiratory, infectious, and intensive medicine departments, and there are few doctors and nurses in the nephrology department.

Patients who need blood purification are critically ill, and the probability of a cytokine storm is high, so it is necessary to provide sophisticated care. Dedicated nursing care consumes more human resources, which has led to a shortage of specialist nurses in Wuhan for hemodialysis.

"It's not that you don't want to change it, but no one is changing it." Qi Jianjun said. In his view, now is the most strenuous period. If these stock cases can be digested, there are no confirmed patients on the outside, and no one becomes severe again, then you can take a breath. "Now it's like fighting an obstruction. Everyone is tired, and there is even the problem of reducing staff due to infection, but the position must be held and not lost." He said. He Fan also called for the hope that nurses from the blood purification department would come to Wuhan to support them, "after all, they have been overloaded for a long time."

China Youth Daily · China Youth Daily reporter Li Yanhui Photography report Source: China Youth Daily