提升肝臟移植術後病人中心靜脈導管照護之完整性

Increasing the Completion Rate of Central Vascular Catheter Bundle Care for Patients with Liver Transplantation

黃珮琪(Pei-Chi Huang) ； 吳碧素(Pi-Su Wu) ； 莊靜娟(Ching-Chuan Chuang)

《榮總護理》 33卷1期 (2016/03) Pp. 41-49

https://doi.org/10.6142/VGHN.33.1.41

摘要

院內感染為醫療照護重要品質指標之一，若發生中心靜脈導管相關血流感染，會增加病人疾病嚴重產生合併症甚至導致死亡。統計單位病人使用中心靜脈導管佔64%，連續3年以血流感染居第一，故引發專案動機。經現況分析發現， 執行管路技術前未確實洗手；插管前皮膚清潔不落實；管路消毒方式不正確；導管置入用物不完整及消毒溶液未統一；未每日進行導管護理評估；無教育訓練及定期稽核。為提升執行完整率，擬定介入措施：一、制定中心靜脈導管照護標準流程；二、使用2%克菌寧消毒溶液使用，導管置入用物箱及查檢表，導管照護評估表；三、制定專科照護標準化作業流程；四、舉辦在職教育訓練；五、定期監控稽核；成效為醫護人員執行中心靜脈導管置入完整性87.9%提升至100%，護理人員執行導管照護完整性83.2%提升至98.8%，照護認知率86.6%提升至 100%，進而達到提升人員認知及照護技巧，營造安全醫療環境。

關鍵字

導管相關血流感染 ； 肝臟移植

並列摘要

Nosocomial infection is one of the crucial medical care quality indices. Central catheter-related blood stream infections increase disease severity as well as mortality. Our patients with central vascular catheters (CVCs) account for 64% whose blood stream infections have been ranked fi rst for 3 consecutive years. A multifactorial analysis was conducted, which indicated that certain factors, such as handwashing, skin cleaning and disinfection, the laying size of sterile towels, using incorrect disinfection techniques, incomplete catheter insertion with various disinfectants, insuffi cient daily catheter assessment, and lack of on-the-job training and regular review, altered the effectiveness of CVC bundle care. To increase the completion rate, we proposed the implementation of several improvement measures, including a CVC nursing SOP, the use of chlorhexidine gluconate (2%), placement of a catheter insertion box with a checklist, assessment of catheter care, CVC bundle care for specialists, and arrangement of on-the-job training. Consequently, the completion rate of CVC insertion and comprehensive bundle care increased from 87.9% to 100% and 83.2% to 98.8%, respectively; furthermore, nurses' comprehension rate increased from 86.6% to 100%. In conclusion, nurses' comprehension and nursing techniques improved after the improvement measures for a safe medical environment with implemented.

並列關鍵字

catheter-related bloodstream infection ； liver transplant

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