降低腎臟造瘻引流管路滑脫率之專案

Plan to Reduce the Catheter Slippage for Percutaneous Nephrostomy

郭惠貞(Hui-Chen Kuo) ； 蔡素玉(Su-Yu TSAI) ； 楊喻涵(Yu-Han Yang) ； 李文英(Wenying Lee) ； 王琳華(Ling-Hua Wang)

《腫瘤護理雜誌》 20卷2期 (2020/12) Pp. 21-33

https://doi.org/10.6880/TJON.202012_20(2).04

摘要

本專案目的是降低婦癌病人腎臟造瘻（Percutaneous nephrostomy, PCN）引流管滑脫率，經收集本病房2017年7月至9月現況，發現放置PCN引流管有16人，期間PCN管路滑脫共9件佔56%，分析原因為：（1）未依照護流程執行、（2）未查核PCN膠布固定、（3）照護者衛教未落實執行、（4）固定的敷料易致皮膚悶熱癢、（5）引流袋掛置不當及（6）PCN照護知識不足。本專案執行期間為2017年11月至2018年4月，執行改善策略包含：（1）宣導PCN引流管路固定標準流程、（2）研發製作管路照護之教學影片、（3）改良PCN引流管之固定輔助物、（4）照護人員之在職教育與（5）透明膠膜之固定使用等。評值2018年1月至4月管路滑脫率降至7.7%，達本專案目的。本案實施後，不僅提升專業照護人員的專業知識，亦提升病人的照護安全。建議PCN管路照護可拍攝成教學影片，並納入新進人員在職教育。

關鍵字

腎臟造瘻口 ； 引流管 ； 照護規範

並列摘要

This project aims at improving the catheter of Percutaneous Nephrostomy (PCN) care in Gynecologic Oncology Patients. From July to September 2017, catheter slippage occurred in 56.3% of the PCN. The cause was associated with six factors: (1) absence of a PCN care operation procedure, (2) failure to recheck the insertion of PCN catheter, (3) lack of PCN care education for the caregiver, (4) subsequent wet and itchy skin from the dressing, (5) improper hanging of the PCN drainage bag, and (6) insufficient knowledge and skills in PCN care. The improvement plans included: (1) to advocate the standard tube drainage fixation technique, (2) to establish norms for care of PCN tube and produce instructional videos, (3) to improve the fixed aid of PCN tube, (4) to provide nursing staff with in-service training, and (5) to use transparent waterproof membrane for fixing the PCN tube. After implementation of this project, the rate of improper PCN care decreased to 7.7% from November 2017 to April 2018, thus achieving the goals of this project. This PCN care project enhanced not only the professional knowledge and skills of nurses but also the patient care safety.

並列關鍵字

percutaneous nephrostomy ； PCN catheter ； nursing care guidelines

參考文獻

彭佳玲、莊莉苓、李珮琪、張淑芳（2013）．降低胸腔Pig-tail引流管路滑脫率改善方案．榮總護理，30（1），10-17。doi:10.6142/vghn.30.1.10

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