降低血腫科病房癌症病人人工血管血流感染密度

Reducing Port-A-Cath related Bloodstream Infections rate in Cancer Patients

陳椀湄(Wan-Mei Chen) ； 謝雅玲(Ya-Ling Hsieh) ； 鄭淑雯(Shu-Wen Cheng)

《腫瘤護理雜誌》 21卷2期 (2021/12) Pp. 53-65

https://doi.org/10.6880/TJON.202112_21(2).05

摘要

癌症病人因接受周期性抗癌治療而須裝置內植式輸液導管（subcutaneous infusion port, Port-A），化療後免疫力下降為導管血流感染危險因素。單位人工血管血流感染密度從2015年（千分之3.0）到2016年（千分之3.3），引發專案小組改善動機，經現況分析發現：1.護理人員面：人工血管照護技能不足且未依據規範執行置針、2. 病人面：皮膚薄且易流汗、皮膚清潔度不佳、3. 制度面：人工血管照護在職教育不足、缺乏定期稽核機制、4. 設備面：未使用合適人工血管固定敷料。擬定措施包含：規劃人工血管照護教育訓練計畫、更換人工血管固定敷料、修訂人工血管彎針注射規範。專案改善後血流感染密度由（千分之3.3）下降至（千分之1.01），有效降低癌症病人人工血管血流感染密度。

關鍵字

癌症病人 ； 人工血管 ； 血流感染

並列摘要

Cancer patients often receive treatments through central venous access ports (Port-A-Cath) insertion which carries a risk factor for catheter related bloodstream infections stemmed from the chemotherapy-compromised immune system. The increased rates of catheter-related bloodstream infection in our oncology unit from (3.0 per mille) in 2015 to (3.3 per mille) in 2016 prompted us to create the improvement project. Through data analysis, the causes identified were: 1) lack of training in Port-a-Cath care and failure to adhere to the needle insertion guidelines, 2) patient's vulnerable and clammy skin from sweating, 3) insufficient on-the-job training in Port-a-Cath care for nurses and clinical audit mechanism in place for assessment, and 4) inappropriate dressings for Port-a-Cath. The improvement strategies subsequently implemented comprised: 1) development of educational programs in Port-a-Cath skills to render optimal care, 2) application of appropriate dressings for Port-a-Cath, and 3) revision of guidelines for the insertion of noncoring port needles. The catheter-related bloodstream infection rate was decreased from (3.3 per mille) to (1.01 per mille), showing an effective reduction of catheter-related bloodstream infections in cancer patients.

並列關鍵字

cancer patients ； Port-a-Cath ； bloodstream infection

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