提升末期腎衰竭病人血液透析通路預先建立率

背景：各國指引皆建議預先建立透析通路，以免病人進入末期腎衰竭時，緊急置入暫時性雙腔透析導管；本單位2014年1月至3月血液透析病人通路預先建立率僅20％，導致住院天數及醫療耗用增加，病人與家屬身心受創、護理人員工作壓力劇增，故激發成立專案小組之動機。目的：藉本專案提升末期腎衰竭病人血液透析通路預先建立率。解決方案：明確訂定CKD收案標準、增設多元衛教工具、制訂衛教成效監測辦法、促進其對疾病認知進而降低壓力、舉辦病友支持團體以提升自我效能，真正達到提升末期腎衰竭病人的血液透析通路預先建立率。結果：末期腎衰竭病人血液透析通路預先建立率由改善前20％提升至81.8％，達成專案目的。結論：此專案運用策略促進自我效能，讓病人不需住院緊急置入暫時性雙腔透析導管，而能由門診順利進入血液透析，達到護病雙贏的成效。

關鍵字

末期腎衰竭；血液透析通路；護理衛教；自我效能

並列摘要

Background & Problems: Creation of vascular access (VA) prior to initiation of hemodialysis was advocated but it was difficult for the rate of VA creation before hemodialysis initiation to increase worldwide. The rate of VA creation prior to hemodialysis initiation in our hemodialysis center from January to March of 2014 was as low as 20%. The low rate of VA creation prior to hemodialysis initiation will result in the need for emergency placement of hemodialysis catheters and hospitalizations, subsequently putting heavy mental and physical burdens on ESRD patients and increasing workload of staffs; therefore the establishment of ad hoc groups was inspired. Purpose: Improve the creation rate of vascular access prior to initiation in patients with End Stage Renal Failure. Resolution: To modify standard operating procedure of inclusion criteria for chronic kidney disease, establish standards to monitor the effects of education and organize activities for ESRD support groups in order to effectively improve the creation rate of VA prior to initiation in patients with ESRD. Result: The rate of VA creation before hemodialysis initiation was significantly raised from 20% to 81.8%. Conclusion: Improved patient self-efficacy, patients consequently did not suffer the procedure of temporal hemodialysis catheter placement and its associated complications. The rate of outpatient hemodialysis initiation was improved compared to inpatient hemodialysis initiation. Moreover, the workload of nurse was significantly decreased, subsequently creating a situation mutually beneficial to both nurse and patients.

並列關鍵字

end stage renal disease ； vascular access ； health education ； self-efficacy

參考文獻

Brian, D., Bradbury, F. C., Anna, F., Ronald, L., Pisoni, M. K., Donna, M., & Mahesh, K. (2009). Conversion of vascular access type among incident hemodialysis patients: Description and association with mortality. American Journal of Kidney Diseases, 53(5), 804-814. doi: 10.1053/j.ajkd.2008.11.031

Cassidy, B. P., Getchell, L. E., Harwood, L., Hemmett, J., Moist, L. M. (2018). Barriers to Education and Shared Decision Making in the Chronic Kidney Disease Population: A Narrative Review. Canadian Journal of Kidney Health and Disease. doi: 10.1177/2054358118803322.

台灣腎臟醫學會（2014，6 月）．103 年度腎臟病健康促進機構自評表．取自 http://www.tsn.org.tw/UI/K/K008.aspx