降低血液透析病人人工血管阻塞率之改善方案

Strategies to Decrease the Obstruction Rate of Arteriovenous Graft in Hemodialysis Patients

陳秀惠(Shiu-Hua Chen) ； 陳采琳(Tsai-Lin Chen) ； 陳麗琴(Li-Chin Chen)

《北市醫學雜誌》 5卷2期 (2008/04) Pp. 261-274

https://doi.org/10.6200/TCMJ.2008.5.2.10

摘要

對於血液透析治療的病人而言，一條功能良好的人工血管無疑是最重要生命線，人工血管發生阻塞不但危急生命更增加醫療成本負擔。本專案目的旨在降低血液透析病人人工血管阻塞率，經由問題分析發現人工血管阻塞率高達32.43%，進一步分析原因為：護理人員不熟悉人工血管穿刺護理程序、人工血管穿刺技術不一致、透析病人對人工血管照顧及加壓止血知識不足，經專案小組討論並參考文獻後，修訂正確且詳細人工血管穿刺護理程序、繪圖病人手術血管走向及穿刺方向於病歷中、鈕釦式穿刺輪序登記單張使用、人工血管穿刺難度者之標示、指導病人透析後血管正確加壓方式後，人工血管阻塞率降為12.5%，達到提昇護理照顧品質之最終目的。

關鍵字

血液透析 ； 人工血管 ； 阻塞

並列摘要

It is important to maintain good function of arteriovenous grafts (A-V graft) in patients on hemodialysis. Obstruction of an arteriovenous graft is life-threatening and increases medical costs. The aim of this study is try to find the causes of obstruction of A-V grafts and thereby lower the incidence of obstruction. The incidence rate of A-V graft obstruction was about 32.43% in this study. Analysis of the causes of obstruction showed that the nursing staff was not familiar with the needle insertion procedure, there was no standard procedure for needle insertion, and hemodialysis patients' did not have enough information on how to care for A-V grafts. After a search of references and team discussion with specialists, we set a standard, detailed A-V graft needle insertion procedure and recorded the route, direction and any puncture difficulties in the A-V graft vessel. We used the button method for needle insertion. Marked the vessel and directed patients on exactly how to apply compression. The incidence rate of A-V graft obstruction decreased to 12.5%. The quality of nursing care was promoted.

並列關鍵字

hemodialysis ； A-V graft ； obstruction