降低血液透析病人人工腎臟凝固率改善專案

Strategies to Decreasing the Clotting Rate of Artificial Kidney in Hemodialysis Patients

陳秀惠(Shiu-Hua Chen) ； 廖怜俞(Ling-Yu Liao) ； 陳麗琴(Li-Chin Chen) ； 陳麗美(Li-Mei Chen)

《北市醫學雜誌》 7卷1期 (2010/03) Pp. 67-81

https://doi.org/10.6200/TCMJ.2010.7.1.07

摘要

本專案旨在探討血液透析病人人工腎臟凝固之相關因素，以降低其凝固率及提升護理人員臨床技能，且減少醫療成本支出。小組統計單位2008年5月人工腎臟凝固率達6.14%，經分析後其導因依序為：對人工腎臟凝固定義認知不一，造成延遲處置43.75%；缺乏血液透析細項技術標準，導致執行技術疏失26.04%；不熟悉血液透析機器警報排除，造成停機過久血液凝固19.79%。經修訂血液透析護理技術作業標準：確立人工腎臟凝固定義與生理食鹽水灌注步驟、設置紅色警示標籤提醒抗凝劑用量，與製作透析機器警報排除簡易操作流程等方案，凝固率降至2.95%。專案的施行，使護理人員正確執行技術，且預防人工腎臟凝固，促進病人安全，提升透析護理品質。

關鍵字

血液透析 ； 人工腎臟 ； 凝固

並列摘要

The aim of this project, through discussing the factors related to artificial kidney/dialyzer clotting in hemodialysis patients, was to reduce the dialyzer clotting rate, to improve the clinical skill level during nursing care, and to decrease medical costs. According to the statistics compiled by the team, the dialyzer clotting rate had reached 6.14% by May, 2008. The analysis showed that the causes were delayed treatment due to disagreement about the definition of dialyzer clotting (43.7%), unintentional mistakes due to deficiencies in the detailed operational standards for hemodialysis (26.04%) and blood clotting during overlong shutdowns because of unawareness of troubleshooting procedures (19.79%). Modifications of the nursing care operational standards for hemodialysis were instigated. These included establishing a unified definition of dialyzer clotting and the infusion steps used with normal saline, the setting up of warning red labels to remind staff of the correct anticoagulant dosage and the provision of easily comprehensible dialyzer troubleshooting procedures. After these changes took place, the dialyzer clotting rate was reduced to 2.95%. On execution of this project, the nurses now were able to perform correctly their clinical tasks, many cases of dialyzer clotting were prevented and the safety of patients was promoted. Finally, overall, the quality of nursing care in the hemodialysis was improved.

並列關鍵字

hemodialysis ； artificial kidney/dialyzer ； clotting