降低透析後穿刺部位滲血率之改善方案

A project approach in reducing the rate of oozing from puncture site after dialysis

張麗惠(Li-Hue Chang) ； 郭瑜珊(Yu-Shah Kuo) ； 蕭秀佳(Hsiu-Chia Hsiao) ； 陳慧瑛(Hui-Ying Chen) ； 劉嘉恩(Chia-En Liu)

《安泰醫護雜誌》 22卷1期 (2016/06) Pp. 31-46

摘要

本專案目的旨在降低透析後穿刺部位滲血率，經由單位病情討論會發現透析後因穿刺部位多次滲血，造成急需輸血之情況，進一步分析發現透析後穿刺部位滲血率高達18.9%，主要原因為；紗布太寬無法正確判斷出血點、膠帶太短加壓力道不夠、加壓時間不足與靜脈壓力高，經專案小組討論並參考文獻後，規範穿刺針口敷料用物之使用、加壓止血方式、並訂定血管照護作業規範，穿刺部位滲血率降為6.4％，除此之外，更減少敷料成本29000元/年，減少護理工時754.86分/月，達到減少因滲血造成之血液流失、減少透析護理工作量，促進病人安全進而提升護理照護品質及內外顧客滿意度。

關鍵字

血液透析 ； 穿刺部位滲血 ； 滲血率

並列摘要

The purpose of this project is aimed at reducing the rate of blood oozing from needle puncture needle sites at the termination of hemodialysis. After the group seminar and discussion the observations revealed the frequent incidents of blood loss from due to blood oozing from puncture site was the caused necessitating emergent blood transfusions. On further analysis, the rate of blood oozing reaches up to 18.9%. The main causes are; the use of wide size grauze which deprive one to acurately detect the bleeding puncture hole, the size of the plaster is too short causing not enough pressure strenght for compression, the insufficient time given for compression and high pressure of the venous access. After the discussion and literature review, the use of appropriate dressing for puncture needle, the application of enough compression, as well as standardizing the care for vascular access care, resulted the incident to fall to 6.4%, In addition it reduced the dressing utility cost to 29,000 NT/year. Other advantage noted were: it reduced nursing working time to 754.86 minutes/month, lessening the blood loss due to oozing of blood, dialysis nursing workload reduction, promoting patient safety thereby enhancing the quality of nursing care. as well as customer satisfaction.

並列關鍵字

Hemodialysis ； puncture site blood ； oozing rate