降低暫時性血液透析導管非預期滑脫率之專案

Reducing the Unexpected Slippage of Temporary Hemodialysis Catheters

杜嘉秦(Jia-Chin Du) ； 朱璧岑(Pi-Chen Chu) ； 王姿文(Tzu-Wen Wang) ； 辛怡芳(Yi-Fang Hsin)

《澄清醫護管理雜誌》 17卷3期 (2021/07) Pp. 77-86

摘要

目的：本專案旨在降低暫時性血液透析導管滑脫率。單位2018年1至3月滑脫率高達0.12%，接連的管路異常事件，除了病人需面臨再次植入導管的痛苦，也引發家屬及醫療團隊質疑護理的專業性，故成立專案小組。方法：利用異常事件回溯資料分析、實際查核及人員訪談，確立問題一、人員：管路安全敏感性不足、約束不正確、未提供衛教；二、設備：管路固定不牢、約束工具不足；三、制度：缺乏稽核制度及照護查核指引。進行改善措施：包括一、增設管路提醒圖卡；二、舉辦在職教育；三、制作管路固定模具及固定教學影音檔；四、改變敷料加強固定；五、提供照護查核指引；六、稽核及獎懲回饋機制。結果：暫時性血液透析導管滑脫率由0.12%降為0%；暫時性血液透析導管照護正確率皆達100%，成效甚佳。結論：藉由暫時性血液透析導管照護標準的建立，落實暫時性血液透析導管評估及留置照護，可提升病人管路安全。

關鍵字

滑脫 ； 血液透析 ； 暫時性血液透析導管

並列摘要

Purposes: This study aimed to reduce the slippage rate of temporary hemodialysis catheters. From January to March 2018, the slippage rate in our institution was as high as 0.12%. Successive abnormal tubing events not only cause patients pain caused by catheter re-implantation, they make family members and the medical team question nursing professionalism. Methods: Through a retrospective data analysis, an on-site inspection, and personnel interviews about abnormal events, the following problems were identified: (1) Personnel: insufficient sensitivity about tubing safety, incorrect binding, and inadequate health education; (2) Devices: tubing inadequately fixed and insufficient binding tools; and (3) System: lack of an auditing system and nursing inspection guidelines. The improvement measures included: (1) adding tubing reminder picture cards; (2) organizing on-the-job education; (3) creating tubing fixation molds and fixation instruction audiovisual files; (4) changing dressings to reinforce the fixation; (5) providing guidelines for nursing inspection; and (6) performing audits and creating reward and punishment feedback mechanisms. Results: The slippage rate of temporary hemodialysis catheters decreased from 0.12% to 0%. The temporary hemodialysis catheter success rate was 100%, and its effect was very satisfactory. Conclusions: Patients' tubing safety can be improved through the establishment of temporary hemodialysis catheter care standards as well as the implementation of temporary hemodialysis catheter evaluations and indwelling care protocols.

並列關鍵字

Slippage ； Hemodialysis ； Temporary hemodialysis catheter