降低人工腎臟與血液迴路管凝固率方案

本專案皆在降低透析人工腎臟與血液迴路管凝固率。在2011年第一季單位衛材盤點發現，每月人工腎臟平均耗費約多出25支、血液迴路管組多出45套，經查檢2011年6月人工腎臟與迴路管凝固率為11.09%。經特性要因分析找出問題有：血流不足、透析管路準備未依標準作業執行、人工腎臟材質、透析中未以生理食鹽水灌洗透析管路及抗凝劑劑量不足等五項。採行解決方案包括：透析評估及作業標準化、落實透析器及管路作業標準、護理指導病人每次透析前體重增加少於標準體重6%。專案改善後，除有效降低人工腎臟與迴路管凝固率至3.00%，更提高透析服務品質及增進病人安全，並減少每月耗材成本及廢棄物處置費用一萬四千元，增加醫院營收。

關鍵字

血液透析；凝固；凝固率

並列摘要

This project aims to reduce the rate of blood clotting hemodialysis artificial kidney and extracorporial blood circuit tubings. The result of the inventory audit in the first quarter of 2011 which was done during the month of June 2011 showed that, an average of about 25 sets of artificial kidney and 45 sets of blood circuit tubings consumed per month was found in excess by a rate of 11.09%. After thorough analysis, 5 important causes were found: inadequate blood flow, blood lines preparation which was not in accordance with standard technique, the quality of the artificial kidney material, intradialytic failure to flush with Normal saline. and the inadequate anticoagulation. The obtained solutions to these causes include: the evaluation and standardization of dialysis adequacy, implementation of dialyses and extracorporeal blood lines operating standards, educating the patient to limit the interdiaytic weight gain to less than 6% of his dry weight. After the improvements made, in addition to effectively reduced the clotting rate of artificial kidney and circuit tubing to 3%. it has improved the quality of dialysis services rendered as well as enhanced patient safety, and reduced the delivered cost and waste disposal expenses to 14,000NT per month, which inturn increase our hospital revenues.