早期放氣及移除經橈動脈行冠狀動脈造影術後止血加壓器：護理質量改善計劃

Early deflation and removal of vessel compressor of coronary angiography in trans-radial approach: a nursing care quality improvement project

梁立彤(LEONG Lap Tong) ； 劉少華(LAO Sio Wa)

《鏡湖醫學》 21卷2期 (2021/12) Pp. 80-82

摘要

目的：運用PDSA模式（Plan-Do-Study-Act cycle）推行循證護理，探討縮短經橈動脈穿刺（Transradial approach, TRA）行冠狀動脈造影（Cononaryangiograpy, CAG）手術後病人止血器壓迫時間，對病人橈動脈穿刺部位出血及血腫發生率、瘀斑面積大小和疼痛程度。方法：選取澳門某醫院經TRA行CAG術，手術後使用止血器壓迫TERUMO TR Band®止血氣囊進行壓迫止血的病人，根據不同的減壓時間和頻率將其分為干預前組與干預後組。干預措施介入前的病人納入為干預前組，執行常規操作；干預措施介入後的病人納入為干預後組，按循證護理操作以縮短止血加壓器壓迫及移除時間。結果：干預前後病人的年齡、性別、橈動脈穿刺所用導管及CAG術中所用肝素份量均沒有差異（P>0.05）。術後穿刺點發生出血、血腫及瘀斑，計劃前、後的發生率皆沒有統計學差異（P>0.05）。縮短橈動脈加壓膠帶的壓迫時間後，病人術後對因穿刺點作加壓止血引致疼痛的評分，在術後4小時（P=0.023）及6小時（P=0.030）有明顯下降，且有統計學差異。結論：運用PDSA模式推行循證為本的護理質量改善計劃，有效減輕病人的術後疼痛程度，且不增加臨床出血風險。

關鍵字

動脈穿刺 ； 止血器 ； 壓迫時間 ； 冠狀動脈造影術

並列摘要

Objective: To apply PDSA cycle and evidence-based nursing in investigating compression time reduction by vessel compressor for coronary angiography (CAG) with transradial approach (TRA). The radial artery bleeding and bruising rate, size of a bruise, and patient pain level were evaluated. Methods: Patients who had undergone CAG in TRA and post-operative (post-op) vessel compression given by TERUMO TR Band® were recruited. The patient assignment was according to intervention difference in compression time and deflation frequency. Patients were included before intervention as a pre-intervention group (pre-group) and under routine care. The post-intervention group (post-group) was given evidence-based care to achieve early deflation and removal of the vessel compressor. Results: The background data in age, gender, catheter and heparin used for CAG were shown no difference between participants in pre-group and post-group (P>0.05). There was no statistical difference in bleeding rate, bruising rate and bruise size for between-group comparison (P>0.05). Patient pain level reduction was significantly different in the post-group at post-op 4-hour (P=0.023) and 6-hour (P=0.030). Conclusion: The care quality improvement project applied the PDSA cycle in evidence-based nursing and achieved reduced patient pain with no increase in bleeding risk.

並列關鍵字

Transradial approach ； Vessel compressor ； Compression time ； Coronary angiography