臨床病人經檢查其肋膜腔異常積液大於300 CC時,會選擇置入胸腔Pig-tail引流管輔助引流肋膜積液。本單位於2009年10月到2010年1月統計所有接受胸腔Pig-tail引流管置入術病人中,共發生滑脫件數10件佔8.2%(10/122),分析發生原因為現行引流管固定法不適用、護理師未確實執行標準流程及執行護理指導,且缺乏稽核制度。為了能順利降低胸腔pig-tail引流管路滑脫率。於2010年4月至2011年3月進行12個月的時間,進行此改善專案,小組成員討論選出4項解決方案修訂引流管固定法標準技術、製作提醒掛牌、舉辦引流管固定法相關在職教育、制定護理稽核表及組織品管小組進行執行狀況稽核,對策實施後評值期3 個月,胸腔Pig-tail引流管滑脫率由8.2%降低至1.1%,達專案目標,希望將此心得分享於臨床照護參考。
Clinically, the patient will undergo pigtail insertion for pleural effusion drainage if the amount exceeds 300 CC. Our unit measured the total pigtail insertion events since Oct. 2009 till Jan. 2010, episodes of slip-out of the pigtail catheter was 10, accounting for 8.2% (10/122). We analyzed the cause of the slip-out episodes to find (1) inadequate catheter fixation method, (2) the nursing staff did not perform standard procedure nor did they have enough nursing education, and (3) lack of audit system. To decrease the slip-out rate of the pigtail catheter, we discussed possible solutions after a period of 12 months (Apr. 2010 to Mar. 2011) and concluded as follows: (1) revising the standard drainage tube fixation technique, (2) using reminding marker, (3) giving the pigtail fixation method associated in-service education, and (4) making nursing audit tables and procedure audit tables. After 3-month application, the slip-out rate reduced to 1.1% from 8.2% and achieved the project goal. We would like to share this experience for reference of clinical nursing care.
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