高齡老人入院當時導尿管留置狀況之初探

The Preliminary Study on the Initial Use of Indwelling Urinary Catheters among Hospitalized Elderly Patients

標詩婷(Shih‐Ting Piao) ； 胡芳文(Fang‐Wen Hu) ； 張家銘(Chia‐Ming Chang) ； 陳清惠(Ching‐Huey Chen)

《護理暨健康照護研究》 9卷4期 (2013/12) Pp. 253-260

https://doi.org/10.6225/JNHR.09.4.253

摘要

背景：住院老人留置導尿管比率約73%，其中高達33%至49%為不恰當導尿管留置。不恰當留置導尿管不僅易產生多項併發症，甚至延長住院天數、增加醫療成本及死亡率，但台灣仍欠缺本土的實證資料。目的：調查台灣住院老人不恰當導尿管留置之發生率與原因。方法：採橫斷式相關性研究設計，以立意取樣調查台南某醫學中心到院後留置導尿管之老人共115位，資料收集包括人口學屬性及導尿管留置適應症，並於病患住院後48小時內完成。資料以描述性統計、兩組獨立樣本t檢定、卡方檢定進行分析，不恰當導尿管留置原因則以內容分析法呈現。以結構式問卷包括人口學屬性及導尿管留置適應症評量表收集資料。結果：不恰當留置導尿管發生率為37.4%。恰當留置原因以「手術需求」最多（43.1％），其次為「需要精確評估尿液輸出量」（37.5％），而不當留置原因以「照護方便」最多（62.8％），其次為「急性尿滯留未單導處理」（18.6％）及「其他」（18.6％）。統計分析結果顯示，恰當留置導尿管與不恰留置導尿管於人口學變項皆未呈現顯著差異。結論／實務應用：台灣住院老人超過三分之一為不恰當導尿管留置，甚至照護者常為求照護方便而忽略導尿管留置可能引發之相關合併症。因此，不僅醫護人員，連同病人與照顧者都應強化對恰當使用導尿管之觀念。

關鍵字

住院老人 ； 不恰當使用 ； 導尿管留置

並列摘要

Background: Approximately 73% of catheterized inpatients are elderly, of which up to 33%-49% are improperly used. Indwelling of urinary catheters (IUCs) are not only associated with prolong length of hospital stay, increase cost of treatment, but also associated with increased mortality rate. There are no studies explored the use of IUCs in Taiwan.Purpose: The aim of this study was to explore the incidence rate of inappropriate use of IUCs and the reasons for use of IUCs.Methods: A cross-sectional and correlation study design was used in the study. The subjects were selected with a purposive sampling method at a medical center in Southern Taiwan. A total of one hundred and fifteen hospitalized elderly patients who used indwelling urinary catheters after admission were recruited. Instruments included demographic sheet and the scale of indications for use of IUCs. Data were collected during 48 hours after admission and analyzed through descriptive statistic, chi‐square, and t‐test, and content analysis.Results: The incidence rate of inappropriate use of IUCs was 37.4%. The most common indication for appropriate catheterization was surgical intervention (43.1%), the second was accurate assessment of urinary output (37.5%). Moreover, the most common reasons that inappropriate IUCs use was for convenience (62.8%), the second was used for manage acute urinary retention without assessment (18.6%) and others (18.6%). The finding also indicated that there is no statistically significant difference in demographic variables.Conclusions/Implications for Practice: The results of this study clearly disclosed more than one‐third elderly patients in Taiwan are inappropriate use of IUCs. In order to make it easy to care, patients often ignore the compilations of use of IUCs. Therefore, education about appropriate use of IUCs should be available both for nurses, patients and caregivers.

並列關鍵字

hospitalized elderly ； inappropriate use ； indwelling urinary catheters

參考文獻

Apisarnthanarak, A., Rutjanawech, S., Wichansawakun, S., Ratanabunjerdkul, H., Patthranitima, P., Thongphubeth, K., … Fraser, V. J. (2007). Initial inappropriate urinary catheters use in a tertiary-care center: Incidence, risk factors, and outcomes. American Journal of Infection Control, 35(9), 594−599. doi:10.1016/j.ajic.2006.11.007

Apisarnthanarak, A., Thongphubeth, K., Sirinvaravong, S., Kitkangvan, D., Yuekyen, C., Warachan, B., … Fraser, V. J. (2007). Effectiveness of multifaceted hospitalwide quality improvement programs featuring an intervention to remove unnecessary urinary catheters at a tertiary care center in Thailand. Infection Control and Hospital Epidemiology, 28(7), 791−798. doi:10.1086/518453

Davoodian, P., Nematee, M., & Sheikhvatan, M. (2012). Inappropriate use of urinary catheters and its common complications in different hospital wards. Saudi Journal of Kidney Diseases and Transplantation, 23(1), 63−67. doi: 10.1016/j.eimc.2013.02.013

Edwards, J. R., Peterson, K. D., Andrus, M. L., Dudeck, M. A., Pollock, D. A., & Horan, T. C. (2008). National Healthcare Safety Network (NHSN) Report, data summary for 2006 through 2007, issued November 2008. American Journal of Infection Control, 36(9), 609−626. doi:10. 1016/j.ajic.2008.08.001

Fakih, M. G., Shemes, S. P., Pena, M. E., Dyc, N., Rey, J. E., Szpunar, S. M., & Saravolatz, L. D. (2010). Urinary catheters in the emergency department: Very elderly women are at high risk for unnecessary utilization. American Journal of Infection Control, 38(9), 683−688. doi:10.1016/ j.ajic.2010.04.219