降低血液透析病人血管通路異常之改善專案

Reduction of Occurrence of Blood Vascular Access Abnormalities in Patients with Hemodialysis

彭碧慧(Pi-Hui Peng) ； 劉佩珍(Pei-Zhen Liu) ； 賴思妤(Su-Yu Lai)

《領導護理》 10卷3期 (2009/12) Pp. 109-120

https://doi.org/10.29494/LN.200912.0011

摘要

血管通路是透析病人的第二生命，尤其血液透析病人每週需面對三次的血管穿刺，若血管通路發生異常，例如血管阻塞、出血或血管狹窄，不但增加病人和家屬之困擾及醫療人力時間的浪費，亦影響透析效果及生活品質，嚴重時甚至造成生命威脅，攸關醫療品質及病人安全，因而引發本小組執行此專案的動機，於2008年7月1日至12月31日期間，針對常規透析病人做查檢，追溯2008年01至06月，得知透析總人次爲19,885人次，血管通路異常人次爲101人次，血管通路異常率爲5.10%。針對現況問題，提供在職教育，確認護理人員能提供正確之護理措施及衛生指導，訂立「透析病人衛教執行率稽核表」以及「透析護理紀錄完整性稽核表」稽核同仁是否落實執行標準照護，確認病人是否獲得應知道之相關照護技巧後，病人血管通路異常率也顯著下降至2.0%，經以上改善措施，提昇更優良的護理照護，讓透析病人維持良好之生活品質。

關鍵字

血管道路 ； 血液透析

並列摘要

Blood vascular access is viewed as a second life to a patient with hemodialysis. Therefore, it is especially vital to keep the blood vascular access open for patients who need to puncture blood vessels prior to each hemodialysis, that is, three times every week. The occurrences of blood vascular access abnormalities such as occlusion, bleeding, or narrowing of blood vessels are not only troublesome to the patient and family and time-consuming for the medical professionals to repair, but also affects the effectiveness of hemodialysis and the patient's quality of life. The abnormalities could also lead to a life-threatening situation impacting the hospital's quality of care and the patient's safety. A project team was established with the intention of reducing the occurrence of blood vascular access abnormalities. The patients regularly receiving hemodialysis between July 1 to December 3, 2008, were examined, and the medical records of patients who received hemodialysis between January to June, 2008 were reviewed. During this period of time, the total number of hemodialysis performed was 19,885, and the number of occurrences of blood vascular access abnormalities was 101, i.e. 5.1% occurrence rate. The strategies to solve the problems regarding blood vessel access abnormalities included the provision of patient education with accurate information on nursing interventions and infection control. The monitoring forms were adopted to ensure that the nurses follow the care standards in providing patient education and completing nursing documentation during hemodialysis, and to teach patients hemodialysis-related care skills. With the implementation of the above strategies, the occurrence rate of blood vascular access abnormalities dramatically dropped to 2%, quality of nursing care was promoted, and patients' quality of life was improved.

並列關鍵字

vascular access ； Hemodialysis