應用無針式密閉系統裝置於血液腫瘤病患中心靜脈導管照護上之成本與效益分析

Cost and Effectiveness of Applying Needleless Closed System Device on Central Catheter Care for Hemato-Oncology Patients

張雪梅

血液腫瘤 ； 血流感染 ； 滿意度 ； 成本效益 ； Hemato-Oncology ； Bloodstream Infection ； Patient Satisfaction ； Cost Effectiveness

臺北醫學大學護理學系碩士暨碩士在職專班學位論文

2005年

碩士

盧美秀

繁體中文

血液腫瘤病患的治療經常需接受中心靜脈導管留置注射，在治療過程中容易遭受感染的侵犯與威脅，本研究目的是希望了解與比較血液腫瘤病患使用無針式密閉系統裝置與一般注射帽在中心靜脈導管上相關血流感染率、服務滿意度、醫療成本上之差異及何者較具成本效益。 本研究採前瞻性隨機研究設計，針對台北市某醫學中心血液腫瘤專科性病房，接受中心靜脈注射治療的病患，以隨機分派方式分配為實驗組與對照組，實驗組為使用無針式密閉系統裝置，對照組則接受一般注射帽處置。 總共收案28人，實驗組與對照組各14人，兩組診斷上以淋巴瘤與急性骨髓性白血病為多，對照組的平均住院天數較實驗組多出3.9天（t＝-.898; P=.378），兩組各項基本資料統計檢定結果分析，均未達統計上顯著差異。 研究結果在導管血流感染方面，產生導管相關之血流感染有5人，兩組在導管相關的血流平均感染率上分別為實驗組1.3?、對照組1.95?，對照組感染率較高。受到感染的個案以白血病病人為多，有感染病患較未感染病患的平均住院天數多出11.8天（t＝2.23; P=.035），達到統計上顯著差異，顯示有感染病患其住院天數較未感染者長。 在服務滿意度方面，對照組在注射接頭的重量、體積大小、外觀及顏色上，表達非常滿意者較多，但未有統計上顯著差異，在操作技術上實驗組感到非常滿意者較多，在使用前衛教上實驗組非常滿意者多於對照組，並有統計上顯著差異（t＝2.841; P= .010），顯示實驗組病患對於使用前衛教較對照組滿意，在整體服務上兩組沒有統計上顯著差異。 醫療成本與效益分析上，實驗組的效益為92,018元，對照組是99,930元，每增加1人感染其就需增加115,755元。故雖然無針式密閉系統裝置其單價成本較高，但其醫療效益上較一般注射帽有成效。 本研究結果顯示對於血液腫瘤病患高感染群，在導管照護上應適時應用避免感染的裝置，減少感染機會的發生，降低醫療成本的耗用與提升照護上的品質。

Introduction: Because the hemoato-oncological patients receiving frequent central venous catheter injection during treatment course are prone to be threatened by infections; therefore, the purposes of this study were to understand and analyze the differences of blood stream infection rates, service satisfactory rate, and medical costs between the needleless closed system device and the common intravenous lock. Method: The design was prospective randomized study. Totally, twenty eight patients were enrolled, who received central venous catheter injection therapy in a hemato-oncological ward of medical center in Taipei. Fourteen patients were randomized into the experimental group using needleless closed system device and the other 14 into the control group using intravenous lock. Most patients were diagnosed as lymphoma and acute myeloid leukemia. The average length of hospital for the control group was 3.9days longer than the experimental group (t=-.898; P=.378). There was no significant difference at baseline between groups. Results: Catheter related blood stream infection occurred in 5 patients. Average catheter related bloodstream infection rate was 1.3 ? in the experimental group and 1.95 ? in the control group. Infected patients mostly belonged to leukemia and had statistically significant 11.8 days longer hospital stay than control group (t＝2.23; P=.035). As regarding to the service satisfaction, higher satisfaction rate was found in the control group about the weight of injection connector, size volume, appearance and color. The experimental group had higher satisfaction about the manipulation technique and the education prior to the usage and showed statistical significance (t＝2.841; P= .010 ). However, no significant. difference was found between groups about the entire service. The cost in experimental group was NT 92,018 dollars with respect to NT 99,930 dollars in the control group. Since the cost increased NT 115,755 dollars in each infection patient, needleless closed system device with higher single unit price had more benefit than usual intravenous lock. Our study showed appropriate use of needleless closed system device in care of intravenous catheter may decrease the infection rate for hemato-oncological patients, reduce medical cost and improve the quality of patient care. Key word：Hemato-Oncology, bloodstream infecton, patient satisfaction, cost-effectiveness

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