降低血液透析病人管重穿刺率

Reducing Re-puncture Rate of Shunt in Hemodialysis Patients

患者進行血液透析時，護理人員會在其管穿刺兩針，所以穿刺技術非常重要。本專案旨在減少在某一區域醫院血液透析室的重新穿刺率—定義為多少比例的患者在管的一處曾穿刺超過一次；實行專案前約為 5％。重新穿刺的因素有兩方面：護理人員方面是管評估不當、經驗不足；和缺乏指導病人如何照護管。病人方面的是管太腫、深、細或硬； 管不夠成熟；或對管的照護不當。重新穿刺會傷害管，也縮短使用壽命。藉由進行教育訓練和對患者進行管照護的指導，將重新穿刺率從 5％減少至 1.1％。而指導完成率，定義為護理同仁指導病人照護管的數個項目確實完成教導的比例，也由 60.5％提高到 91.4％。本專案顯著提高了照護品質，也提升透析效率，更增進醫護人員和患者之間的關係。

Patients undergoing long-term hemodialysis (HD) receive two punctures in their shunt during each treatment session in order to initiate HD so the puncture technique of nursing staff is very important. This study focused on how to reduce the re-puncture rate in a HD unit at a regional teaching hospital. The re-puncture rate is defined as the percentage of patients who had repeated puncture at one site and was at about 5% prior to our intervention. There are two perspectives to the factors that contribute to re-puncturing. The first perspective is that of the nursing staff: improper assessment of shunt and lack of experience; and patients not instructed on proper shunt care. From the patient’s perspective: the shunt is too swollen, deep, thin, or stiff; the newly-built shunt is not yet mature; and improper care of fistula by the patient. Re-puncturing not only harms the shunt but also shortens the life of vascular access. This project reduced the re-puncture rate from 5% to 1.1% through education and training for the nursing staff and instructing patients on shunt care. The completion rate of shunt care instruction was defined as proper execution of the items that should taught to the patients and this improved from 60.5% to 91.4%. The project significantly improved the quality of care, boosted the efficiency of dialysis treatment, and enhanced the relationship between medical staff and patients.