兒科病房非計劃性靜脈重注改善專案

A Project of Improving Unplanned Re-Catheterization Intravenous in Pediatric Ward

週邊靜脈輸液治療是住院病童最常遇到之醫療措施，亦是病童住院中的主要壓力源之一。多數病童缺乏自我照顧能力，在其輸液過程中，若照顧者或護理人員未提供妥善照護，則易發生導管阻塞、浸潤等問題，致必須重新注射。本專案目的在降低兒科病房非計劃性靜脈重注率。筆者針對兒童內科病房中接受靜脈輸液治療之病童，探討其接受非計劃性靜脈重注之原因，結果發現主要原因為局部腫脹及輸液導管阻塞；而分析局部腫脹導因以注射處吸收不良及藥物滲漏為主，導管阻塞導因則以接頭鬆脫及未注意點滴瓶高度等造成回血凝固為最多，以上因素除導致病童須再次接受靜脈注射，亦造成護理工時及醫材之耗損。本專案藉由：人員在職教育、改善注射部位固定方式、製作「點滴注射叮嚀小卡」、制定監控機制等方案進行改善，結果顯示靜脈重注率由原22.5％降低為5.8％，護理工時每週由1540.35分鐘降低為1149.15分鐘，醫材耗費每週亦由7371元減少至1872元。本專案改善具顯著成效，提高護理照顧品質與降低成本，可作為兒科臨床護理之參考。

The purpose of this project was to reduce unplanned re-catheterization intravenous injection. Factors associated with re-catheterization intravenous therapy were identified, including local swelling of an insert site and obstruction of a transporting tube. The major causes associated with local swelling of an insertion site were insufficient absorption of the fluid and medication leakage within the insertion site. The components associated with the obstruction of the transporting tube were due to displacement of a connector and inappropriate distance from the insertion site to the IV (intravenous) bottle. All these factors resulted in increasing nursing efforts and wasting the medical materials. Thus, a continuous nursing education in relation to intravenous injection was designed and applied. An IV caution card was hanged on the IV bottle. The results revealed a decrease in the re-catheterization rate from 22.5% to 5.8%. In addition, both nursing workload and expurgate medical material were reduced. The results of this study presented an improving of re-catheterization of intravenous injection, and improving quality of nursing.