血液透析病患雙腔導管照護之改善方案

Improvement of Double Lumen Central Catheter Care in Patients Receiving Hemodialysis

血液透析病患因放置雙腔導管，需接受雙腔導管照護，傳統方式多以紙膠固定管路而加重皮膚搔癢不適，易造成病患身體心像改變、活動受限及個人衛生清潔困擾，進而影響透析病患生活品質。本單位護理人員對照護技術的教導僅為口述指導或個人經驗分享，缺乏照護技術一致性及在職教育，導致雙腔導管照護正確率僅69.4%，病患對護理人員執行雙腔導管照護技術滿意度僅74.1%。經專案小組：修訂雙腔導管照護技術標準、換藥方式及用物準備標準；運用單位護理創新作品「雙腔導管固定袋」；製作雙腔導管照護技術教學光碟及手冊；舉辦雙腔導管照護技術在職教育；實施雙腔導管照護技術監測。雙腔導管照護執行正確率由69.4%提升至91.2%，病患滿意度由74.1%提升至83.1%，達專案目的。

Patients receiving hemodialysis have a double-lumen central catheter inserted in their bodies. The traditional method of catheter care was to secure the catheter to the skin with a piece of paper tape. It caused patient discomfort secondary to itching, patient body image change, limitation of patient daily activities, and further negative impacts on patient quality of life. Patient education on catheter care was focused on verbal guidance and personal experience sharing. Teaching care techniques were inconsistent, and nursing on-job in-service training were missing. Studies showed that patient satisfaction of the accuracy of catheter care teaching was only 69.4%, and 74.1% of the catheter care itself. The project team revised double-lumen catheter care standards and the dressing change procedure. A catheter bag was created to secure the double lumen catheter. Compact disks with handbooks for double lumen catheter teaching were produced for friendly usage. Continuing education training on the subject of double-lumen catheter care were also held for nurses. Quality monitoring on catheter care was implemented. With these interventions, the accuracy of catheter care teaching was improved from 69.4% to 91.2%, and the patient satisfaction level increased from 74.1% to 83.1%. The goal of the improvement project of double lumen central catheter care for patients receiving hemodialysis was achieved.