末期腎病血管通路照護方案成效之探討

A Strategy for Improving Nursing Care of Vascular Access in Patients with End Stage Renal Disease

本研究之目的主要探討末期腎病患者廔管通路的穿刺異常情形及失敗原因，藉由主護護理介入措施，期待降低病患廔管通路的穿刺失敗率。研究族群為本院末期腎病患者且接受長期血液透析治療之門診病患，以類實驗設計研究，為期三個月。結果發現：廔管穿刺總失敗率由3.44%下降為2.94%；動脈穿刺失敗率由1.05%降為0.98%；靜脈穿刺失敗率由3.73%降為3.03%；一年內新進護理人員的失敗率，由22.15%降為17.59%。由此可知，主護護理可降低廔管穿刺異常。建議臨床病人的照護上，可採用主護護理，以促進新進護理人員對於病患廔管的熟悉度，進而減少其護理人員穿刺時的挫折感並延長患者廔管通路的壽命。

This study explored the (1) unusual vascular access puncture, and (2) the reason for puncture failure in End Stage Renal Disease (ESRD) patients. Through the implant of primary nursing care system, we expect to improve puncture failure rate in those patients. The population for f this study is based on existing ESRD patient with regular hemodialysis therapy in our center. We implemented primary nursing care system to every subject. Total follow-up was three months. Results showed that the total rate of puncture failure was improved from 3.44% to 2.94%. Artery access puncture failure improved from 1.05% to 0.98%; puncture failure on vein access improved from 3.73% to 3.03%; and puncture failure of the junior dialysis nurse (first-year) improved from 22.15% tol7.59%. The results of this study show that primary nursing care can help nurses become more familiar with patients' vascular access, and can also reduce the nurse's frustration, as well as decrease the puncture failure rate. Therefore, it can prolong vascular access function.