降低人工腎臟凝固率專案

Reduce the Severity of Blood Coltting in Dialzer

血液透析是尿毒症病患的主要治療方式之一，在血液透析過程中，若發生人工腎臟凝固，不但加重病患貧血問題，降低透析品質，亦增加醫院成本的支出及人力的浪費。由於在臨床上曾發現人工腎臟凝固與監測有不符之現象，因此本專案針對血液透析病患發生人工腎臟凝固現象問題進行查檢，經自擬之查檢表，對於造成人工腎臟凝固，提出之解決辦法有（一）穿刺技術再教育（二）正確執行透析技術及抗凝劑流程（三）輸血技術標準化（四）護理評估及記錄之完整性。並修訂相關之標準技術，作為臨床作業之準則。結果，本單位之人工腎臟凝固率由10.8%降至3%，更因而節省了更換人工腎臟相關耗材及人力成本等費用，一年約可節省94萬元，不但提高了病患透析品質，也有效降低醫療成本。

Hemodialysis (HD) is one of the major treatment modalities for uremic patients. If blood clotting in the dialyzer develops, it may aggravate anemia during HD, reduce the adequacy of dialysis, and increase the cost and workload of the nursing staff. Clinically, it's not uncommon to observe a discrepancy between the true frequency of blood clotting in a dialyzer and the monitor records. In this project, we used the following method to perform inspections and verify the self-checklist to manage dialyzer clotting in HD patients. First, puncture technique re-training; second, correct hemodialysis technique & anticoagulant processing; third, blood transfusion technique standardization; and fourth, nursing assessment & complete record. We also revised the related standard procedures as clinical guidelines .As a result, we reduced the percentage of dialyzer clotting from 10.8% to 3%. This reduced the necessity for dialyzer replacement and labor cost. It can save about nine hundred and forty thousand NT dollars per year, and enhanced the quality of dialysis.