降低暫時性血液透析導管引發之血流感染率

Decreasing the Bloodstream Infection Rate for Temporary Catheter-Related Hemodialysis

血液透析病患在動靜脈導管未能使用前，需置入暫時性血液透析廔管接受洗腎，最常見且嚴重的合併症是廔管引起的血流感染，不但加重病情的變化，也耗費醫療資源及影響照護品質。93年4-8月本單位暫時性血液透析廔管引起之血流感染率平均為10.71‰，佔血流感染的80%。其要因有暫時性血液透析廔管換藥過程不完整、廔管置入過程不完整、廔管放置過久、傷口評估不確實。透過換藥流程標準化、落實廔管置入過程完整性、按時廔管及傷口評估表與換藥記錄單之制訂與執行，93年9月到94年1月感染率下降至2.65‰，目標達成率為188.3%，進步率為75.3%。此專案能確實提供對暫時性血液透析廔管之執行準則外，也可有效降低廔管相關之血流感染率，對臨床頗具效益。

Before the adoption of the arteriovenous fistula, a temporary hemodialysis catheter is introduced into patients who need dialysis therapy. The most common and severe complication is the catheter-related bloodstream infection. This infection not only exacerbates the patient's condition and consumes the medical resources, but also influences the quality of care. From April to August 2004, the average temporary hemodialysis catheter-related infection rate was 10.71‰ in our ward. The infection reached 80% of the bloodstream. The main causes are imperfect dressing changes, imperfectly catheter implantation, long-term implantation, and inaccurate wound evaluation. The infection rate decreased to 2.65‰ from September 2004 to January 2005 after the following steps were taken: standardization of dressing changes, integrity of catheter implanted implementation, prompt removal of the catheter, establishment and execution of recordkeeping formats of both wound evaluation and dressing-change processes. The goalachievement rate was 188.3%, and the progress rate was 75.3%. Thus we concluded that this project not only provided an effective guideline for execution of temporary hemodialysis catheters, but also effectively decreased the catheter-related infection rate. Both results are beneficial to our clinical works.