血液透析穿刺針固定方法之改善專案

A Project for Improving Fixing Methods for Hemodialysis Puncture Needle

穿刺針的固定方法對一位接受血液透析個案而言是重要的，只要有些許的不牢固都可能導致失血的危險。依據本單位2001年至2004年不良事件統計發現每年皆有1-2件穿刺針滑脫事件；其滑脫原因除自拔者外皆與固定方法不良有關，經由要因分析整理出主要原因為：固定方法之標準作業不理想、病人之個別性問題（需額外增強固定方法）。本專案將傳統直式固定法改為U型固定法並增加固定紙膠的長度；對於需要額外加強固定者則使用彈性止血帶輔助。於一年後統計穿刺針滑脫件數則已降到零發生率且於執行後病患及護理人員的滿意度亦明顯提昇。本專案實施結果，達到降低血液透析患者穿刺針滑脫之目的及提升病人透析照護之安全品質；希望藉此專案與其他同儕分享，並尋找出更佳之透析針固定法以減少個案之傷害。

The fixing method used to make a needle puncture is very important to a person receiving hemodialysis treatment. Even minor looseness may cause bleeding. Based on our statistics of accidents from 2001 to 2004, we found 1~2 accidents each year that were caused by puncture needles slipping-out. Reasons for slip-outs included being pulled out by patients or being fixedimproperly. These are categorized as: defects in traditional vertical methods of fixing, and individual patients' cases (which required stronger fixing methods). The project used U-type fixing methods which could be strengthened fixing by an elastic tourniquet for patients that need the reinforcement. One year later, the accidents caused by needle slip-outs were reduced to zero, which significantly increased satisfaction among both patients and nursing staff. The implementation of the project was helpful to achieve the objective of keeping puncture needles in place and promoting the health-care quality of hemodialysis patients. We would like to present it as a reference to other medical staff to attain better fixing methods for puncture needles to reduce injury.