人工腎臟凝固率之改善專案

Reduce the Severity of Blood Clotting in Dialyzer

末期腎病病人需長期依賴透析治療來移除體內的毒素與水分，而血液透析治療是台灣現階段最主要的治療方式。執行透析的過程中，病人因人工腎臟凝固而導致血液流失，將會加重貧血的症狀，且無法達到適量的透析。本專案是針對導致人工腎臟凝固的四項主因：血流不足、抗凝劑不足、抗凝劑劑量錯誤、未用生理食鹽水灌洗；提出改善措施：（一）制訂抗凝劑使用之標準作業流程、（二）制訂暫時性雙腔廔管自我照護衛教單、（三）加強護理人員依標準作業流程執行之確實性、及病人廔管通路自我照護和血壓控制衛教。因專案的施行，人工腎臟凝固率由11.4%降至3.4%，不但改善病人貧血的狀況，降低醫療成本的支出，也達成提升病人透析品質及提供病人最佳的護理服務。

In order to remove toxins and excess water from their body, patients with end-stage renal disease (ESRD) rely on long-term renal replacement therapy, of which hemodialysis is the most popular choice in Taiwan. Because of dialyzer clotting, the patient will lose blood during hemodialysis, resulting in inadequate dialysis as well as anemia. Regarding the four main causes of dialyzer clotting: low blood flow, low anticoagulant, wrong dose of anticoagulant, and non normal saline flush, this project offers methods to improve hemodialysis, as follows: (1) standardization of the dose of anticoagulant; (2) providing a list of self-care steps when using a temporary catheter; (3) ensuring that nursing staff will follow the standard procedure of nursing and that patients will follow the standard procedure to take care of the vascular access and control their blood pressure. As a result, this project not only reduced the rate of dialyzer clotting from 11.4% to 3.4% but also ameliorated the resulting anemia. It also decreased the cost of the treatment, achieved adequacy of dialysis, and offered the best nursing care for the patients.