降低血液透析後動靜脈瘻管穿刺部位滲血率專案

A Project to Reduce the Blood Loss Rate of Fistula Puncture Site after Hemodialysis

本專案旨在降低血液透析後動靜脈瘻管穿刺部位滲血率，以增進血液透析照護品質。血液透析動靜脈瘻管的照護對末期腎衰竭病人而官是極為重要的，透析後穿刺部位止血影響著瘻管功能，只要有些許不慎將會造成病人傷害。經分析發現主要滲血原因為止血時沒有壓對點(44.3%)、止血力道太輕(27.0%)、止血知識不足(9.0%)為多，佔80.3%，本單位瘻管穿刺部位滲血率為10.6%；經文獻查證及討論後，於2007年10月至2008年2月期間進行對策實施：修訂動靜瘻管穿刺部位止血標準作業規範，以2.5×2.5×0.5立方公分小紗進行加壓止血、以徒手加壓止血法進行止血至少10分鐘、提升病人對動靜脈瘻管穿刺部位止血相關知識等方法，來改善病人透析後滲血問題。結果：在對策實施第一個月後滲血率由10.6%降低至4.4%，對策實施第三個月後降低為2.12%。本專案能降低病人血液透析後動靜脈瘻管穿刺部位止血滲血率，並維護動靜脈瘻管功能。

The aim of the project was to reduce the bleeding rate at the arteriovenous fistula puncture site during hemodialysis to enhance the quality of dialysis care. The care of the arteriovenous fistula is very important for hemodialysis patients. Hemostasis of fistula puncture site after hemodialysis influences the function of arteriovenous fistula. Even a minor oversight can harm the patient. Project analysis found that in 80.3% of all cases blood loss was caused by wrong compression site (44.3%), inadequate compression pressure (27.0%) and poor knowledge of hemostasis (9.0%). The blood loss rate of fistula puncture site was 10.6% in our hemodialysis facility. After a literature review and discussions, a project was launched between October 2007 and February 2008 to modify the guidelines for hemostasis of fistula puncture site including usage of a 2.5×2.5×0.5 cm3 gauze for hemostasis, manual compression for 10 minutes or longer to attain hemostasis, and promoting knowledge of hemostasis for fistula puncture sites. Result: In the first month, blood loss rate dropped from 10.6% to 4.4% and after the first three months dropped to 2.12%. The project was therefore effective in reducing blood loss rate of fistula puncture site after hemodialysis and protecting the function of the arteriovenous fistula.