動靜脈血管照護改善專案

Improving Nursing Care for Arterio-venous Fistula

經常的瘻管衰竭會導致不適量透析，增加醫療成本，影響生活品質。本院2008年動靜脈瘻管重建率大於健保局閾值2／百人月，故專案目的期望將瘻管建率降至1.07／百人月。由統計分析發現血管加壓不當導致血管阻塞、血管狹窄導致血流過小及脫水量過多導致透析中血壓降低是造成血管衰竭的主要原因，藉由重新制訂穿刺標準技術－－採用鈕扣式穿刺法、舉辦穿刺技術訓練、建立體重雙重確認方式、透析中及透析結束標準作業流程，瘻管重建率由2.14／百人月降至0.4／百人月、重建成本由1,178,800元降至487,600元、病人對護理師專業技術滿意度由85.6分進步至93.8分，透過本專案之執行能增進同仁創意思考與專業能力，病人獲得更佳的照護品質。

Frequent arterio-venous fistula failure may lead to inadequate dialysis, increased medical cost,and impaired quality of life. In our institute, the incidence of arterio-venous fistula failure was higher than the standard defined by Bureau of National Health Insurance (2 episodes per 100 patient-month). The purpose of this project was to reduce incidence of arterio-venous fistula reconstruction to 1.07 episodes per 100 patient-month. Analysis identified improper compression leading to shunt thrombosis, stenotic arterio-venous fistula and higher ultrafiltration rates as potential factors leading to access failure. Several initiatives were adopted to improve access patency rates: (1) standardized puncture protocols including the adoption of the Button-Hole-Method; (2) ensuring protocol compliance through education; (3) adding double-checking of body weights to the SOP; (4) defining a SOP dialysis and end of dialysis. After the intervention, incidence of arterio-venous fistula reconstruction declined from 2.1 to 0.4 episodes per 100 patient-month, the cost from arterio-venous fistula reconstruction declined from NT$1,178,800 to NT$487,600 and Patient Satisfaction score increased from 85.7 to 93.8. The execution of this project helped to improve the creative thinking and professional skills of nursing personnel and also improved the quality of care for patients.