血液透析患者使用永久性血管通路之評估與護理

The Assessment and Nursing Care of Permanent Vascular Access in Patients Receiving Hemodialysis

據統計，在美國有超過40萬的病患被診斷為慢性腎臟疾病（chronic kidney disease, CKD）第五期，且須進行腎臟替代治療（renal replacement therapy），在這其中最常使用的治療方式即為血液透析（hemodialysis）治療。當病患進行血液透析治療時需裝置暫時性或永久性的導管，而對於這些導管的照護品質直接與病患的罹病率與死率息息相關。因此，本文基於2006年美國腎臟學會（National Kidney Foundation）所發展出的美國國家腎臟基金會（Kidney Disease Outcomes Quality Initiative, KDOQI）針對血管通路之指引為標準，並佐以較近期之研究文獻，對於血液透析病患使用永久性的血管通路的型態、合併症、臨床評估、以及護理措施做一敘述，可以做為臨床護理人員照護永久性血管通路的參考。

Dialysis can serve as a bridge to renal transplantation or as a permanent treatment for end-stage renal disease when transplantation is not an option. Vascular access for dialysis can be through any temporary catheter and/or a more permanent access created for chronic dialysis. Quality of vascular access has a remarkable influence in hemodialysis patient outcomes.The latest KDOQI (Kidney Dialysis Outcome Quality Initiative) guidelines published in 2006 address the parameters for adequate of hemodialysis treatment. Using the KDOQI guidelines as the basis, this paper covers the different types of permanent vascular access, complications, clinical assessment and nursing interventions. The information will hopefully provide clinical nursing personnel with a guide to best practice for permanent vascular access care.