以多媒體教學介入透析病人血管通路穿刺異常之改善專案

Improving Solutions to Vascular Access Problems with Hemodialysis Patients through Multimedia Teaching Intervention

血液透析病人每個月平均需接受十三次的透析治療，換言之，每年約有300多次穿刺的機會。一旦穿刺失敗或異常，除造成管損傷影響透析效果引發各種合併症外，甚而危及病人生命安全。故良好的穿刺技術，對動靜脈管的維護尤其重要。專案小組根據2010年4月1日～4月30日資料收集得知，血管通路穿刺異常率為千分之16.4 per mille。經分析發現導致穿刺異常之原因有：護理人員專業知識與技能不足、護理人員未按標準作業執行評估、單位訓練工具不足等。經採多媒體教學，包括血管通路學習書、管穿刺教學手冊、血管通路穿刺DVD教學檔、血管潮音辨識教學音檔及以假手臂訓練穿刺之技能後，筆試成績由73.2分提升為92.2分，假手臂穿刺成功率由80%提升至100%，血管穿刺異常率也由千分之16.4 per mille降為千分之6.9 per mille。且在血管正、異常潮音之分辨，亦有明顯進步。由此可知，藉由多媒體教材進行完整一致的教育訓練，確能改善血管穿刺異常率。故將此改善措施，列為單位教育訓練之重點項目，並落實於臨床實務之運作。期能改善病人透析效果及生活品質外，更能提升透析護理人員之專業技能。

A hemodialysis patient undergoes around 300 puncture procedures per year, and a failed access procedure could cause injury of the fistula, and also results in a number of possible complications. Our data analysis revealed the following factors leading to puncture failures: 1) Nurses are not knowledgeable or skillful enough to handle the procedure. 2) Nurses failed to assess situation or execute procedure according to the standard operating procedures. 3) The organization is not adequately equipped to provide the necessary personnel training. A marked improvement in performance was noted after employing multimedia aid in providing personnel instructions, including aids such as, vascular access textbooks, fistula access teaching manuals, vascular access teaching DVD files, vascular sound identification teaching sound file, and artificial arm puncture technique skill training sessions. Written test scores improved from 73.2 points to 92.2 points; success rates of artificial arm puncture procedures rose from 80% to 100%; and the vascular puncture failure rate dropped from 16.4 per mille to 6.9 per mille. It is apparent from the foregoing that use of multimedia teaching aids in the course of the orientation and training classes could indeed decrease the vascular puncture failure rate.