降低心導管術後鞘管留置病人腰背酸痛發生率

Reducing the Incidence of Back Pain in Post-Percutaneous Coronary Intervention Patients With Femoral Sheath

背景：心導管術後因鞘管留置，患肢需被制動及臥床休息，造成病人發生腰背酸痛發生率高，容易讓病人心煩不安而影響其心臟的康復。本單位經股動脈心導管術後病人腰背酸痛＞ 3分的發生率為100%，酸痛指數平均6分，分析主要原因為：護理師對心導管術後產生腰背酸痛及肢體活動的認知不足、缺乏肢體活動指引與未列入稽核、缺乏肢體活動指導與教材。目的：心導管術後肢體活動指導完整率提升至90.0%；心導管術後腰背酸痛分數＞ 3分發生率降至35.0%。解決方案：藉由執行在職教育訓練，製作並運用肢體活動多媒體衛教影片、護理指導單張與品管稽核等策略。結果：心導管術後肢體活動指導完整率由32.5%提升至90.0%，心導管術後病人腰背酸痛＞ 3分的發生率由100%降至26.8%。結論：本專案經由加強心導管術後肢體活動指導，輔以多媒體教材指導，並將護理指導納入品管稽核等措施，確實能有效降低心導管病人腰背酸痛之不舒適感。 Background & Problems: Patients undergoing percutaneous coronary interventions (PCIs) are restricted to bedrest and immobilization of the affected leg for sheath retention. These result in high incidences of back pain and emotional irritation, which may negatively affect cardiac rehabilitation. One-hundred percent of the post-transfemoral PCI patients in our unit had a back-pain score of 3 or higher, with an average pain score of 6. Analysis showed the main causes to be: poor awareness of nurses regarding back pain and physical activity; lack of physical activity guidelines and no regular auditing of physical activity; and lack of education and related materials. Purpose: To increase the completion rate of instruction for physical activity to over 90.0% and to reduce the incidence of back pain (score of 3 or higher) among post-PCIs to 35.0% or less. Resolutions: We conducted in-service education, revised related instruction materials, filmed the recommended physical activity for post-PCIs, and conducted a quality assurance audit. Results: The completion rate among post-PCIs for the instructions for physical activity increased from 32.5% to 90.0%. The incidence of back pain (score ＞ 3) reduced from 100% to 26.8%. Conclusions: Implementing a physical activity education program with multimedia materials and regular audits effectively reduces the discomfort of patients following PCIs.

Background & Problems: Patients undergoing percutaneous coronary interventions (PCIs) are restricted to bedrest and immobilization of the affected leg for sheath retention. These result in high incidences of back pain and emotional irritation, which may negatively affect cardiac rehabilitation. One-hundred percent of the post-transfemoral PCI patients in our unit had a back-pain score of 3 or higher, with an average pain score of 6. Analysis showed the main causes to be: poor awareness of nurses regarding back pain and physical activity; lack of physical activity guidelines and no regular auditing of physical activity; and lack of education and related materials. Purpose: To increase the completion rate of instruction for physical activity to over 90.0% and to reduce the incidence of back pain (score of 3 or higher) among post-PCIs to 35.0% or less. Resolutions: We conducted in-service education, revised related instruction materials, filmed the recommended physical activity for post-PCIs, and conducted a quality assurance audit. Results: The completion rate among post-PCIs for the instructions for physical activity increased from 32.5% to 90.0%. The incidence of back pain (score ＞ 3) reduced from 100% to 26.8%. Conclusions: Implementing a physical activity education program with multimedia materials and regular audits effectively reduces the discomfort of patients following PCIs.