提升透析中心護理人員動靜脈瘻管穿刺技術正確率

Improve the accuracy of arteriovenous fistula puncture skill among hemodialysis center nurses

動靜脈瘻管為透析病人的第二生命線，在透析過程中每週需接受三次的血管穿刺，所以護理人員在執行穿刺技術時的正確性就相對重要，這不僅會影響病人透析效果和生活品質，也會間接影響病人就醫選擇之意願。因此本專案目的在提升護理人員動靜脈瘻管穿刺技術正確性之成效，經由實地觀察及查檢透析中心護理人員有關動靜脈瘻管穿刺技術正確率僅54.9%，分析原因確立問題其主要原因為：護理人員不清楚下針角度、參照舊針孔下針、無技術指導課程、無作業標準以及不清楚正確瘻管穿刺技術。針對上述問題擬定改善對策及實施包括：制定瘻管穿刺作業標準書、規劃臨床技術指導課程、建立血管圖、製作影音多媒體學習光碟、增購遠紅外線照射儀。經改善方案實施後，護理人員對動靜脈瘻管穿刺技術正確率由54.9提升至92.0 %；同時對整體滿意度結果由改善前78%上升至87%。本專案發現運用有效的方法與政策的推動，不但可增加護理人員動靜脈瘻管穿刺技術的正確率，同時也能提升病人對護理服務的整體滿意度。

Arteriovenous fistula is the lifeline for hemodialysis patient and punctures must be made three times a week during hemodialysis. Proficiency with fistula punctures among nursing staff is therefore critical to hemodialysis efficacy and quality of life for the patient as well as the willingness of the patient to accept medical treatment. The purpose of this project was to improve the accuracy of arteriovenous fistula puncture skill among nursing staff. At the initial investigation, the accuracy of arteriovenous fistula puncture performed by nursing staff was only 54.9%. The main causes were not knowing the correct angle of puncture, punctures based solely on previous puncture scars, no technique training courses, no standard procedure guidelines and not knowing the correct arteriovenous fistula puncture technique. To correct these problems, our strategies included developing a standard procedure for fistula puncture, arranging for clinical technique training courses, establishing a vessel map, producing a multimedia learning CD-ROM, and purchasing a far-infrared irradiation machine. After the implementation of the reform strategies, the accuracy of arteriovenous fistula puncture improved from 54.9% to 92.0%. The overall satisfaction rate was also increased from 78% to 87%. This project discovered that effective measures and policies not only improved the accuracy of arteriovenous fistula puncture technique, but also increased the overall satisfaction of the nursing staff.