降低血液透析室護理師執行動靜脈瘻管穿刺失敗率

Reducing the Rate of the Failure during the Execution of Arteriovenous Fistula (AVF) Punctures by Nurses in a Hemodialysis Center

動靜脈瘻管是血液透析病人之生命線，若經常發生穿刺失敗，容易導致瘻管狹窄或阻塞之合併症，而影響透析品質，本單位2012年動靜脈瘻管穿刺失敗率高達6.2％，故引發此改善專案之動機，期望藉由制訂穿刺技巧指引、辦理教育課程、經驗分享、種子人員臨床指導及宣導鈕釦孔穿刺法等改善措施，降低血液透析室護理師執行動靜脈瘻管穿刺失敗率，並提升護理師執行動靜脈瘻管穿刺技術自我滿意度。專案執行後其結果成效顯著，不僅穿刺失敗率由6.2％降至4.3％（降幅達31.0％）、護理師執行動靜脈瘻管穿刺技術自我滿意度也由77.9分提升至80.1分，顯示透過專案之執行，有效提升護理師之動靜脈瘻管穿刺知識與執行技巧，降低穿刺失敗率，進而提供優質的透析服務。

The arteriovenous fistula (AVF) is the lifeline of hemodialysis patients. Frequent AVF puncture failures increase the risk of complications such as fistula stenosis or obstruction that impact the quality of hemodialysis. The motivation for the project was an AVF puncture failure rate of up to 6.19% at our hemodialysis center in 2012.
The aim of the project was to reduce the rate of AVF puncture failures among nurses at the hemodialysis center. Improvements introduced included the defining of puncture technique guidelines, holding of education courses, sharing of puncturing experience between staff members, as well as clinical guidance and promotion of the button hole puncture technique by seed instructors. As a result, puncture failure rate was significantly reduced from 6.19% to 4.28%. The self-satisfaction score among nurses with their AVF puncture technique was also increased from 77.9 to 80.1. The implementation of the project effectively enhanced the knowledge and techniques of nurses on AVF punctures, reduced the rate of AVF puncture failures and enabled the delivery high quality nursing care to hemodialysis patients.