降低血液透析後病人動靜脈瘻管穿刺部位滲血率

Reduce the Bleeding Rate of Puncture Site of A-V Shunt in Hemodialysis Patients

動靜脈瘻管為末期腎衰竭病人進行血液透析主要通路；某醫學中心於2013 年1-3 月連續發生兩起因血液透析後動靜脈瘻管穿刺部位滲血影響瘻管功能事件。藉專案資料收集發現造成瘻管滲血原因如下：一、病人與護理人員對瘻管加壓止血知能不足；二、缺乏動靜脈瘻管加壓止血照護相關規範；三、缺乏具體可測量動靜脈瘻管加壓止血教具。為了有效改善滲血問題，予擬定解決方案：一、加壓止血床邊教學指導；二、製作加壓止血提醒小卡；三、安排動靜脈瘻管照護在職教育課程；四、培育瘻管加壓止血臨床種籽；五、增修動靜脈瘻管加壓止血照護規範；六、擬定新病人衛教流程；七、研發加壓止血教具。本專案於2013 年6 月執行，同年11 月調查400位透析病人評估本方案執行成果，結果發現血液透析後動靜脈瘻管刺部位滲血率由19.9％降至4.5％，持續追蹤至2014 年3 月皆低於標準值6％。最後，期望透過本專案提供之內容，以能幫助血液透析病人在臨床治療上有更好的醫療品質。

 

The arteriovenous (A-V) shunt is the main pathway for hemodialysis in patients with end stage renal failure. In a medical center from January to March in 2013, two patients had A-V shunt bleeding after hemodialysis and it affected the function of fistula. After data collection, we found the possible reasons of the accident were as follows: (a) The patients and nurses lacked the knowledge on how to prevent A-V shunt bleeding; (b) There was no standard protocol to control the hemostasis of A-V shunt after hemodialysis; (c) There was no teaching instrument to measure the hemostatic pressure of A-V shunt. To effectively improve the condition of bleeding in A-V shunt, we provided solutions for patients and nurses. (a) To offer clinical guidance for hemostasis; (b) To make reminder cards of hemostasis; (c) To provide arteriovenous fistula care on-the-job education; (d) To educate clinical nurses on arteriovenous fistula hemostasis; (e) To amend the rules of arteriovenous fistula care; (f) To formulate new education guideline for patients; (g) To develop the teaching instruments. The project was implemented in June 2013. In November of the same year, 400 dialysis patients were surveyed to evaluate the implementation results of this program. The results showed that the rate of A-V shunt bleeding after hemodialysis decreased from 19.9% to 4.5%, and continued to track until 2014, the results from all the ensuing months were below the standard value of 6%. Finally, it is hoped that the content provided by this project will help hemodialysis patients to have better medical quality in clinical treatment.