降低裝置內植式輸液塞之癌症病童發生醫療黏膠皮膚損傷率

Reduce the incidence Rate of Medical Adhesive- Related Skin Injuries in pediatric cancer patients with Implanted Infusion Port

內植式輸液塞彎針置入後需使用醫療膠帶黏貼固定，周圍皮膚常因黏膠長時間反覆黏貼，造成醫療黏膠皮膚損傷，導致破皮感染引發菌血症。本專案旨在降低裝置內植式輸液塞病童發生醫療黏膠皮膚損傷率，現況分析：護理人員對醫療黏膠皮膚損傷認知不足、黏貼方式無一致性及黏膠的黏貼移除操作不當；病童因疾病治療致皮膚屏障差及對黏膠敏感致皮膚損傷；照顧者對黏貼觀念錯誤及未接受正確照護指導；未制定醫療黏膠皮膚損傷照護流程及缺乏照護教育訓練；缺乏評估工具、照護衛教單張及未設置合適皮膚黏貼敷料為主因。擬定改善對策：規劃醫療黏膠皮膚損傷教育訓練課程，瞭解高風險病童的評估及照護；設計醫療黏膠皮膚損傷監測圖卡，透過評估機置及早介入處理；建立安全的內植式輸液塞皮膚照護流程；引進合適皮膚黏貼敷料。經以上改善對策介入後，有效降低裝置內植式輸液塞病童發生醫療黏膠皮膚損傷率，由改善前31.4% 降至改善後11.9%；護理人員對醫療黏膠皮膚損傷認知得分，由改善前平均78.3 分提升至改善後100分；執行內植式輸液塞醫療黏膠黏貼正確率由改善前61.6% 提升至改善後97.9%，顯示本專案推動成效良好。建議此照護模式推展至兒童加護單位，降低使用醫療黏膠造成的皮膚損傷，提升病童的照護品質。

After the infusion port is inserted, a medical adhesive tap is used to fix it in place. However, skin injuries, a higher risk of infection or bacteremia may cause by repeated and long time adhesive taping. Our project aims to reduce the incidence rate of medical adhesive-related skin injuries in pediatric cancer patients with implanted infusion ports. Analysis of possible causes include 1. Nurses’insufficient awareness of medical adhesive-related skin injuries, inconsistency in adhesive procedures, 2. Children’s poor skin barrier due to disease treatment and hypersensitivity towards adhesives, 3. Incorrect taping techniques and insufficient wound care education, of caregiver, 4. Lack of standard care protocol in terms of medical adhesive-related skin injury and lack of wound care training course of nurses, 5. Lack of evaluation tools, educational flyers and appropriate dressing material. Improvement plans include 1. Arrange nursing educational sessions regarding medical adhesive-related skin injuries to enhance understandings in evaluation and caring techniques in high risk pediatric patients. 2. Design medical adhesive-related skin injuries flashcards for early evaluation and intervention. 3. Establish a safe standard protocol for skin care. 4. Change appropriate skin dressing in our unit. After the implementation, a significant effect in this project was approved. The incidence of medical adhesive-related skin injuries was decreased from 31.4% to 11.9%. Score of understanding in medical adhesive-related skin injuries of nurses was increased from 78.3 to 100. Accuracy of adhesive taping implanted infusion port was increased from 61.6% to 97.9%. We suggest propagating this caring mode to pediatric intensive care unit to reduce the incidence of medical adhesive-related skin injuries and improve the care quality of children.