超音波導引周邊靜脈導管置放於困難靜脈注射病人之應用

Implementation of Ultrasound-Guided Peripheral Intravenous Cannulation in Patients with Difficult Venous Access

周邊靜脈導管放置為常見護理處置，當困難注射時，常規方式耗時且易失敗。超音波導引係近年提升注射成功率之關鍵，但建立臨床流程仍具挑戰。本文旨在探討超音波導引於困難注射病人之可行性與價值。以實證醫學5A步驟（ask, acquire, appraisal, apply, and audit），綜整文獻並導入超音波於臨床，比較超音波導引實施前後之靜脈注射成功率。綜整7篇文獻顯示，超音波導引能提升困難注射病人成功率。本計劃發現超音波導引實施後的首次成功率58.4%，優於實施前一年常規組29.4%（p < 0.05）；整體成功率72.6%，優於常規組51.4%（p = 0.005）；且平均嘗試注射次數減少（p < 0.01），併發症無差異（p = 0.24）。透過系統性培訓與臨床流程優化，以超音波導引周邊靜脈注射於困難注射病人，能增加成功率並減少醫療成本。建議未來擴大培訓年資2年以上護理人員，推廣不同病人群體應用，全面提升醫療品質。

Peripheral intravenous catheterization is a common nursing procedure. However, in patients with difficult venous access (DVA), conventional techniques are often time-consuming and associated with high failure rates. Ultrasound-guided (US-guided) peripheral intravenous catheterization has become a key strategy to improve injection success rates. Nevertheless, establishing standardized clinical protocols remains challenging. This review aimed to evaluate the feasibility and clinical value of implementing US-guided cannulation in patients with DVA. Guided by the five steps of evidence-based practice (Ask, Acquire, Appraise, Apply, and Assess), we synthesized evidence from seven relevant studies and implemented US-guided intravenous catheterization in clinical settings. The injection success rates before and after implementation were compared. Literature findings supported the effectiveness of US-guided cannulation in improving outcomes in DVA patients. After implementation, the US-guided group achieved a first-attempt success rate of 58.4%, significantly higher than the 29.4% observed in the conventional group from the prior year (p < 0.05) The overall success rate was 72.6% versus 51.4% (p = 0.005), with fewer average cannulation attempts (p < 0.01) , and no significant difference in complication rates (p = 0.24). Systematic staff training and clinical workflow optimization facilitated the successful integration of US-guided techniques into routine practice. These findings suggest that expanding training to nurses with more than two years of clinical experience and promoting broader application across various patient populations may further enhance care quality and reduce healthcare costs.