提升急診護理人員於周邊困難靜脈導管置入成功率

Improving the Success Rate of Difficult Peripheral Intravenous Cannulation Performed by Emergency Nurses

背景：周邊靜脈導管置入為臨床常見的侵入處置，惟病人疾病因素常造成置入困難。2023年4月至6月，單位發生25起周邊靜脈導管置入相關抱怨事件，其中72%為多次穿刺失敗。現況分析顯示急診護理人員周邊困難靜脈導管置入成功率僅53.5%，主因為缺乏困難導管置入標準流程、缺乏輔助工具、環境照明不佳及新進人員缺乏靜脈導管置入的練習機會。
目的：提升急診護理人員周邊困難靜脈導管置入成功率至72.5%以上。
解決方案：擬定改善策略包含設計「HANDS評估」隨身小卡、成立血管小組、制定困難導管置入標準流程、舉辦超音波輔助工作坊、更換照明設備及舉辦新兵訓練營。
結果：專案實施後，困難靜脈導管置入成功率由53.5%改善至75.3%，達專案目的。
結論：本專案有效提升急診護理人員於周邊困難靜脈導管置入成功率，增進病人安全與照護品質，並強化護理專業知能。

Background & Problem: Peripheral intravenous cannulation (PIVC) is a common invasive procedure conducted in clinical settings. However, patient-related conditions often increase the difficulty of successful cannulation. Between April and June 2023, 25 PIVC- related complaints were reported in the emergency department of our hospital, with 72% involving multiple failed attempts. An initial analysis revealed a low success rate (53.5%) for difficult PIVC, with primary contributing factors including a lack of standardized protocols, insufficient assistive tools, poor lighting, and limited hands-on experience among novice nurses.
Purpose: This project was planned and implemented to increase the success rate for difficult PIVC by emergency nurses to above 72.5%.
Methods: The improvement strategies included developing a pocket-sized reminder card incorporating the“HANDS”assessment tool, forming a vascular access team, establishing standardized procedures, conducting ultrasound workshops, upgrading lighting, and implementing a training program for new staff.
Results: After implementation, the success rate of difficult PIVC among emergency nurses increased from 53.5% to 75.3%, achieving the project goal.
Conclusion: Implementing this project effectively improved the success rate for difficult PIVC among emergency nurses, enhanced patient safety and care quality, and strengthened nursing competence.