降低血液透析病人永久性血管通路阻塞率

Reduction in the rate of Permanent Vascular Access Obstruction in Hemodialysis Patients

本專案旨在降低血液透析病人永久性血管通路阻塞率。統計本單位2019年4月至6月永久性血管通路阻塞率為5.37%，高於本單位品質指標監測阻塞率≦3%，經分析原因與護理人員重複施打同位置、病人及主要照顧者未確實執行居家血管通路照護、沒有穿刺位置的標準流程及缺乏團體衛教有關。經由專案小組及跨團隊合作，增設繩梯式打法技術及稽核制度、提供居家血管通路照護圖表及查檢表、製作慢性腎臟病健康管理護照及QR code、舉辦團體衛教及張貼海報。專案推行後，永久性血管通路阻塞率由5.37%降至1.07%，獲得良好成效，不僅發揮團隊功能，且增進永久性血管通路照顧能力，有效降低阻塞率，進而提升更完善的照護品質。

 

This project was conducted to reduce permanent vascular access obstruction in patients undergoing hemodialysis. The average rate of permanent vascular access obstruction in our unit from April to June 2019 was 5.37%, which is 3% higher than the quality monitoring index. An analysis of possible causes revealed that repeated injections at one location, the failure of primary care providers to perform home vascular access care, a lack of standardization for locating puncture sites, and a lack of group education are highly associated with high blockage rates. Through team collaboration, the rope ladder technique and audit system were incorporated. Home vascular access care charts and checklists were also provided. In addition, health passports and quick-response codes for chronic kidney disease were provided. Moreover, group health education programs and posters were organized. After project management, the permanent vascular blockage rate decreased from 5.37% to 1.07%. We not only improved the vascular care capacity but also strengthened the relationships between departments. Overall, the rates of vascular blockage decreased.