| 英文摘要 |
Patients undergoing long-term hemodialysis (HD) receive two punctures in their shunt during each treatment session in order to initiate HD so the puncture technique of nursing staff is very important. This study focused on how to reduce the re-puncture rate in a HD unit at a regional teaching hospital. The re-puncture rate is defined as the percentage of patients who had repeated puncture at one site and was at about 5% prior to our intervention. There are two perspectives to the factors that contribute to re-puncturing. The first perspective is that of the nursing staff: improper assessment of shunt and lack of experience; and patients not instructed on proper shunt care. From the patient’s perspective: the shunt is too swollen, deep, thin, or stiff; the newly-built shunt is not yet mature; and improper care of fistula by the patient. Re-puncturing not only harms the shunt but also shortens the life of vascular access. This project reduced the re-puncture rate from 5% to 1.1% through education and training for the nursing staff and instructing patients on shunt care. The completion rate of shunt care instruction was defined as proper execution of the items that should taught to the patients and this improved from 60.5% to 91.4%. The project significantly improved the quality of care, boosted the efficiency of dialysis treatment, and enhanced the relationship between medical staff and patients. |
