降低恢復室術後病人橈動脈導管移除穿刺部位瘀青發生率

Project to Reduce the Incidence Rate of Ecchymosis in Puncture Sites after Arterial Catheter Removal

10.6142/VGHN.34.3.307

黃佩雯(Pei-Wen Huang)；許雅淳(Ya-Chuen Hsu)；張依涵(Yi-Han Chang)；施瓊芬(Chiung-Fen Shih)

橈動脈導管 ； 瘀青 ； 穿刺部位 ； arterial catheter ； ecchymosis ； puncture site

榮總護理

34卷3期（2017 / 09 / 01）

307 - 315

繁體中文

橈動脈導管是手術病人在麻醉期間經常使用的重要管路，穿刺部位的瘀青範圍影響了手部活動與復原。2014年3月訪視374位恢復室移除橈動脈導管病人的穿刺部位，瘀青發生率達51.3%。本專案目的為降低恢復室術後病人橈動脈導管移除穿刺部位瘀青發生率，改善麻醉手術後照護品質。分析瘀青發生率高的原因為(一)未制訂瘀青高危險群篩選表；(二)護理人員未接受橈動脈導管移除教育訓練；(三)未制訂病人護理指導單張；(四)缺乏加壓止血設備；(五)橈動脈導管移除作業規範不完整。藉由制訂瘀青高危險群篩選表、舉辦導管照護在職教育、新增橈動脈導管移除護理指導單張、增購加壓止血設備及修訂橈動脈導管移除作業指導書，並將橈動脈導管移除作業流程列入新人學習護照內容及訓練後，同年11月瘀青發生率降至15.9%。建議將橈動脈導管移除穿刺部位瘀青發生率列為重症單位的監測指標，提升管路照護安全。

Inadequate compression after arterial catheter removal can result in hematoma and ecchymosis. The complication rate has been reported to be up to 51.3%. We proposed a project to reduce the incidence of ecchymosis. The factors for ecchymosis include procedures for catheter removal, nursing care, compression time and equipment operation, and patient education. Therefore, we standardized the procedures and manuals for catheter removal. In addition, we provided nursing educational programs and devices, screened at-risk patients, and standardized the compression procedure. After project completion the incidence rate of ecchymosis decreased to 15.87%, and the procedures were applied to other units. The incidence of ecchymosis should be monitored to improve the quality of nursing care for patients with catheters.

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