提升血液透析病人動靜脈瘻管血流量之改善方案

Improvement Plan for Enhancing Blood Flow in Arteriovenous Fistula in Patients Undergoing Hemodialysis

10.6142/VGHN.202406_41(2).0009

宋柔郁(Rou-Yu Sung)；涂嘉玲(Chia-Ling Tu)；楊巧慧(Chaio-Hui Yang)；廖淑櫻(Su-Ying Liao)；戴辛翎(Hsin-Ling Tai)；李榮芬(Jung-Fen Lee)

血液透析 ； 動靜脈瘻管 ； 手部運動 ； hemodialysis ； arteriovenous fistula ； hand exercise

榮總護理

41卷2期（2024 / 06 / 01）

177 - 184

繁體中文;英文

血液透析病人動靜脈瘻管血流量不足會增加穿刺時間及次數，並影響透析廓清率，增加住院和死亡率。血流量不足之主要原因為病人執行握球運動情形不佳、病人肌力不足、照顧者輔助握球運動狀況不佳、透析中未正確使用遠紅外線儀、血流量照護追蹤執行未統一。執行組合式手部運動、肌力運動大集合、居家檢核集點活動、遠紅外線儀之使用、照護規範推展及跨專科血流量討論會。專案改善後，血流量達600 ml/min的比率由78.4%提升至87.2%，達專案目標86.2%，有效提升動靜脈瘻管血流量，打造血液透析瘻管的照護模式。

Insufficient blood flow in the arteriovenous fistulas of patients undergoing hemodialysis negatively influences the dialysis' efficiency, leading to increased puncture frequency, prolonged sessions, and elevated hospitalization and mortality rates. Key factors contributing to this suboptimal blood flow include inadequate patient performance in grip exercises, insufficient muscle strength, inadequate caregiver support during exercises, improper use of far-infrared devices during dialysis, and lack of standardized blood flow monitoring. To address these concerns, a multifaceted intervention was implemented that included promoting hand exercises, comprehensive muscle training, home-based check-in activities, proper use of far-infrared instruments, establishment of care standards, and interdisciplinary discussions on blood flow management. The intervention resulted in the proportion of patients achieving the target blood flow of 600 ml/min increasing from 78.4% to 87.2%, surpassing the project's target of 86.2%. Thus, the measures not only enhance blood flow in arteriovenous fistulas but also establish a standardized care model for vascular access in hemodialysis.

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