提升末期腎衰竭病人血液透析通路預先建立率

Improve the Creation Rate of Vascular Access Prior to Initiation in Patients with End Stage Renal Failure

10.3966/172674042019061801004

蔡仲敏(Chung-Min Tsai)；張麗君(Li-Chun Chang)；陳慈君(Tzu-Chun Chen)

末期腎衰竭 ； 血液透析通路 ； 護理衛教 ； 自我效能 ； end stage renal disease ； vascular access ； health education ； self-efficacy

臺灣腎臟護理學會雜誌

18卷1期（2019 / 06 / 01）

46 - 59

繁體中文

背景：各國指引皆建議預先建立透析通路，以免病人進入末期腎衰竭時，緊急置入暫時性雙腔透析導管；本單位2014年1月至3月血液透析病人通路預先建立率僅20％，導致住院天數及醫療耗用增加，病人與家屬身心受創、護理人員工作壓力劇增，故激發成立專案小組之動機。目的：藉本專案提升末期腎衰竭病人血液透析通路預先建立率。解決方案：明確訂定CKD收案標準、增設多元衛教工具、制訂衛教成效監測辦法、促進其對疾病認知進而降低壓力、舉辦病友支持團體以提升自我效能，真正達到提升末期腎衰竭病人的血液透析通路預先建立率。結果：末期腎衰竭病人血液透析通路預先建立率由改善前20％提升至81.8％，達成專案目的。結論：此專案運用策略促進自我效能，讓病人不需住院緊急置入暫時性雙腔透析導管，而能由門診順利進入血液透析，達到護病雙贏的成效。

Background & Problems: Creation of vascular access (VA) prior to initiation of hemodialysis was advocated but it was difficult for the rate of VA creation before hemodialysis initiation to increase worldwide. The rate of VA creation prior to hemodialysis initiation in our hemodialysis center from January to March of 2014 was as low as 20%. The low rate of VA creation prior to hemodialysis initiation will result in the need for emergency placement of hemodialysis catheters and hospitalizations, subsequently putting heavy mental and physical burdens on ESRD patients and increasing workload of staffs; therefore the establishment of ad hoc groups was inspired. Purpose: Improve the creation rate of vascular access prior to initiation in patients with End Stage Renal Failure. Resolution: To modify standard operating procedure of inclusion criteria for chronic kidney disease, establish standards to monitor the effects of education and organize activities for ESRD support groups in order to effectively improve the creation rate of VA prior to initiation in patients with ESRD. Result: The rate of VA creation before hemodialysis initiation was significantly raised from 20% to 81.8%. Conclusion: Improved patient self-efficacy, patients consequently did not suffer the procedure of temporal hemodialysis catheter placement and its associated complications. The rate of outpatient hemodialysis initiation was improved compared to inpatient hemodialysis initiation. Moreover, the workload of nurse was significantly decreased, subsequently creating a situation mutually beneficial to both nurse and patients.

1. 陳俞蓉,許欣虹,白美娟(2017)。提升初期血液透析病人護理指導之成效。臺灣腎臟護理學會雜誌，16(2)，15-29。
   連結：
2. Bonner, A.,Lloyd, A.(2012).Exploring the information practices of people with end-stage kidney disease.Journal of Renal Care,38(3),124-130.
3. Brian, D.,Bradbury, F. C.,Anna, F.,Ronald, L.,Pisoni, M. K.,Donna, M.,Mahesh, K.(2009).Conversion of vascular access type among incident hemodialysis patients: Description and association with mortality.American Journal of Kidney Diseases,53(5),804-814.
4. Cassidy, B. P.,Getchell, L. E.,Harwood, L.,Hemmett, J.,Moist, L. M.(2018).Barriers to Education and Shared Decision Making in the Chronic Kidney Disease Population: A Narrative Review.Canadian Journal of Kidney Health and Disease
5. United States Renal Data System. (2018). International comparisons. Retrieved from https://www.usrds.org/2018/view/v2_11.aspx
6. 台灣腎臟醫學會（2014，6 月）．103 年度腎臟病健康促進機構自評表．取自 http://www.tsn.org.tw/UI/K/K008.aspx
7. 行政院衛生署國民健康局(2010).慢性腎臟病防治手冊.臺北市:台灣腎臟醫學會.
8. 行政院衛生福利部中央健康保險署（2015，4 月）．慢性腎衰竭需定期透析治療患者重大傷病證明申請附表（103.12.19 更新）．取自 http://www.nhi.gov.tw/webdata/webdata.aspx?menu=18&menu_id=683&webdata_id=3471
9. 吳鈴珠(2006)。高雄市，高雄醫學大學醫務管理學研究所。
10. 李育勤,吳淑芬,李梅琛,陳甫安,姚彥宏,王卿凌(2014)。以系統性文獻回顧方式建構慢性腎臟病之自我管理方案。護理雜誌，61(6)，66-77。
11. 國家衛生研究院、台灣腎臟醫學會（2018，6 月）．2017 台灣腎病年報．苗栗縣：國家衛生研究院。取自 https://www.tsn.org.tw/UI/L/TWRD/ebook_2017%E5%B9%B4%E5%A0%B1.pdf
12. 國家衛生研究院,台灣腎臟醫學會(2015).2015 台灣慢性腎臟病臨床診療指引.苗栗縣:財團法人國家衛生研究院.
13. 郭昭玲,方莉(2013)。照護一位末期腎病變初次血液透析病人之護理經驗。臺灣腎臟護理學會雜誌，12(1)，72-86。
14. 陳念歆(2010)。台北市，國立台北護理學院護理研究所。
15. 陳啟亮（2012，10 月）．圖書館學與資訊科學大辭典．取自 http://terms.naer.edu.tw/detail/1679150/
16. 葉惠如(2011)。台中市，中國醫藥大學公共衛生學系碩士班。
17. 鄭夙芬,鄭期緯(2012)。臺灣病友自助團體的運作與助益—以糖尿病病友為例。社區發展季刊，140，176-190。

1. 謝宜均,林曉芳,周小玉(2023)。提升護理人員執行希克曼導管居家照護衛教正確率。領導護理，24(2)，145-159。