改善胃腸肝膽科病房腹腔放液操作流程正確率專案

Establishment of a New Closed Drainage System to Improve the Quality of Ascites Paracentesis Process

10.6530/YYN.202007_14(2).0005

溫明寰(Ming-Huan Wen)；連靜雯(Ching-Wen Lien)；吳雅萍(Ya-Ping Wu)；呂佩瑾(Pei-Jin Liu)

無菌 ； 腹水 ； 密閉式系統 ； 腹腔放液 ； 品質 ； 超音波導引 ； aseptic ； ascites ； closed system ； paracentesis ； quality ； ultrasound guidance

源遠護理

14卷2期（2020 / 07 / 01）

38 - 47

繁體中文

本院腹腔放液技術採自然引流，過程中為避免穿刺針滑脫，採各式各樣之固定方式，容易污染穿刺部位（無菌率為0%），處理腹水易扎傷及曝觸血體液，技術規範未與時俱進，盲放安全性低等問題，產生改善腹腔放液流程之動機；專案目的即改良技術無菌流程，並全面推行。故查閱文獻及參考國內外醫院做法，以密閉式系統理念，根據專科病人特性，創造新的放液流程，並透過教育訓練、建立標準、修訂護理處置規範、稽查監測、超音波導引下進行等解決辦法後，無菌率100%，執行率100%，對於預防病人繼發性血流感染，減少醫護人員扎傷及曝觸血體液風險，進一步提升腹腔放液成功率，專科病房全面實施後推廣至全院，提升病人照護品質，增進醫護人員安全。

The purpose of this research project was to design a new standard of procedures on abdominal paracentesis to addresses shortfalls noted in the past practice and to improve the quality of nursing care. Previous procedures on abdominal paracentesis to relieve massive ascites were guided by physical examination and drain the ascites by natural gravity. Deficits noted included contamination of puncture wound, exposure of ascites fluid to non-aseptic environment, risk of needle stick and high rates of procedure-related complications. The new paracentesis protocol uses a closed drainage system, developed after careful literature review and referencing successful practice of other hospitals. The new standard requires the abdominal paracentesis be performed under the guidance of bedside ultrasound, the puncture needle is stabilized aseptically, and ascites fluid is drained into a closed drainage bag. All physicians and nursing staff involved need to complete a comprehensive training program. This project also established an auditing system to monitor the implementation and to provide feedback for any needed revisions. The goals include reduction of puncture wound contamination, secondary bloodstream infections and needle stick injuries. The use of ultrasound guiding the needle insertion will increase the successful rate of paracentesis. The implementation will be roll out throughout the hospital after the validation in Gastroenterology ward is completed.

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