運用床邊照護檢驗改善重症新生兒檢驗性失血量

Use of Point-of-Care-Blood Test to Reduce Blood Loss for the Critical Neonates

謝函欣(Han-Hsin Hsieh)；沈家伃(Chia-Yu Shen)；馬真德(Chen-Te Ma)

床邊照護檢驗 ； 重症新生兒 ； 檢驗性失血 ； Point-of-Care-Blood Test ； Critically ill neonates ； Blood loss caused by doing test

醫學與健康期刊

11卷3期（2022 / 11 / 01）

57 - 67

繁體中文

重症新生兒血管細小採血不易，易造成穿刺次數和檢驗性失血量增加。運用床邊照護檢驗（Point-of-Care-Blood Test, POCT），可更快速的將檢驗數據提供床邊照護，降低重症新生兒檢驗性失血量及因採檢困難造成的額外穿刺，提升新生兒醫療照護品質及建構安全醫療環境。目的：1.降低重症新生兒7天內檢驗失血量小於7.5ml。2.增加穿刺次數之百分比能下降至34.4%。解決方案：1.舉辦護理人員床邊照護檢驗教育訓練。2.增修床邊照護檢驗流程，增加圖示說明。3.擬訂稽核計畫並執行。經改善方案實施後，1.重症新生兒7天內檢驗失血量由改善前10ml降至4.62ml。2.增加穿刺次數由改善前68.8%降至16.3%。透過本專案使用床邊重點照護檢驗，重症新生兒因檢驗性造成的失血量可下降，減少輸血頻率，縮短抽血過程哭鬧不安的時間，藉此維護新生兒安全、提升照護品質。

It is usually necessary to perform repeated punctures for collecting blood from small blood vessels in critical neonates and cause the increase in their blood loss. Using the Point-of-Care-Blood Test (POCT) can help provide the test data for the bedside care more quickly, and reduce the blood loss caused by doing test for critical neonates and the extra punctures caused by the difficulty of collecting blood for testing, to improve the quality of medical care of the neonates and create a safe medical environment. Purposes: 1. Reduce the blood loss of a critical neonates to less than 7.5ml within 7 days. 2. Reduce the number of punctures by 65.6%. Solutions: 1. Organize education training on key nursing and testing for nursing staff. 2. Amend the key nursing and testing process combined with related illustrations. 3. Develop and implement audit plans. After the implementation of the improvement plan, firstly, the blood loss of critical neonates within 7 days was reduced from 10 ml to 4.62 ml; secondly, the number of punctures was reduced from 68.8% to 16.3%. The use of POCT could reduce the blood loss caused by doing tests for critical neonates, decrease the frequency of blood transfusions, and shorten the time of neonates' crying and suffering during blood collection, thereby maintaining the safety of neonates and improving the quality of care.

1. Cantero, M,Redondo, M,Martín, E,Callejón, G,Hortas, ML(2015).Use of quality indicators to compare point-of-care testing errors in a neonatal unit and errors in a STAT central laboratory.Clinical Chemistry and Laboratory Medicine,53,239-247.
2. Counsilman, CE,Heeger, LE,Tan, R(2019).Iatrogenic blood loss in extreme preterm infants due to frequent laboratory tests and procedures.The Journal of Maternal-Fetal & Neonatal Medicine,1-6.
3. Florkowski, C,Don-Wauchope, A,Gimenez, N,Rodriguez-Capote, K,Wils, J,Zemlin, A(2017).Point-of-care testing (POCT) and evidence-based laboratory medicine (EBLM)-does it leverage any advantage in clinical decision making?.Critical reviews in clinical laboratory sciences,54,471-494.
4. Florkowski, Christopher,Don-Wauchope, Andrew,Gimenez, Nuria(2017).Point-of-care testing (POCT) and evidence-based laboratory medicine (EBLM)-does it leverage any advantage in clinical decision making?.Critical Reviews in Clinical Laboratory Sciences,54,471-494.
5. Hasanbegovic, Edo,Cengic, Nermana,Hasanbegovic, Snijezana,Heljic, Jasmina,Lutolli, Ismail,Begic, Edin(2016).Evaluation and Treatment of Anemia in Premature Infants.Medical Archives,70,408-412.
6. Krleza, JL,Dorotic, A,Grzunov, A,Maradin, M(2015).Capillary blood sampling: national recommendations on behalf of the Croatian Society of Medical Biochemistry and Laboratory Medicine.Biochemia Medica,25,335-358.
7. Lemyre, B,Sample, M,Lacaze-Masmonteil, T(2015).Minimizing blood loss and the need for transfusions in very premature infants.Paediatrics & Child Health,20,451-462.
8. Lowe, G,Stike, R,Pollack, M(2008).Nursing blood specimen collection techniques and hemolysis rates in an emergency department: Analysis of venipuncture versus intravenous catheter collection techniques.Journal of Emergency Nursing,34,26-32.
9. Maheiu, L,Marien, A,de Dooy, J,Mahieu, M,Mahieu, H,van Hoof, V(2012).Implementation of a multi-parameter pointof-care-blood test analyzer reduces central laboratory testingand need for blood transfusion in very low birth weight infants.Clinica Chimica Acta,413,325-330.
10. Pecoraro, V,Germagnoli, L,Banfi, G(2014).Point-of-care testing: where is the evidence? A systematic survey.Clinical Chemistry and Laboratory Medicine,52,313-324.
11. Pecoraro, V,Germagnoli, L,Banfi, G(2014).Point-of care testing: Where is the evidence? A systematic survey.Clinical Chemistry and Laboratory Medicine,52,313-324.
12. Radlowski, EC,Johnson, RW(2013).Perinatal iron deficiency and neurocognitive development.Frontiers in Human Neuroscience,7,585.
13. Singh, M,Anand, L(2014).Bedside procalcitonin and acute care.International Journal of Critical Illness and Injury Science,4,233-237.
14. 潘志玫, CM,陳佩侶, PL,張惠芳, HF(2007)。新生兒足跟採血導致足部瘀傷改善方案。澄清醫護管理雜誌，3，51-58。
15. 龔曉琴, XQ,彭華保, HB,文果, G,朱文軍, WJ,劉海峰, HF(2015)。危重早產檢驗性失血與貧血的相關性。中國新生兒科雜誌，30，12-16。