非外科介入預防自體瘻管失效之臨床照護指引

Abstract

超過六成血液透析病人，曾因自體瘻管障礙及失效需外科介入進行瘻管重建術，倘若無良好的預防措施及追蹤，病人瘻管需再次行外科手術的比率上升，進而增加醫療成本的耗損。本指引透過五個階段建置「以非外科介入預防透析病人自體瘻管失效之臨床照護指引」，第一階段成立指引發展小組；第二階段進行2018年前的文獻搜尋及評讀，共篩選出17篇文獻；第三階段依據2015 年蘇格蘭指引發展組織（Scottish Intercollegiate Guidelines Network, SIGN）之證據等級評定各項指引之建議強度，共建置內含23項目之處置初稿（未含指引範圍界定）；第四階段邀請10位臨床相關領域專家，進行處置初稿之專家效度分析及修改；第五階段邀請46位臨床照護人員、及10位透析病人進行指引之可行性調查，最後完成具有21項目的指引處置內容。本指引共包含五個構面：指引範圍界定4項、藥物在自體瘻管失效上的預防3項、透析治療中的照護措施6項、居家照護要點4項，及常規追蹤與處置8項，共25 個項目。期許本指引能協助血液透析病人預防自體瘻管失效，以降低廔管手術重建率，進而減少醫療成本的耗費  More than 60% of hemodialysis patients need surgical interventions for arteriovenous fistula stenosis or failure. Without adequate preventive treatments and follow-up actions, a high surgery rate resulting in increased medical costs is anticipated. The “ Clinical Care Guidelines of Non-Surgical Interven¬tions to Prevent Arteriovenous Fistula Failure” were developed through the following five phases. In phase one, a team was established for developing guidelines. In phase two, team members searched published literature before 2018 and identified seventeen related articles. In phase three, the level of evidence according to the 2015 Scottish Intercollegiate Guidelines Network (SIGN) was evaluated. The first draft of the clinical guidelines included 23 items (the scope of the guidelines remaining un¬defined). In phase four, expert validity of the draft was assessed by 10 clinical experts. In phase five, 46 clinicians and 10 hemodialysis patients were invited to evaluate the feasibility of the guidelines, and 21 items were selected for the final version of the guidelines. The clinical care guidelines consist¬ed of 5 constructs with a total of 25 items, including the scope of the guidelines (4 items), pharmaco¬logical treatments for arteriovenous fistula failure (3 items), nursing measures during hemodialysis (6 items), home care measures (4 items), and routine follow-up and management (8 items). With the development of the guidelines, we expect to lower the reconstruction rate of arteriovenous fistula and reduce medical costs through the prevention of arteriovenous fistula failure in hemodialysis patients