降低冠狀動脈介入治療術後拔除橈動脈導管之血腫發生率

Abstract

背景：在病人接受冠狀動脈介入治療術後，血腫是拔除橈動脈導管後最常見之合併症，一旦發生也對照護品質造成負面之影響，未改善前血腫發生率高達20.09%。 目的：本專案旨在應用臨床照護指引，來降低病人拔除橈動脈導管後的血腫發生率。 解決方案：參考經橈動脈路徑執行冠狀動脈介入治療的臨床照護指引，擬定解決方法有：（1）定期舉辦冠狀動脈介入治療術後之在職教育；（2）舉辦TR band止血照護的課程與案例討論；（3）制定TR band標準作業流程；（4）制定冠狀動脈介入治療術後照護稽核表與監測制度。 結果：經專案介入後，拔除橈動脈導管後的血腫發生率由20.09%下降至9.3%，不僅達到專案目的，對於護理人員拔除橈動脈導管的認知正確率，也由58.66%提升為96.66%；執行止血照護措施的正確率由57.64%提升至99.21%。 結論：經此專案執行後，不僅降低了拔除橈動脈導管後的血腫發生率，進而也增進了病人在止血過程中的舒適滿意度，結果顯示成效良好，未來將維持此成效以推廣至全院，造福更多心臟病患。  Background: After receiving percutaneous coronary interventions, hematoma is one of the most common vascular complications due to the removal of radial artery. Once happened, there will have a negative impact on the quality of care. The incidence rate of hematoma is up to 20.09% without proper treatment. Purposes: Applying evidence-based clinical care guidelines to effectively assist the medical team to reduce the oc­currence rate of hematoma after the removal of radial artery catheter. Methods and Materials: Designing an evidence-based clinical care guidelines based on empirical literature search­ing and the developed solutions include: regular on-the-job training course, regular TR band hemostasis care course and case study, formulating standard procedures of TR band, formulating a new check list and monitoring system for post-percutaneous coronary intervention. Results and Discussion: After applying the developed guidelines, the occurrence rate of hematoma decreased from 20.09% to 9.3%. As for after-removal of radial artery catheters knowledge, nurses’ cognitive correctness rate increased from 58.66% to 96.66%. The accuracy rate of hemostasis treatment increased from 57.64% to 99.21%. Conclusion: After implementing the project, not only the occurrence of hematoma after removal of radial artery catheter was reduced but also the satisfaction degree about the comfortability was significantly increased. The result indicates that this guideline can be applied in the future to benefit more patients with cardiovascular disease.