血透机及其附件不良事件原因及对策探讨  

Causes and countermeasures for adverse events of hemodialysis machine and its accessories

作　　者：李真 仲辉 成定胜 马宪礼 胡炎 LI Zhen;ZHONG Hui;CHENG Ding-sheng;MA Xian-li;HU Yan(Department of Medical Engineering, Subei People's Hospital, Yangzhou 225001, Jiangsu Province, China)

机构地区：[1]苏北人民医院医学工程部

出　　处：《医疗卫生装备》2019年第8期72-75,共4页Chinese Medical Equipment Journal

摘　　要：目的:分析血透机及其附件不良事件的原因,并提出整改措施。方法:回顾性分析2017年1月至2018年6月院内血液净化中心6个季度内34例血透机及其附件不良事件,采用彩色表格展示各种不良事件的发生例数及重复度,并绘制柏拉图找出不良事件的主要原因。结果:6个季度的血透机及其附件不良事件中,前4个季度发生的不良事件较多,重复度较高。其中血透机故障占61.8%,水电故障占20.6%,透析管路故障占11.8%,不规范操作占5.9%,并对其提出了改进对策。结论:对血透机及其附件不良事件原因进行分析可起到良好的预防作用,从而保障患者透析治疗的安全稳定。Objective To analyze the causes for the adverse events of the hemodialysis machine and its accessories and to propose countermeasures. Methods The adverse events of the hemodialysis machine and its accessories from January 2017 to June 2018 were analyzed retrospectively in the blood purification center of some hospital. Color table was used to show the cases and repeatability of the adverse events in the six quarters, and then Pareto chart was drawn to determine the main causes for the adverse events. Results There was a relatively large amount of adverse events with high repeatability in the first four months, whose causes included hemodialysis machine failures (61.8%), hydropower failures (20.6%), hemodialysis pipeline failures (11.8%) and non-standard operation (5.9%). Some countermeasures were proposed accordingly. Conclusion The analysis on the causes contributes to the prevention of the adverse events, and facilitates the safety and stability of hemodialysis.

关 键 词：血透机 不良事件 柏拉图 透析治疗 预防性维护 

分 类 号：R318.6[医药卫生—生物医学工程] TH772.1[医药卫生—基础医学]