血液透析专科护士的培养及其在血液透析患者血管通路质量管理中的作用  

Cultivation of Hemodialysis Specialist Nurses and Its Role in Quality Management of Vascular Pathway in Maintenance Hemodialysis Patients

作　　者：沈华娟[1] 许秀君[1] 董永泽 陈燕芳[1] 周美玲[1] 王丽英[1] SHEN Huajuan;XU Xiujun;DONG Yongzhe;CHEN Yanfang;ZHOU Meilin;WANG Liying(Zhejiang Provincial People's Hospital,People's Hospital of Hangzhou Medical College,Hangzhou 310014,China)

机构地区：[1]浙江省人民医院,杭州医学院附属人民医院,浙江杭州310014

出　　处：《浙江医学教育》2020年第5期22-24,共3页Zhejiang Medical Education

基　　金：浙江省科技厅基础公益研究计划(编号:LGF19H050005);浙江省中医药科学研究基金项目(A类)(编号:2015ZA014)。

摘　　要：目的:探讨血液透析专科护士的培养及其在维持性血液透析患者血管通路管理中的作用。方法:2013年我院血液净化中心选派1名护士参加血液透析专科护士培训并取得资质,回临床后专职从事透析患者血管通路的维护和管理。结果:血液透析患者的血管通路在专科护士专职管理后,改进内瘘穿刺方式,区域穿刺法从43.2%减少到6.3%,扣眼穿刺法从7.8%增加到48.6%,内瘘季度再循环率监测从7.4%增加到100%,内瘘穿刺图片信息化管理从0递增到100%,人造血管狭窄发生率从48.4%下降到31.0%,血栓形成率从29.0%下降到12.1%,人造血管3个月随访率从61.3%增加到96.6%,使内瘘长期使用率(超过2年)从57.4%递增到79.3%,因血管通路并发症原因而住院的患者从27.8%下降到15.8%,提升了血管通路质量,延长了血管通路使用寿命。结论:以专科护士为主导的血管通路管理模式对血液透析患者血管通路的质量提升具有积极作用。[Objective]To explore the training of hemodialysis nurses and its role in vascular access management in maintenance hemodialysis patients.[Method]In 2013,one nurse was selected to participate in the training of hemodialysis nurses and obtained the qualification.After returning to the clinic,she was engaged in the maintenance and management of vascular access of hemodialysis patients.[Result]The vascular access of hemodialysis patients was managed by special nurses,and the puncture method of internal fistula was improved.The regional puncture method decreased from 43.2%to 6.3%,and the buttonhole puncture method increased from 7.8%to 48.6%,the quarterly monitoring of internal fistula recirculation rate increased from 7.4%to 100%,the information management of Internal Fistula puncture pictures increased from 0%to 100%,the incidence of artificial vascular stenosis decreased from 48.4%to 31%,and the rate of thrombosis from 29%to 12%,the 3-month follow-up rate of vascular graft increased from 61.3%to 96.6%,the long-term use rate of internal fistula(more than 2 years)increased from 57.4%to 79.3%,the inpatient rate of vascular access complication decreased from 27.8%to 15.8%,and the quality of vascular access was improved,prolonged the service life of vascular access.[Conclusion]The Vascular Access Management Mode led by special nurses has positive effect on improving the quality of vascular access in hemodialysis patients.

关 键 词：血液透析 专科护士 血管通路 质量管理 

分 类 号：R459.5[医药卫生—治疗学]