透析套管针与钢针用于内瘘穿刺效果比较

A comparison of Supercath Clampcath and steel needle for fistula puncture

目的比较血液透析(HD)用套管针(下称套管针)与传统内瘘钢针(下称钢针)的使用效果。方法对49例HD患者,每例10次采用套管针穿刺、10次采用钢针穿刺。观察患者HD过程中疼痛感、舒适度、肘部活动度、动静脉压、拔针后止血时间、护理人员满意度。结果套管针穿刺的490例次患者HD过程中舒适度、肘部活动度、拔针后止血时间及穿刺处渗血发生率显著优于490例次采用钢针患者,血流速度一致时动脉压高于而静脉压低于采用钢针患者(均P<0.01);护士认为采用套管针可降低潜在针刺伤风险(P<0.01),但方便性、固定、操作耗时及继续应用意愿较采用钢针差(均P<0.01)。结论采用套管针行内瘘穿刺可增加HD患者舒适度和安全性,但护理人员的操作熟练程度还有待加强。

Objective To compare the effect of $upercath Clampcath and steel needle for fistula puncture. Methods Forty-nine patients undergoing maintenance hemodialysis were recruited and received fistula puncture using Supercath Clampcath and steel needle. Each puncture method was repeated 10 times. Pain in hemodialysis, comfort degree, elbow mobility, venous and arterial pressure, he- mostasis time after removal of the puncture instrument set, nurse% satisfaction were compared. Results Patients experienced more comfort, larger elbow mobility, shorter hemostasis time, and lower puncture site bleeding rate when they received Supercath Clampcath for fistula puncture（P〈~O. O1 for all）. With the same blood flow rate in hemodialysis, the dialysis arterial pressure using the Supercath Clampcath appeared significantly higher while dialysis venous pressure was significantly lower compared to using steel needle（P〈0. 01 for both）. Nurses believed that using the Supercath Clampcath could reduce risk of needlestick and sharp in- juries, but they showed poor attitudes toward use of the Supercath Clampcath for its somewhat less convenience, more difficult to secure, and longer operation time（P〈0.01 for all）. Conclusion Fistula puncture using Supercath Clampcath can increase patientsr comfort and safety, however, nursesI operation skills should be improved.