早期放氣及移除經橈動脈行冠狀動脈造影術後止血加壓器:護理質量改善計劃

Early deflation and removal of vessel compressor of coronary angiography in trans-radial approach:a nursing care quality improvement project

目的運用PDSA模式(Plan-Do-Study-Act cycle)推行循證護理,探討縮短經橈動脈穿刺(Transradial approach,TRA)行冠狀動脈造影(Cononaryangiograpy,CAG)手術後病人止血器壓迫時間,對病人橈動脈穿刺部位出血及血腫發生率、瘀斑面積大小和疼痛程度。方法選取澳門地區某醫院經TRA行CAG術,手術後使用止血器壓迫TERUMO TR Band®止血氣囊進行壓迫止血的病人,根據不同的減壓時間和頻率將其分為干預前組與干預後組。干預措施介入前的病人納入為干預前組,執行常規操作;干預措施介入後的病人納入為干預後組,按循證護理操作以縮短止血加壓器壓迫及移除時間。結果干預前後病人的年齡、性別、橈動脈穿刺所用導管及CAG術中所用肝素份量均沒有差異(P>0.05)。術後穿刺點發生出血、血腫及瘀斑,計劃前、後的發生率皆沒有統計學差異(P>0.05)。縮短橈動脈加壓膠帶的壓迫時間後,病人術後對因穿刺點作加壓止血引致疼痛的評分,在術後4小時(P=0.023)及6小時(P=0.030)有明顯下降,且有統計學差異。結論運用PDSA模式推行循證為本的護理質量改善計劃,有效減輕病人的術後疼痛程度,且不增加臨床出血風險。

Objective To apply PDSA cycle and evidence-based nursing in investigating compression time reduction by vessel compressor for coronary angiography(CAG)with transradial approach(TRA).The radial artery bleeding and bruising rate,size of a bruise,and patient pain level were evaluated.Methods Patients who had undergone CAG in TRA and post-operative(post-op)vessel compression given by TERUMO TR Band®were recruited.The patient assignment was according to intervention difference in compression time and deflation frequency.Patients were included before intervention as a pre-intervention group(pre-group)and under routine care.The post-intervention group(post-group)was given evidence-based care to achieve early deflation and removal of the vessel compressor.Results The background data in age,gender,catheter and heparin used for CAG were shown no difference between participants in pre-group and post-group(P>0.05).There was no statistical difference in bleeding rate,bruising rate and bruise size for between-group comparison(P>0.05).Patient pain level reduction was significantly different in the post-group at post-op 4-hour(P=0.023)and 6-hour(P=0.030).Conclusion The care quality improvement project applied the PDSA cycle in evidence-based nursing and achieved reduced patient pain with no increase in bleeding risk.