人工腎臟凝固率之改善專案 - tnna.org.t · 中華民國99年12月...
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99 12 9 2
*
97 12 31 98 02 16 98 04 01
80 5
0229286060 10501 [email protected]
*
11.4 3.4
End Stage Renal Disease,
ESRD
Besarab
& Brouwer, 2004
Hematocrit, Hct
2000
30-35%
2005
8 22
-
99 12 9 2
15 13
3-18 2006
91%
4
8-9
FB-150G
FB
85
2007.10.17-18
1/3
2007/10/15-20
29
29
A-V fistula Graft catheter
85100% 6171.8 1720 78.2
20 20-24.9 25-29.9 30-34.9 35
85100% 11 1012 3946 2631 910
-
99 12 9 2
9 3.6 31.0 31.0 7 2.8 24.1 55.1 4 1.6 13.8 68.9 3 1.1 10.3 79.2 1 0.4 3.5 82.7 1 0.4 3.5 86.2 1 0.4 3.5 89.7 3 1.1 10.3 100 29 11.4 100
29 20 1/3 6 1/2
3 2/3
2007
10/15 7 47 14.9
10/16 3 37 8.1
10/17 6 47 12.8
10/18 4 36 11.1
10/19 5 46 10.9
10/20 4 38 10.5
29 251
4.8 42 11.4
-
99 12 9 2
3
7 400-550
150
2,700-3,150
11.4
-11.411.479.2853.7
3.5
GFR15
ml/min/1.73 m2
90
2004
-
99 12 9 2
dialysis membrane
polyurethane
20062005
200-300 ml
2006heparin
2006Levy,
Morgan, Brown, 2004
2005
2006
2002
3000-5000
30-60
20022005
100 mmHg
2005
2005Collins, 2002
10-20 ml
200-250 ml
2002
2005
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99 12 9 2
2007 10 8
2008 3 31
2007/10/8-11/3
80/20
()
2007/10/29-2008/1/5
1
2
3
9
4
2007/12/1-15
2007/12/17-31
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99 12 9 2
1-1.
1-1-1.
1-1-2.
1-1-3.
19
19
25
21
19
21
17
21
19
57
59
65
1.
1-2.
1-2-1.
1-2-2.
1-2-3.
19
23
21
21
21
21
23
21
21
53
65
63
2.
2-1.
2-1-1.35%
2-1-2.1/3
25
25
25
23
23
21
73
69
3.
3-1.
3-1-1.
3-1-2.
3-1-3.
3-1-4.
25
25
25
25
25
25
23
21
23
23
23
21
73
73
71
67
4-1.
4-1-1.
4-1-2.
4-1-3.
25
25
25
21
25
25
23
23
25
69
73
75
4.
N/S
4-2.
4-2-1.
4-2-2.
4-2-3.
4-2-4.
25
25
25
25
25
25
25
25
23
25
23
23
73
75
73
73
5315 60
5358060
-
99 12 9 2
100 ml
100 ml
2007/12/31-2008/3/31
2008/2/25-3/1
11.4% 3.4%
70.2%11.4
3.4/11.4100% 101.2%
3.411.4/3.511.4100%
2008/3/24-29
3.8%
2007 2008
10 11 12 1 2 3
1..
2.
3.
1.
2.
3.
4.
5.
1.
2.
3.
11.4%
3.5% 3.4%
0
2
4
6
8
10
12
70.2%
-
99 12 9 2
()
29
17 17
EPO, Erythropoient
2008/2/25-3/1
8 1
1
850 2,700-3,150
2,000 /
% % %
9 3.6 3 1.3 63.9
7 2.8 2 0.9 67.6
4 1.6 1 0.4 75
3 1.1 0 0 100
1 0.4 0 0 100
1 0.4 0 0 100
1 0.4 1 0.4 0
3 1.1 1 0.4 63.6
29 11.4 8 3.4 70.1
10
9
7
6
8
12
0 00
2
4
6
8
10
20 20-24.9 25-29.9 30-34.9 35
07.10.17-18
08.02.27-28
%
-/100%
-
99 12 9 2
11.4 3.4
2,000 /
-
99 12 9 2
MED-
HR
1.
2.
3.
4.
1.Heparin Fragmin
2.
Heparin 5000U 5-10
300 ml/min
3.
4. 5
5.
6.
30 100 ml
1/3
7.
1/3
97.03.10
96.03.31
97.03.10
HR
-
99 12 9 2
1
2
1
2
1
2
3
4
5
6
7
8
9
10
-
99 12 9 2
2000
-
465-74
2004
164241-246
2005
172123-125
2006
99-115
2006/
82-86
2002
193296-305
2005
171
1-10
2002-
12174-176
2005
174
226-235
2005
Besarab, A., & Brouwer, D. (2004). Aligning hemodialysis treatment practices with the National Kidney Foundations K/DOQI vascular access guidelines. Dialysis & Transplation, 33 (11), 694-702.
Collins, A. J. (2002). Influence of target he-moglobulin in dialysis patient on mor-bidity and mortality. Kidney, 61, 44-48.
Levy, J., Morgan, J., & Brown, E. (2004). Oxford handbook of dialysis. New YorkOxford University Press.
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99 12 9 2
RN, Cardinal Tien Hospital Yung-Ho Branch 5F Hemo-Room HN, Cardinal Tien Hospital Yung-Ho Branch 5F Hemo-Room *
ReceivedDes. 31, 2008 RevisedFeb.16, 2008 Accepted for publicationApr. 01, 2008 CorrespondenceChing Yu Fang, 5F, 80, Jung- Shing ST, Yung- Ho, Taipei Hsien, Taiwan R.O.C. Telephone0229826060 ext 10501 [email protected]
Reduce the Severity of Blood Clotting in Dialyzer
Ching-Yu Fang Tsuan-Yu Ko* Yu-Jo Lin
Yu-Chen Huang Yueh-Ping Guan Li-Chen Lin
Abstract
In order to remove toxins and excess water from their body, patients with end-stage renal disease (ESRD) rely on long-term renal replacement therapy, of which hemodialysis is the most popular choice in Taiwan. Because of dialyzer clotting, the patient will lose blood during hemo-dialysis, resulting in inadequate dialysis as well as anemia. Regarding the four main causes of dialyzer clotting: low blood flow, low anticoagulant, wrong dose of anticoagulant, and non normal saline flush, this project offers methods to improve hemodialysis, as follows: (1) stan-dardization of the dose of anticoagulant; (2) providing a list of self-care steps when using a temporary catheter; (3) ensuring that nursing staff will follow the standard procedure of nursing and that patients will follow the standard procedure to take care of the vascular access and con-trol their blood pressure. As a result, this project not only reduced the rate of dialyzer clotting from 11.4 % to 3.4 % but also ameliorated the resulting anemia. It also decreased the cost of the treatment, achieved adequacy of dialysis, and offered the best nursing care for the patients.
Key wordshemodialysis, dialyzer clotting, anemia
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