혈액투석 환자의 도관 기능부전 관리 프로토콜 적용이도관개존 성공률 및 출혈 합병증에 미치는 영향
Effect of Evidence-Based Practice Protocol for Catheter Dysfunction in Hemodialysis Patients: Focus on Patency Rates and Bleeding Complications
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목적: 이 연구는 혈액투석환자의 도관 기능부전 관리 프로토콜 적용 후 도관 개존율 및 출혈합병증을 알아보기 위한 후향적 코호트 연구이다. 방법: 서울 1개 대학병원에서 도관 기능부전을 경험한 94명의 환자를 후향적으로 분석하였으며, 대조군 55명과 프로토콜 그룹 39명이다. 프로토콜은 혈액투석도관 기능의 사정, 투석도관 기능호전을 위한 보존적 중재, 도관 기능호전을 위한 약물적 중재, 도관 기능 호전평가, 도관 기능의 지속적 유지관리를 위한 권고안으로 구성되어 있다. 수집된 데이터는 SPSS 23.0 프로그램을 통해 기술 통계, t-검정, Chi-square검정을 사용하였다. 결과: 프로토콜 그룹의 도관 개존율은 대조군에 비해 유의하게 높았으며, 출혈 합병증은 통계적으로 유의하지 않았다. 결론: 프로토콜의 적용은 출혈 합병증 없이 카테터의 개존율을 유의하게 높이는 결과를 가져왔다. 가이드라인이 혈액투석 환자의 도관 기능 향상을 위해 많은 간호사에게 유용하게 사용되기를 바란다.
Abstract
Purpose: This study was a retrospective cohort study to evaluate the effect of evidence-based guidelines for catheter dysfunction among hemodialysis patients, Success rate and bleeding complications in catheterization were examined. Methods: We performed a retrospective cohort study, including 94 patients with catheter dysfunction who were receiving hemodialysis at a university hospital; 55 in the control group and 39 in the protocol group. This protocol was composed of the catheter dysfunction assessment, conservative management of catheter dysfunction, drug management of catheter dysfunction, catheter function test and maintenance management. Data were analyzed with a Chi-square test and t-test using SPSS/WIN 23.0 program. Results: The patency rate of the protocol group was significantly higher than that of the control group. The rate of bleeding complications was not statistically significant for either the control group or the protocol group before or after application. Conclusion: The application of the guidelines effectively increased the patency rate of the catheter without bleeding complications. It is hoped that this guideline can be disseminated to nurses nationwide to improve the efficiency of catheter function for hemodialysis patients.
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