99 12 9 2

*

97 12 31 98 02 16 98 04 01

80 5

0229286060 10501 nursing@cthyh.org.tw

*

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

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

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.

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 E-mailnursing@cthyh.org.tw

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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