中国血液净化

中国血液净化 ›› 2025, Vol. 24 ›› Issue (06): 518-523.doi: 10.3969/j.issn.1671-4091.2025.06.016

• 护理研究 • 上一篇    下一篇

经自体动静脉内瘘穿刺行血液透析治疗上机操作(视频演示)全国30个省市横断面调查

国家卫生健康委能力建设和继续教育中心透析专项规范化技能竞赛标准编写工作组   

  1. 100044 北京，北京大学人民医院肾内科
  • 收稿日期:2024-12-12 修回日期:2025-03-31 出版日期:2025-06-12 发布日期:2025-06-12
  • 通讯作者: 王颖 E-mail:13611203602@163.com
  • 基金资助:
    北京大学人民医院护理研究项目

Hands-on operation of hemodialysis treatment by autologous arteriovenous fistula puncture (video demonstration): a cross-sectional survey of 30 provinces and cities in China

Capacity Building and Continuing Education Center, National Health Commission    Department of Nephrology, Peking University People's Hospital, Beijing 100044, China   

  1. Capacity Building and Continuing Education Center, National Health Commission    Department of Nephrology, Peking University People's Hospital, Beijing 100044, China
  • Received:2024-12-12 Revised:2025-03-31 Online:2025-06-12 Published:2025-06-12

摘要： 目的 了解血液透析护理人员对使用自体动静脉内瘘的维持性血液透析患者规范化上机的操作现状。 方法 2023年7月—8月通过“国家卫生健康委员会透析综合管理能力建设专项”平台，收集全国范围内经自体动静脉内瘘穿刺行血液透析治疗上机操作的视频。由2名专家依据自制评分表，从仪表与职业防护、手卫生时机及方法、操作前评估与检查、血管通路穿刺与药物注射、安全核查5个维度进行评审，并记录扣分原因，比较不同医院级别、是否为血液净化教学基地及职称间的得分差异。 结果 共收集419份有效视频，5个维度得分率分别为：仪表与职业防护85.232%、手卫生时机及方法84.417%、操作前评估与检查74.213%、血管通路穿刺与药物注射77.513%、安全核查68.702%。来自三级及以上医院者总得分高于其他医院者(t=3.466，P=0.015)，来自血液净化教学基地者总得分高于非基地者(t=5.062， P=0.004)，不同职称的护士总得分差异无统计学意义(F=0.292，P=0.747)。 结论 操作环节中失分率由高到低顺序为：安全核查、操作前评估与检查、血管通路穿刺与药物注射、手卫生时机及方法、仪表与职业防护，提示今后作为侧重点优先加强培训。三级以下医院及非教学基地操作质量欠佳，需重点关注。

Abstract: Objective  To investigate the current status of standardized operation of maintenance hemodialysis by autologous arteriovenous fistula puncture in hemodialysis nurses.  Methods  In July to August 2023, the videos of hemodialysis operation by autologous arteriovenous fistula puncture were collected nationwide through the platform of “Comprehensive Dialysis Management Capacity Building Project, National Health Commission”. Two experts reviewed the videos by using a self-made scoring scale that contains  five dimensions: instrument and occupational protection, hand hygiene timing and method, pre-operation assessment and inspection, vascular puncture and drug injection, and safety verification, and the reasons for point deduction were recorded. Differences of scores were compared among hospital levels, whether or not from a blood purification teaching base, and by different professional titles.  Results  A total of 419 valid videos were collected. The scoring rates of the five dimensions were as follows: instrument and occupational protection (85.232%), hand hygiene timing and method (84.417%), pre-operation assessment and inspection (74.213%), vascular puncture and drug injection (77.513%), and safety verification (68.702%). Total scores were higher from tertiary hospitals and above than from other hospitals (t=3.466, P=0.015); total scores were higher from blood purification teaching bases than from non-teaching bases (t=5.062, P=0.004); total scores had no significant difference from nurses of different professional titles (F=0.292, P=0.747).  Conclusion  The scoring rates of the five dimensions ordered from low to high are as follows: safety verification, pre-operation assessment and inspection, vascular puncture and drug injection, hand hygiene timing and method, and instrument and occupational protection, suggesting the key points of hemodialysis operation training in the future. The operation quality is relatively lower in the hospitals below the tertiary level and non-teaching bases, highlighting the hemodialysis units we should concern with and pay assistance to.