本專案旨在降低血液透析病人人工血管之阻塞率，現況訪查後發現人工血管阻塞 率高達 33.3％，分析其原因有：（1）護理人員血管穿刺時位置無輪換、（2）對於早 期之血流異常聲音未能辨別錯失提早發現阻塞時機、（3）護理人員及病人對人工血 管透析後之止血力道無法正確評估。經由文獻查證與小組討論後，擬訂出下列措施來 進行改善：（1）修訂人工血管聽診評估程序及制訂相關記錄表、（2）設置客制化人 工血管穿刺圖暨輪序表、（3）修訂人工血管加壓止血衛教單張、（4）教導護理人員 正確評估人工血管止血力道、（5）舉辦定期教育訓練及腎友團體衛教。經由以上數 項措施介入後大幅改善人工血管阻塞率，並將人工血管阻塞率降至 14.3%，且合乎台 灣腎臟醫學會之透析診療指引之建議。

The aim of this project is to decrease the occlusion rate of A-V graft in the patients receiving hemodialysis. Our investigation found an A-V graft occlusion rate of up to 33.3%. The causes of the occlusion included: (1) No alternation of the puncture sites by nurses when puncturing the A-V graft. (2) Failure to pay more attention to abnormal sounds from unusual blood flow that would’ve enabled the early detection of occlusions. (3) Inability of nursing staff and patients to effectively gage the optimal compression pressure over the A-V graft after hemodialysis. After reviewing the literature and team discussions, we made the following improvements: (1) Modified the procedure for auscultation of the A-V graft while also adding additional documentation. (2) Set up personalized A-V graft puncture charts and rotations. (3) Modified instruction for A-V graft compression. (4) Enhanced nursing staff training on optimal compression pressure for A-V graft. (5) Regular education and training as well as health education for renal disease patient support groups. After the above methods were applied the occlusion rate of A-V grafts was reduced from 33.3% to 14.3% and therefore conformed with the recommended hemodialysis guidelines issued by the Taiwan society of Nephrology.