P1562IMPLEMENTATION FOR INTEGRATED PROGRAM OF HEMODIALYSIS VASCULAR ACCESS PUNCTURE TRAINING AND AN ALARM SYSTEM MAY REDUCE THE INCIDENT OF VENOUS NEEDLE DISLODGMENT AND BLEEDING
Authors: Hsin Chi-Yang , Lin HsuanMing , Chen KuanYu , Lin YuChih , Hu HsiangWei 
Published: June 2020

Abstract

Background and Aims
A puncture of vascular access is commonly used in clinical treatment, such as hemodialysis or central venous catheters. At this time, leakage or infection associated with Venous needle dislodgement(VND) is a high risk of fatality, especially for patients with restlessness, impaired cognition, isolation, or home dialysis. In general dialysis procedures, medical personnel relies on patient reports and caregivers to manually inspect the site of dialysis puncture and detect the occurrence of needle removal and blood transfusion. There are some devices for detecting the presence of needle dislodgement in the market. Still, there are no large-scale reports for the integrated program for nursing training and device implantation. This study aims to conduct a program for an integrated training course and the VND device and hopes to reduce the incidence of needle removal and blood leakage.

Method
This study was divided into two phases, the control phase, and the study period. In the first phase, the abnormal events of ou venous needle dislodgement and blood leakage was recorded in the hemodialysis unit room during the first three months. Before the study period, we introduced an integrated program, including the standard process of fistula puncture, care during hemodialysis, an inspection of the venous puncture site, and an alarm system. In the study period, we also conducted the standard program and collected the data of the events of venous dislodgement or bleeding.

Results
The control phase was conducted during the three months from July 2019 to September 2019, and the study period was performed in November 2019. A total of 62 patients completed the study. During the control period, there were a total of 2087 dialysis treatments, of which 30 patients had venous needle dislodgement or bleeding. There were a total of 70 events of venous needle dislodgement or bleeding occurred, and the incidence rate was 3.3 events per 100 sessions. After the conduction of the integrated program and implantation of the alarm system in November 2019, there were a total of 682 dialysis sessions, and 15 events of venous needle dislodgement or bleeding occurred. The incidence rate was 2.2 events per 100 courses.

Conclusion
This study introduced venous needle dislodgement or bleeding alarm system in the hemodialysis unit. Compared with the traditional method, after the integrated care program, including fistula puncture, care, inspection, introduction, and use of the alarm system, venous needle dislodgement or bleeding dropped from 3.3 to 2.2 per 100 sessions. Therefore, through standardized training and program, it may be related to the decrease in the incidence of venous needle dislodgement or bleeding. This training mode can be worth promoting to more dialysis units to improve the quality of patient care. More follow-up studies are needed to provide multiple evidence.