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Reducing Acute Kidney Injury Due to Contrast Material: How Nurses Can Improve Patient Safety

机译：减少因造影剂引起的急性肾脏损伤：护士如何改善患者安全

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BACKGROUND Acute kidney injury due to contrast material occurs in 3% to 15% of the 2 million cardiac catheterizations done in the United States each year. OBJECTIVE To reduce acute kidney injury due to contrast material after cardiovascular interventional procedures. METHODS Nurse leaders in the Northern New England Cardiovascular Disease Study Group, a 10-center quality improvement consortium in Maine, New Hampshire, and Vermont, formed a nursing task force to reduce acute kidney injury due to contrast material after cardiovascular interventional procedures. Data were prospectively collected January 1, 2007, through June 30, 2012, on consecutive nonemergent patients (n = 20 147) undergoing percutaneous coronary interventions. RESULTS Compared with baseline rates, adjusted rates of acute kidney injury among the 10 centers were significantly reduced by 21% and by 28% in patients with baseline estimated glomerular filtration rate less than 60 mL/min per 1.73 m2. Key qualitative system factors associated with improvement included use of multidisciplinary teams, standardized fluid orders, use of an intravenous fluid bolus, patient education about oral hydration, and limiting the volume of contrast material. CONCLUSIONS Standardization of evidence-based best practices in nursing care may reduce the incidence of acute kidney injury due to contrast material.
机译：背景技术在美国，每年进行的200万例心脏导管插入术中，由于造影剂引起的急性肾损伤发生率在3％至15％之间。目的减少心血管介入治疗后造影剂引起的急性肾脏损伤。方法北部新英格兰心血管疾病研究小组的护士负责人组成了一个由10个中心组成的质量改进联盟，位于缅因州，新罕布什尔州和佛蒙特州，是一个由10个中心组成的质量改善联盟，该小组成立了一个护理工作队，以减少心血管介入手术后由于造影剂引起的急性肾脏损伤。前瞻性收集了2007年1月1日至2012年6月30日接受连续经皮冠状动脉介入治疗的非合并患者（n = 20 147）的数据。结果与基线率相比，基线估计的肾小球滤过率每1.73 m2低于60 mL / min的患者在10个中心的急性肾脏损伤的调整率分别降低了21％和28％。与改善相关的主要定性系统因素包括：多学科团队的使用，标准化输液顺序，静脉输液的使用，对患者口服水合的教育以及限制造影剂的使用量。结论护理中基于证据的最佳做法的标准化可能会减少由于造影剂引起的急性肾损伤的发生率。

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