降低肝膽胃腸科病人之鼻胃管阻塞率

背景　住院病人因疾病或治療因素無法由口進食時，經由鼻胃管提供腸道營養及給藥是十分普遍的護理措施；然而，鼻胃管阻塞是此類病人常面臨的管路異常問題。根據本單位2011年1月至9月統計，鼻胃管阻塞事件共發生7件（0.76%），且經評估後皆必須移除重新放置。目的　降低鼻胃管阻塞率低於0.31%。解決方案　實施的措施有：（1）舉辦護理師管灌技能在職教育訓練、（2）單位設置磨粉過篩裝置、（3）制定「Esomeprazole（Nexium®）藥物灌藥技術」、（4）鼻胃管管灌技術標準並修訂「鼻胃管灌食技巧」護理指導單張、以及（5）定期稽核護理師之鼻胃管管灌及特殊灌藥技術正確性。結果　經專案實施後，鼻胃管阻塞率由原本0.76%下降至0%，護理師的管灌技術正確率提升，尤其是特殊灌藥技術正確率由16.7%提升至100%成效顯著。結論　本專案結合護理師、醫師、藥師等跨專業團隊合作方式共同商討，制定標準作業規範，改變護理師過去的管灌技巧，最後順利達成降低鼻胃管阻塞率目標。

關鍵字

鼻胃管；灌食管路阻塞

並列摘要

Background & Problems: When oral intake is inadequate or not recommended for patients with underlying diseases or specific treatments, it is common for these patients to receive nutrition enterally through a nasogastric tube. However, tube occlusion is a common complication of enteral feeding tubes. Data collected at our hospital from January to September 2011 identified 7 nasogastric tube occlusion events. All events were resolved by replacing the original tube with a new tube.Purpose: The purpose of this project was to reduce the nasogastric tube occlusion rate to 0.31% or less.Resolutions: Implemented interventions included: 1) developing and administering a course for nurses on nasogastric- tube feeding techniques; (2) providing a filter for powdered medications; (3) developing a standard procedure for administering Nexium through nasogastric tubes; (4) updating patient-education pamphlets for nasogastric tube feeding; and (5) enhancing the quality of nurse auditing on nasogastric tube feeding techniques and nasogastric-tube medication-administration techniques.Results: The average nasogastric tube occlusion rate decreased from 0.76% to 0% and the average nasogastric tube feeding technique compliance rate for nurses increased. The accuracy rate for specific medication administration techniques through nasogastric tubes increased dramatically from 16.7% to 100%.Conclusion: The project involved a multidisciplinary team of physicians, nurses, and pharmacists. This team developed a standard protocol for nasogastric tube feeding and specific medication administration recommendations for nasogastric tubes; revised nursing practice standards; and decreased the rate of nasogastric tube occlusion.

並列關鍵字

nasogastric tube ； enteral feeding tube occlusion

參考文獻

Best, C. (2009). Percutaneous endoscopic gastrostomy feeding in the adult patient. British Journal of Nursing, 18(12), 724-729.

Boullata, J. I. (2009). Drug administration through an enteral feeding tube. AJN: American Journal of Nursing, 109(10), 34－42. doi:10.1097/01.NAJ.0000361488.45094.28

Bourgault, A. M., Heyland, D. K., Drover, J. W., Keefe, L., Newman, P., & Day, A. G. (2003). Prophylactic pancreatic enzymes to reduce feeding tube occlusions. Nutrition in Clinical Practice, 18(5), 398－401. doi:10.1177/0115426503018005398

Devlin, J. W., Bakshi, A., Bungay, K., & Olsen, K. M. (2006). An in vitro comparison of different providers to deliver four proton pump inhibitor products through a feeding tube. Alimentary Pharmacology & Thearapeutics, 24(11- 12), 1603－1611. doi:10.1111/j.1365-2036.2006.03169.x

Heineck, I., Bueno, D., & Heydrich, J. (2009). Study on the use of drugs in patients with enteral feeding tubes. Pharmacy World & Science, 31(2), 145－148. doi:10.1007/s11096- 008-9268-6

國際替代計量

降低肝膽胃腸科病人之鼻胃管阻塞率

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