降低食道癌病人空腸造瘻管阻塞率

Reducing the Feeding-Tube Obstruction Rate in Esophageal Cancer Patients with Jejunostomy

金盈君(Ying-Chun Chin) ； 謝佩穎(Pei-Yin Hsieh) ； 張慈惠(Tsyr-Huei Chang)

《護理雜誌》 62卷3期附冊 (2015/06) Pp. 30-38

https://doi.org/10.6224/JN.62.3S.30

摘要

背景　食道癌病人長期吞嚥困難，須在空腸建立灌食管道作為營養之用。臨床上常見空腸灌食管道阻塞，導致病人營養失調，嚴重者致死。本專案經現況分析，發現單位病人發生空腸造瘻管阻塞發生率高達27.6%。導因包括管路縫合過緊造成直角、管路管徑過小、未建立造瘻管灌食準則、護理師及主要照顧者缺乏灌食技巧及護理師未落實衛教等，故引發專案小組改善動機，以期降低阻塞發生率。目的　本專案旨在降低食道癌病人空腸造瘻管之阻塞率，由27.6%降至 ≤ 3%。解決方案　藉由明確的策略，包含修正中央靜脈導管式空腸造瘻管植入近端縫合方式、建置灌食準則、製作衛教單張、課室教學及技術考、制訂空腸造瘻管灌食居家查核表等方案，降低食道癌病人放置空腸造瘻管之阻塞率。結果　食道癌病人放置空腸造瘻管之阻塞率，由27.6%降為6.7%。雖未達專案目的，但阻塞下降幅度高達75.7%。結論　本專案透過跨團隊合作及持續教育推廣等措施，確實有效降低食道癌病人放置空腸造瘻管之阻塞率，且大大提升此類病人之營養與照護品質。

關鍵字

食道癌 ； 空腸造瘻管 ； 阻塞率

並列摘要

Background & Problems: Patients with esophageal cancer experience chronic dysphagia. This condition typically necessitates the use of a jejunal feeding tube to provide the patient with adequate nutrition. Obstruction of the jejunal feeding tube is common in clinical practice and results in malnutrition in most patients and mortality in the most serious cases. An analysis of the status of jejunostomy-tube use in our unit found that these tubes were obstructed in 27.6% of the cases. The causes of this obstruction were: tube bending due to tight suturing, small inner-tube diameter, the absence of adequate jejunal-feeding standards, and failure to implement relevant training strategies. These findings motivated us to attempt to reduce the incidence of jejunostomy-tube obstruction at our center. Purpose: This project was designed to reduce the incidence of jejunostomy-tube obstruction in esophageal cancer patients from 27.6% to ≤ 3%. Resolutions: Clear strategies, including modification of the stitching method used at the implantation end of the central venous catheter-type jejunostomy tube, establishment of feeding standards, creation of educational guidelines and leaflets, classroom teaching, and technical examinations, were used to reduce the prevalence of obstruction incidents. Results: The jejunostomy-tube obstruction rate was reduced from 27.6% to 6.7%. While the study objective was not achieved, the magnitude of the reduction was still significant at 75.7%. Conclusions: Cross-disciplinary collaboration, continuous education and training, and the promotion of standards of practice were used to significantly reduce the jejunostomy tube obstruction rate in esophageal cancer patients. This result substantially increased the nutrition and quality of care received by this patient population.

並列關鍵字

esophageal cancer ； jejunostomy tube ； obstruction rate

參考文獻

American Society for Gastrointestinal Endoscopy Technology Committee, Kwon, R. S., Banerjee, S., Desilets, D., Diehl, D. L., Farraye, F. A., … Tierney, W. M. (2010). Enteral nutrition access devices. Gastrointestinal Endoscopy, 72(2), 236–248. 10.1016/j.gie.2010.02.008

Chen, A. M., Li, B. Q., Lau, D. H., Farwell, D. G., Luu, Q., Stuart, K., … Vijayakumar, S. (2010). Evaluating the role of prophylactic gastrostomy tube placement prior to definitive chemoradiotherapy for head and neck cancer. International Journal of Radiation Oncology • Biology • Physics, 78(4), 1026–1032. 10.1016/j.ijrobp.2009.09.036

Fujita, T., Daiko, H., & Nishimura, M. (2012). Early enteral nutrition reduces the rate of life-threatening complications after thoracic esophagectomy in patients with esophageal cancer. European Surgical Research, 48(2), 79–84. 10.1159/000336574

Han-Geurts, I. J. M., Hop, W. C., Verhoef, C., Tran, K. T. C., & Tilanus, H. W. (2007). Randomized clinical trial comparing feeding jejunostomy with nasoduodenal tube placement in patients undergoing oesophagectomy. British Journal of Surgery, 94(1), 31–35. 10.1002/bjs.5283

Kight, C. E. (2008). Nutrition considerations in esophagectomy patients. Nutrition in Clinical Practice, 23(5), 521–528. 10.1177/0884533608323427