降低非計劃性氣管內管拔除率方案

A Project of Reducing the Unplanned Extubation Rate of Endotracheal Tubes

林淑芬(Shu-Fen Lin) ； 邱正怡(Cheng-Yi Chiu) ； 張素菁(Suh-Jing Chang) ； 賴正芬(Chang-Fen Lai) ； 黃致閔(Zhi-Min Huang) ； 梁啟娟(Chi-Chuan Liang)

《慈濟護理雜誌》 2卷4期 (2003/12) Pp. 105-113

https://doi.org/10.6974/TCNJb.200312.0105

摘要

本護理專案的目的在降低重症病房氣管插管病患之非計劃性拔管率，以維持病患呼吸道通暢及呼吸功能。專案小組回溯89年11月1日至90年3月31日之意外事件報告表，發現在138位氣管內管留置病患中，發生非計劃性氣管內管拔除的有19人次，拔除率為13.8%。經病房專案小組分析發生原因後發現：缺乏適當約束的有7件（36.8%），躁動未適當使用鎮靜劑者有6件（31.6%），缺乏有效溝通的有5件（26.3%），氣囊破裂滑脫的有1件（5.3%）。經過改善專案─「適當的約束病患」、「適當的使用鎮靜劑」、「加強探視病患並做有效溝通」及「加強氣囊功能與壓力檢測」等對策的實施後，在172位置放氣管內管的病患中，非計劃性氣管內管拔除發生事件降為10件，非計劃性拔管率為5.8%，明顯的達到專案的目的。

關鍵字

非計劃性拔管 ； 氣管內管 ； 插管

並列摘要

The purpose of this project was to reduce the rate of unplanned extubation (UE) in ICU patients who were endotracheally intubated in order to keep a patent and functional airway for the patients. Data collection was from November 1, 2000 till March 31, 2001 from the accidental reports by a team of project retrospectively. Before the project, there were 138 patients who had been endotracheally intubated, and 19 patients (13.8%) occurring unplanned extubation. Analytically, the causes of UE were: lack of proper physical restraints in 7 patients (36.8%), no adequate sedation used in 6 irritable patients (31.6%), lack of efficient communication in 5 patients (26.3%), and I patient with ruptured cuff (5.3%). Unplanned extubation ensued in 10 of 172 intubated patients after strategies, including “proper physical restraints of patients”,” close observation and efficient communication”, and “close monitoring of the cuff function”. The rate of unplanned endotracheal extubation was 5.8%. It reached the goal of this project successfully.

並列關鍵字

unplanned extubation ； endotracheal ； intubation