提升腫瘤病人引流管傷口周圍皮膚完整性之專案

Management to Improve the Integrity of skin in Cancer Patients with Drainage Tubes

高玉鳳(Yu-Feng Kao) ； 郭于綾(Yu-Ling Kuo) ； 李佳宜(Chia-Yi Li) ； 曾雅婷(Ya-Ting Tsen) ； 李淑慧(Shu-Hui Lee) ； 王意雅(I-YA Wang)

《腫瘤護理雜誌》 17卷2期 (2017/12) Pp. 47-59

https://doi.org/10.3966/168395442017121702005

摘要

本專案目的為提升腫瘤病人引流管傷口周圍皮膚完整性。臨床發現病人引流管傷口滲液量多，雖依規範換藥，仍產生皮膚受損，引發專案動機。經調查發現病人管路周圍皮膚之完整性僅達47.2%，透過現況分析及文獻查證，確立問題為：敷料種類吸附滲液後無法隔絕皮膚與滲液、護理人員引流管傷口更換時機及敷料選擇造成傷口長期浸潤、無傷口滲液分級照護標準及教育訓練。透過專案改善方案、引流管傷口滲液分級照護評估指引、引流管傷口滲液評估分級照護步驟圖卡、防滲漏聰明袋、規劃教育訓練，專案改善結果顯示病人管路周圍皮膚之完整性提升至83.9%。病人傷口做分級評估及照護介入，不僅可提升引流管傷口皮膚完整性，也減少因頻繁換藥造成病人的不適及困擾，護理人員依照護指引提供適當照護，改善病人舒適感，提升護理品質，進而改善生活品質。

關鍵字

引流管傷口 ； 腫瘤病人 ； 皮膚完整性

並列摘要

The purpose of this project is to improve the integrity in cancer patients with drainage tube. The important clinical finding is increased amount of drainage in cancer patients with routine wound change, patients still suffered from skin damage. Therefore, the observation helped to guide this project. The survey found that only 47.2% of patients with drainage tube also have skin integrity. Based on results of situation analysis along with literature review, the problems were identified as 1. certained dressings are unable to isolate skin from exudate, 2. inappropriate choices of dressing may cause long-term exudate of wound, 3. the lack of standards and education on the classifications of exudated skin. The project include 1.Establishation of assessment guidelines for exudated wound’s classification. 2. Making cards to illustrate wound’s classifications, steps of wound’s care.3.Usages of smarts bags to prevent exudate. 4. Planing educational and training programs. The results showed the percentage of integrity skin was improved up to 83.9% in cancer patients with drainage tube. Triaging wounds and interventional care could reduce drainage tubing related skin injury and discomfort induced by frequent dressing. Nursing staff shall follow care guideline to provide appropriate service improve care, and life quality of patients.

並列關鍵字

drainage tube of wound ； cancer patient ； skin integrity

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