降低手術全期置入鼻彎管病人鼻翼壓力性損傷發生率

Reduction in Incidence of Nasal Ala Pressure Ulcers in Surgery Patients with Nasotracheal Intubation

王勝昌(Sheng-Chang Wang) ； 葉菁怡(Jing-Yi Yeh) ； 程淑靜(Shu-Ching Cheng) ； 施瓊芬(Chiung-Fen Shih)

《榮總護理》 36卷3期 (2019/09) Pp. 277-286

https://doi.org/10.6142/VGHN.201909_36(3).0007

摘要

經鼻置入鼻彎管行麻醉手術病人，若因管路照護不當發生鼻翼壓力性損傷，可能因傷口結疤造成患者身體心像改變，也易引發醫療爭議。因手術全期的鼻翼壓力性損傷發生率高達46.67%，故引發改善動機；專案目的為降低手術全期鼻彎管留置病人的鼻翼壓力性損傷發生率。現況資料分析原因有：鼻彎管照護流程不一致、管路黏貼法摩擦鼻翼且無法持續觀察、缺乏有效鼻彎管固定工具，及護理人員鼻彎管照護認知不足等。透過制訂鼻彎管插管護理常規、研發改良式鼻彎管黏貼法、製作鼻彎管固定架，及舉辦在職教育提升管路照護技能等措施，經多次會議宣導，讓手術全期醫護團隊共同合作，將發生率降至11.42%，達專案目標。並將專案發展的改良式鼻彎管黏貼法及固定架，透過院內外競賽平行推展至其他醫療院所。

關鍵字

鼻彎管 ； 鼻翼壓力性損傷 ； 手術全期

並列摘要

Patients who undergo anesthesia via nasotracheal intubation are at risk of nasal-ala pressure sores due to improper tube care. The occurrence of nasal-ala pressure sores and scars that they leave may cause the patient to experience negative changes to their body image and can also lead to medical disputes. The incidence of nasal-ala pressure sores in the unit is as high as 46.67%; the purpose of this project was to reduce the incidence of nasal pressure sores in patients with nasotracheal intubation during the entire surgical period. Reasons for the analysis include inconsistent processing of the nasotracheal tube by nurses, friction of the nose caused by the method used to attach the pipe and the continuous observation of the pipe, lack of effective tools for attaching the nasotracheal tube, and lack of awareness by the nursing staff for the care of the nasotracheal tube. Methods used to reduce the incidence of nasal-ala pressure sores included the development of nasotracheal tube care routine, research and development of improved nasotracheal tube attachment methods, development of a nasotracheal tube fixator, and providing on-the-job education to improve pipeline care skills, along with other measures. The team worked together to reduce the incidence to 11.42% and reach the project goal. The improved nasotracheal tube attachment method and the fixed frame developed by the project can easily be adopted by other medical institutions.

並列關鍵字

nasotracheal intubation ； nasal ala pressure ulcer ； perioperative nursing

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