導(dǎo)尿管之選擇與護理課件

導(dǎo)尿管之選擇與護理慈濟技術(shù)學(xué)院江明珠Incidenceof

catheterization10%

of

patients

in

hospital（Mulhall

etal,1988）25%

of

patients

in

hospital（Saint

etal,1999）4%

of

patients

receiving

nursing

services

athome（Getliffe

and

Mulhall,1991）Indications

for use

of

urinarycathetersShort-term

catheterizationUrologic

surgerySurgery

on

contiguous

structuresCritically

ill

patients

requiring

accuratemeasure

of

urinary

outputAcute

urinary

retention途徑Transurethra

catheterizationTransvesical

catheterization（

suprapubiccatheterization

）What

issuprapubiccatheterization？恥骨上導(dǎo)尿管：在膀胱脹滿水之後由恥骨上正中央插入導(dǎo)引器然後插入導(dǎo)尿管suprapubic

catheterizationsuprapubic

catheterizationConsider suprapubic

or

urethralurethralShort

termintermittentPost-specific

surgeryDifficulties

with

suprapubiccatheterizationsuprapubicLong

term（includingincontinence）Sexually

active

clientsPost-specific

surgeryUrethra

traumaSome

wheelchair-bound

clientsDifficulties

with

urethral

catheterConsider suprapubic

or

urethralcatheterizationsuprapubicSpecificAltered

bodyimagePotential

leakage

from

andaround

siteRequires

a

registeredmedical

practitioner

toinserturethraldisadvantagesAltered

bodyimageImpedes

sexual

intercourseHigher

risk

of

infectionSelection

of

cathetersCatheter

sizeMale:14-16Ch（length

40-45cm）Female:12-14Ch（length20-26cm）Balloon

size5-10ml

recommended30ml

surgery

onlyCatheter-related

problemBypassingUTIBlocked

catheterInadvertent

catheter

removalCatheter-related

problem-BypassingCommon

causes

of

bypassingConstipationKinked

tubingCatheter

size

and

length/balloonDetrusor

instabilityTrigone

irritationblockageCatheter-related

problem-UTI直接影響導(dǎo)尿管造成感染之因素：放置時間長短Detect

significant

microbial

counts-3daysaftercatheterization（Bach

et

al,1990）The

risk

of

developing

bacteriuriaGaribaldi

et

al

（1974）：

8.1%

for

each

dayMulhall

et

al（1988）：5-8%

for

each

daySedor（1999）：5%

for

each

dayBacteriuria

is

virtually

inevitable

within

3-4

weeks（Jewes

et

aal,1988）Catheter-related

problem---UTI危險因素：引流袋污染糖尿病女性患者抗生素使用頻頻測量尿輸出量腎功能不良技術(shù)不良Catheter-related

problem---UTICatheter-related

problem---UTI致病菌Extogenous

organisms（e.g.serratia

spp.And

Pseudomonas

aeruginosa）found

inthe

environment

and

on

handEndogenous

faecal

orurethralmicroorganisma（e.g.Gram-positive

cocciand

Klebesiella）Complications

associated

withurinary

cathetersLong-term

catheterization菌尿癥是很常見，一般多於6週內(nèi)發(fā)生有癥狀泌尿道感染、發(fā)燒、急性腎盂腎炎、菌血癥、甚至死亡導(dǎo)尿管阻塞、尿路結(jié)石、局部尿道周圍感染、慢性腎炎、腎衰竭、甚至術(shù)年後發(fā)生膀胱癌男性長期導(dǎo)尿管放置可導(dǎo)致尿道炎、尿道廔管、副睪炎、陰囊膿瘍、攝護腺炎或攝護腺膿瘍長期導(dǎo)尿管之病人尿中有95%為多重菌感染，菌種為

E.coli、P.aeruginosa、P.mirabilis，少數(shù)為Providentiastuartii及M.morganii病患留置導(dǎo)尿前之護理評估病患留置導(dǎo)尿的適應(yīng)癥選擇合適的導(dǎo)尿管評估病患留置導(dǎo)尿前的排尿情形病患留置導(dǎo)尿前之護理指導(dǎo)正確置入導(dǎo)尿技術(shù)Maintaining a

closed

urinarydrainage

systemDON’TDon’t

allow

any

tension

on

the

tubing

that

coulddislodge

the

catheter

or

damage

the

urethraDon’t

allow

tubing

to

loop

below

thedrainagebagDon’t

attach

the

drainage

to

a

bed

rail

or

allow

itto

rest

on

thefloorDon’t

allow

the

patient

to

lie

on

the

tubingMaintaining

a

closed

urinarydrainage

systemMaintaining

a

closed

urinarydrainage

systemMaintaining

a

closed

urinarydrainage

systemMaintaining

a

closed

urinarydrainage

systemMaintaining

a

closed

urinarydrainage

systemUrinary

catheter

securement導(dǎo)尿管固定好可降低尿管意外脫落，及由於過拉扯尿管或尿袋所造成的組織損傷及發(fā)炎尿管滑脫之比例為17%-41%，而不適當(dāng)?shù)墓潭ㄊ侵饕奈ｋU因子，常引起沒有計劃性

的尿管拔除。創(chuàng)傷及發(fā)炎與重複導(dǎo)尿管移動及尿道受壓有關(guān)，當(dāng)尿管沒有適當(dāng)固定或病人拉扯尿管

會造成尿管沒有目的的移動，移動尿管會

造成創(chuàng)傷及發(fā)炎，使其更容易造成感染、

組織壞死、尿道腺體阻塞及膀胱不穩(wěn)定或

痙攣。Urinary

catheter

securement膠布是最古老的固定方法，將尿管黏貼於大腿或腹部，採chevron

method，即使臨床研究其固定效果不佳，

然在沒有其他選擇下，膠布仍然是主要固定尿管之方

法。優(yōu)點：便宜、方便缺點：易脫落常引起皮膚不同程度的反應(yīng)重複的膠布使用，使得尿管感覺黏黏的，微生物即

容易聚積在上面，而增加管腔外染污之危險性，使微生物進而進入膀胱引起泌尿道感染。Maintaining

a

closed

urinarydrainage

systemUrinary

catheter

securement導(dǎo)尿管固定帶Dale

Foley

Catheter

HolderUrinary

catheter

securement導(dǎo)尿管固定帶為專利產(chǎn)品，利用容易鬆綁之魔

鬼膠帶，將導(dǎo)管固定，避免導(dǎo)管晃動拉扯脫出、感染，適合長期照護，急診手術(shù)後需留置導(dǎo)管

病患使用。導(dǎo)尿管固定帶簡易、方便，沒有使用貼膠所引起皮膚的過敏或不舒服Dale

Foley

Catheter

Holder可分#316大腿固定帶及#330腰部固定帶Urinary

catheter

securementtape

may be

the

oldestmethod,butit’s not

the

only

oneThe

statlock

Foleydevice,an

adhesiveanchor

for

urinarycathetersUrinary

catheter

securementTThe

Statlock

FoleyPediatric

devicestabilizes

the

urinarycatheter

via

a

teddybear-shaped

adhesiveanchorUrinary

catheter

securementTThe

Flexi-Trakdevice,

a

mutipurposeanchor,can

be

adjustedto

secure

evenlarge-diameter

drainagetubingCDC

Guidelinesfor

preventionof

Catheter-Associated

UTICategory1.strongly

recommendedCatheterize

only

when

necessaryEducate

personnel

in

correct

techniques

of

catheter

insertion

andcareEmphasize

handwashingInsert

catheter

using

aseptic

technique

and

sterile

equipmentSecure

catheter

properlyMaintain

closed

sterile

drainageObtain

urine

specimensaspeticallyMaintain

unobstructed

urineflowCDC

Guidelines