鼻空肠管Chapter 4 Nasojejunal tube
学习目标
1.掌握鼻空肠管常规护理
2.熟悉堵管处理方法
3.掌握以下词汇
enteral nutrition 肠内营养
syringe 注射器
bowel peristalsis 肠蠕动
blockage 堵管
adequately 充分的
rub 研磨
cram 填满
filtration 过滤
Liu Mei is a patient with acute pancreatitis.She will be returning home tomorrow with a nasojejunal tube for further nutritional therapy.Xiao Hui is a digestive specialist nurse.She will evaluate Liu Mei's management ofnasojejunal tube today.
Xiao Hui: Now let's begin.Just relax.
Liu Mei: First, take out the nutrient solution from a cool and dry place.Nutrient solution should be prepared right before use.After removing the air from the infusion tube, pulse flush the tube using 20 mL warm drinking water with a 20 mL syringe.During the infusion process, repeat the flush every 4 hours.The temperature of nutrient solution should not be too high, between 37 to 40℃.Moderate expercises may be taken to promote bowel peristalsis during the infusion.Finally, flush the tube at the end of the infusion.Fix the tube with nasal patches.Record the exposed length of the tube, perinasal skin condition, infusion volume, and any discomfort such as abdominal pain on a daily basis.
Xiao Hui: Over time, tube blockage may occur.Two major causes of blockage are residue and incompletely crushed drug fragments adhering to the tube wall.The tablets should be thoroughly ground to prevent tube blockage caused by cramming of particles.Gauze filtration can be used if necessary.Well, Liu Mei, what should be done in case ofblockage?
Liu Mei: Stop infusing and increase the frequency and volume oftube flushing until the blockage is gone.
Xiao Hui: Yes.If it is still blocked, you can inject 5%NaHCO3 solution into the tube.Keep it sealed for 30 minutes and rinse with warm water.Or you can come to the hospital and ask us for help.Dial the number on the follow-up card in case you have any other problems.
Liu Mei: Thank you.
译文
刘梅是一名急性胰腺炎患者，明天要带着鼻空肠管回家继续营养治疗。消化科护士小慧将评估刘梅营养管操作。
小慧：现在开始吧，放松点。
刘梅：首先，将营养液从阴凉干燥处取出，现用现配。排空输注管内的空气，输注前用20 mL注射器抽20 mL温开水脉冲式冲管，输注过程中每4小时冲管一次，输注温度为37～40℃，温度不可过高，输注过程中可适当活动，促进肠蠕动。最后，输注结束后再次冲管，妥善固定鼻贴，每天记录管道的外露长度、鼻子周围的皮肤情况，输注量，有无腹痛等不适。
小慧：时间久了，有可能会堵管，堵管的主要原因是残渣和粉碎不全的药物碎片黏附于管腔内，所以应充分研磨药片，避免颗粒导致堵管，必要时可用纱布过滤。那么刘梅，出现堵管时应如何处理？
刘梅：应暂停输注，增加冲管的频率及量，直至管路通畅。
小慧：是的，如果管路还是不通，可以推注5% NaHCO3溶液，封管保持30分钟，再用温水冲洗。你也可以直接来医院找我们，有其他任何问题都可以拨打随访卡上的电话咨询。
刘梅：谢谢。