腹腔置管护理Chapter 5 Abdominal catheter care
学习目标
1.掌握腹腔置管的注意事项
2.熟悉腹腔置管如何冲洗
3.掌握以下词汇
debridement of peripancreatic necrosis 胰周坏死组织清除术
squeeze 挤压
hand hygiene 手部卫生
aseptic technique 无菌技术
Zhang Yi is a patient with severe acute pancreatitis complicated by abdominal infection.He underwent debridement of peripancreatic necrosis a week ago, and is currently in ICU.He has 3 drainage cannulas, which are right-side peripancreatic abscess cannula, right-side T-tube and right-side colon fistula cannula.
Li Li, an ICU nurse, is handing over work to the next shift with Liu Fen.She straightens out and fixes the drainage tubes on the abdominal wall with 3M tape using high platform method.The same drainage and inlet tubes are marked with the same color using color labels.The tube names and exposed lengths are also marked.
Liu Fen: Li Li, is there anything special about these drainage cannulas for shift handover?
Li Li: The smooth drainage of cannula must be ensured.Check drainage tubes once an hour.Squeeze drainage tubes constantly.Semi-recumbent position can be applied to facilitate drainage when vital signs are stable.Help the patient change positions per hour.
Liu Fen: How to flush the abdominal cannula?
Li Li: Dropping speed and negative pressure of flushing fluid should be adjusted timely according to the natures of the drainage fluid.The average speed is 25 to 50 drops per minute and the negative pressure is 10 to 20 kPa.The total amount of physiological saline per day is 2500 to 5000 mL.
Liu Fen: How to care for the skin around the catheter?
Li Li: Change dressings 1 to 2 times a day to keep them dry and clean.If necessary, apply zinc oxide to protect skin and prevent skin irritation caused by drainage fluid.
Liu Fen: Ok, I will keep that in mind.
Li Li: We must guarantee the hand hygiene of medical staff.Hand washing, or rapid hand disinfection is mandatory before and after operation or contact with patients.Aseptic technique should be properly employed.
译文
张毅是一位重症急性胰腺炎合并腹腔感染的患者，1周前行胰周坏死组织清除术，住在监护室，带有右胰周脓肿引流套管、右T管及右结肠瘘管。
李丽是ICU的护士，正在与刘芬交接班。她理顺并用3M胶布用高举平台法将引流管固定于腹壁上，采用彩色标识，同一根引流管和进水管贴同一颜色，标明管道名称及外露长度。
刘芬：李丽，这些管道有哪些特殊情况需要交班吗？
李丽：一定要确保导管引流通畅，每小时察看1次，经常挤压引流管，生命体征平稳后可取半坐卧位，每小时变换体位1次，以利于引流。
刘芬：平时如何冲洗呢？
李丽：冲洗液的滴速及负压根据引流液的性质随时做适当的调整，一般滴速为每分钟25～50滴，负压为10～20 kPa，每天的生理盐水总量为2 500～5 000 mL。
刘芬：置管处周围的皮肤如何护理呢？
李丽：每天换药1～2次，保持敷料干洁，必要时涂抹氧化锌保护皮肤，防止引流液腐蚀皮肤。
刘芬：好的，我会牢记在心。
李丽：要确保医护人员手卫生管理，操作前后、接触患者前后都要洗手或快速手消毒，严格无菌操作。