鼻胃管喂养护理风险分析及管理策略
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摘要
鼻胃管喂养是临床上最常见的肠内营养支持途径,护理风险存在于鼻胃管置管过程中的各个环节。本文采用护理风险管理的方法,分析鼻胃管置管各个环节潜在的护理风险点,如置管前评估不全面、鼻胃管位置的确定方法不规范、并发症发生率高以及用药错误等。针对各风险点提出管理策略,如置管前全面评估、建立胃管位置确认规范化指引、遵循"六度原则"及执行"三标识、四专用"等,以提高护士的风险责任意识,有效规避护理风险,减少护理不良事件的发生,保障患者安全。
Nasogastric tube feeding is the most common way of enteral nutrition support in clinic. Nursing risks exist in all aspects of nasogastric tube insertion. This paper adopts a method of nursing risk management to analyze potential nursing risk points of various links during nasogastric tube insertion,such as incomprehensive assessment before catheter insertion,irregular methods of affirming the right nasogastric tube position,high incidence of complications and medication errors. We put forward the corresponding management strategies,such as comprehensive assessment before insertion,the guideline of determining position of gastric tube,basic six principles and the application of specific signals and equipments,so as to raise nurses' awareness of risks,avoid nursing risks effectively,reduce the occurrence of nursing adverse events and ensure patients' safety.
Nasogastric tube feeding is the most common way of enteral nutrition support in clinic. Nursing risks exist in all aspects of nasogastric tube insertion. This paper adopts a method of nursing risk management to analyze potential nursing risk points of various links during nasogastric tube insertion,such as incomprehensive assessment before catheter insertion,irregular methods of affirming the right nasogastric tube position,high incidence of complications and medication errors. We put forward the corresponding management strategies,such as comprehensive assessment before insertion,the guideline of determining position of gastric tube,basic six principles and the application of specific signals and equipments,so as to raise nurses' awareness of risks,avoid nursing risks effectively,reduce the occurrence of nursing adverse events and ensure patients' safety.
引文
[1]李小寒,尚少梅.基础护理学[M].北京:人民卫生出版社,2017.
[2]杨晓容.护理风险管理在呼吸内科预防老年患者跌倒坠床中的应用[J].护理实践与研究,2013,10(22):56-58.
[3]ELLETT M L.What is known about methods of correctly placing gastric tubes in adults and children[J].Gastroenterol Nurs,2004,27(6):253-261.
[4]刘从秀,吴雪兰,吴丽娟,等.确定胃管置入位置困难患者的综合判断措施[J].护理学杂志,2013,28(15):46-48.
[5]葛津津,刘薇群,汤培凤,等.鼻胃管位置判断方法的研究进展[J].解放军护理杂志,2015,32(19):37-39.
[6]PROEHL J A,HEATON K,NACCARATO M K,et al.Emergency nursing resource:gastric tube placement verification[J].J Emerg Nurs,2011,37(4):357-362.
[7]张慧.特重型脑外伤患者鼻饲并发症的预防性护理对策分析[J].中国医药导报,2012,14(5):904-905.
[8]孙建丽,申屠雄芽.昏迷患者鼻饲中存在的问题及护理对策[J].护理与康复,2011,4(10):322-323.
[9]任婴.安全防范措施在神经内科鼻饲患者中的应用评价[J].心理医生杂志,2012(6):16-17.
[10]SIMMONS D,SYMES L,GUENTER P,et al.Tubing misconnections:normalization of deviance[J].Nutr Clin Pract,2011,26(3):286-293.
[11]陈蓓蕾,曹雪萍.改进风险评估方法对鼻饲管置管并发症的影响[J].健康研究,2017,37(5):597-598.
[12]廖喜琳,钟美容,蔡超群.标准吞咽功能评估及预见性护理对老年脑卒中吞咽障碍患者康复的影响[J].中国老年学杂志,2015,35(8):2036-2038.
[13]胡延秋,程云,王银云,等.成人经鼻胃管喂养临床实践指南的构建[J].中华护理杂志,2016,51(2):133-141.
[14]彭南海,高勇.临床营养护理指南——肠内营养部[M].南京:东南大学出版社,2012.
[15]CJ P T.Nursing management of nasogastric tube feeding in adult patients[EB/OL].(2010-07-01).[2014-01-21].http://www.moh.gov.sg/content/dam/moh_web/HPP/Nurses/cpg_nursing/2010/nasogastric%20tube%20feeding%20-%20book.pdf.
[2]杨晓容.护理风险管理在呼吸内科预防老年患者跌倒坠床中的应用[J].护理实践与研究,2013,10(22):56-58.
[3]ELLETT M L.What is known about methods of correctly placing gastric tubes in adults and children[J].Gastroenterol Nurs,2004,27(6):253-261.
[4]刘从秀,吴雪兰,吴丽娟,等.确定胃管置入位置困难患者的综合判断措施[J].护理学杂志,2013,28(15):46-48.
[5]葛津津,刘薇群,汤培凤,等.鼻胃管位置判断方法的研究进展[J].解放军护理杂志,2015,32(19):37-39.
[6]PROEHL J A,HEATON K,NACCARATO M K,et al.Emergency nursing resource:gastric tube placement verification[J].J Emerg Nurs,2011,37(4):357-362.
[7]张慧.特重型脑外伤患者鼻饲并发症的预防性护理对策分析[J].中国医药导报,2012,14(5):904-905.
[8]孙建丽,申屠雄芽.昏迷患者鼻饲中存在的问题及护理对策[J].护理与康复,2011,4(10):322-323.
[9]任婴.安全防范措施在神经内科鼻饲患者中的应用评价[J].心理医生杂志,2012(6):16-17.
[10]SIMMONS D,SYMES L,GUENTER P,et al.Tubing misconnections:normalization of deviance[J].Nutr Clin Pract,2011,26(3):286-293.
[11]陈蓓蕾,曹雪萍.改进风险评估方法对鼻饲管置管并发症的影响[J].健康研究,2017,37(5):597-598.
[12]廖喜琳,钟美容,蔡超群.标准吞咽功能评估及预见性护理对老年脑卒中吞咽障碍患者康复的影响[J].中国老年学杂志,2015,35(8):2036-2038.
[13]胡延秋,程云,王银云,等.成人经鼻胃管喂养临床实践指南的构建[J].中华护理杂志,2016,51(2):133-141.
[14]彭南海,高勇.临床营养护理指南——肠内营养部[M].南京:东南大学出版社,2012.
[15]CJ P T.Nursing management of nasogastric tube feeding in adult patients[EB/OL].(2010-07-01).[2014-01-21].http://www.moh.gov.sg/content/dam/moh_web/HPP/Nurses/cpg_nursing/2010/nasogastric%20tube%20feeding%20-%20book.pdf.