降低某外科病房空腸造廔灌食阻塞率之改善方案

An Improvement Plan of Reducing Jejunostomy Catheters Feeding Tube Obstruction Incidence Rate in Surgical Units

10.29494/LN.202106_22(2).0010

林文淑(Wen-Shu Lin)；陳婷琬(Ting-Wan Tan)

空腸造廔灌食 ； 空腸造廔阻塞 ； 空腸造廔護理指導 ； jejunostomy catheters feeding ； jejunostomy obstruction ； jejunostomy nursing education training

領導護理

22卷2期（2021 / 06 / 01）

141 - 157

繁體中文

本專案旨在改善空腸造廔灌食阻塞率。經現況調查發現：導管材質軟，接管處易反折、固定方式錯誤及護理人員執行護理指導不完整，其造成空腸造廔灌食阻塞率高達68.2%。經進行解決方案：一、標準制定及教育宣導：制定空腸造廔灌食護理指導標準內容及作業規範，舉辦在職教育訓練課程，加強護理人員對空腸造廔灌食之認知；二、制定查核制度：制定空腸造廔灌食護理指導監測指標辦法及計畫定期審核。經實施方案後，空腸造廔灌食阻塞率由68.2%降至11.1%，達本專案的目的。此改善最重要是減少空腸造廔灌食阻塞後導致重插管危險性，避免增加對病人傷害，另外，經由水平推展至全院病房，提昇照護護理品質，是本專案最大的收穫。

This project aims to improve the rate of obstruction of jejunum infusion. The investigation of the current situation found that the catheter is a soft material, easy to bend at the junction, incorrect fixation method, and incomplete nursing guidance by the nursing staff, those causes the obstruction rate of jejunostomy catheters feeding to as high as 68.2%. The solutions have been implemented: Firstly, standardize formulation and education promotion: formulate the content and work specifications of the nursing guidance standard for jejunostomy catheters feeding, hold on-the-job education and training courses, and strengthen nursing staff's cognition of jejunostomy catheters feeding; Secondly develop an inspection system: Formulate methods and plans for regular review of jejunostomy catheters feeding nursing guidance and monitoring indicators. After the implementation of the program, jejunostomy obstruction was reduced from 68.2% to 11.1%, and reached the goal of this project. Most importantly, this improvement aims to reduce the risk of reintubation after jejunostomy obstruction and to avoid additional injury to the patients. In addition, the biggest benefit of this project is extending the level to the entire hospital ward and improves the quality of care.

1. Blumenstein, I.,Shastri, Y. M.,Stein, J.(2014).Gastroenteric tube feeding: techniques, problems and solutions.World Journal of Gastroenterology,20(26),8505-8524.
2. Choi, A. H.,O'Leary, M. P.,Merchant, S. J.,Sun, V.,Chao, J.,Raz, D.,Kim, J.(2017).Complications of feeding jejunostomy tubes in patients with gastroesophageal cancer.Journal of Gastrointestology Surgery,21(2),259-265.
3. Fisher, C.,Blalock, B.(2014).Clogged feeding tubes:a clinician’s thorn.practical gastroenterology,127,16-22.
4. Friedman, A. J.,Cosby, R.,Boyko, S.,Hatton-Bauer, J.,Turnbull, G.(2011).Effective teaching strategies and methods of delivery for patient education: A systematic review and practice guideline recommendations.Journal of Cancer Education,26(1),12-21.
5. Gupta, V.(2019).Benefits versus risks: A prospective audit. Feeding jejunostomy during esophagectomy.World Journal of Surgery,33(7),1432-1438.
6. Levy, A. C. J.,Kovacs, S.(2019).A simple method of unclogging enteral feeding tubes: even when traditional methods have failed.MOJ Clinical & Medical Case Report,9(1),5-7.
7. Roveron, G.,Antonini, M.,Barbierato, M.,Calandrino, V.,Canese, G.,Chiurazzi, L. F.,Coniglio, G.,Gentini, G.,Marchetti, M.,Minucci, A.,Nembrini, L.,Neri, V.,Trovato, P.,Ferrara, F.(2018).Clinical practice guidelines for the nursing management of percutaneous endoscopic gastrostomy and jejunostomy (PEG/PEJ) in adult patients: An executive summary.Journal of Wound Ostomy Continence Nursing,45(4),326-334.
8. Saha, S.,Loranger, D.,Pricolo, V.,Degli-Esposti, S.(2019).Feeding jejunostomy for the treatment of severe hyperemesis gravidarum: a case series.Journal of Parenteral & Enteral Nutrition,33(5),529-534.
9. Yang, S. M.,Hsiao, W. L.,Lin, J. H.,Huang, P. M.,Lee, J. M.(2017).Laparoscopic percutaneous jejunostomy with intracorporeal V-Loc jejunopexy in esophageal cancer.Surgery Endoscopy,31(6),2678-2686.
10. 衛生福利部（2018，04 月 27 日）．統計資料動態查詢主目錄．2018 年 12 月 7 日取自https://statis.moi.gov.tw/micst/stmain.jsp?sys=100