降低大腸直腸癌病人術後腸造口袋滲漏發生率

A Project to Reduce the Rate of Colostomy Pouch Leakage in Postoperative Colorectal Cancer Patients

10.3966/168395442017121702006

廖英純(Ying-Chun Liao)；林棻慧(Fen-Hui Lin)；林月娥(Yueh-E Lin)；黃麗碧(Li-Bi Hwang)

大腸直腸癌 ； 造口袋 ； 滲漏率 ； colorectal cancer ； colostomy pouch ； leakage rate

腫瘤護理雜誌

17卷2期（2017 / 12 / 01）

61 - 77

繁體中文

臨床大腸直腸癌病人約30%術後有腸造口留置，而腸造口常造成病人生活困擾，故提供良好腸造口照護對於大腸直腸癌病人是很重要的術後護理。調查發現術後造口袋滲漏率高達37.5%（12/32）。現況分析發現原因為：使用束腹帶無法直接觀察造口袋排泄量、未及時清理造口袋、造口袋剪裁直徑過大、清潔造口袋技術不熟練等；且主要照顧者腸造口照護的認知正確率僅76.9%，經制訂腸造口照護須知、造口袋清潔及造口袋剪裁流程圖、腸造口照護查檢表、開發改良式造口束腹帶及使用操作指引方案。於2014年11月8日至2015年1月23日共評值32位主要照顧者執行專案後腸造口照護認知率由76.9%提升至98.1%；其造口袋滲漏率也由37.5%降為6.2%，達成專案目的。本專案能有效降低造口袋滲漏率，及提升大腸直腸病人之生活品質。

Approximately 30% of colorectal cancer patients received indwelling colostomy surgery which caused unpleasant interruptions in their life. It is very important to provide good post-op colostomy nursing care for colorectal cancer patients. The authors conducted a survey and saw a result of pouch leakage rate at 37.5% (12/32). The reasons are as follows: the use of the corset belt makes it difficulty in assessing the leakage amount in colostomy pouch, infrequent cleaning, unsuitable diameter of colostomy pouch, skills of colostomy cleansing, and the low level of awareness in family caregivers at 76.9%. After analyzing the procedures, the proposed project of improvement included: (1) building guidelines for colostomy care; (2) making instruction flow chart for cleaning and making colostomy pouch; (3) developing modified corset belt of colostomy; and (4) creating the operating manual for corset belt of colostomy pouch. After the implementation of the improvement project, 32 family caregivers were assessed between November 8, 2014 and January 23, 2015. The results showed that (1) family caregivers' awareness of colostomy care had improved from 76.9% to 98.1%; (2) the leakage rate of colostomy had improved from 37.5% to 6.2% which reached the project goal. The project can significantly improve the leakage of colostomy and improve the quality of life for colorectal cancer patients.

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