一位化療藥物外滲肝癌病患的護理經驗

Nursing Experience of a Hepatoma Patient with Chemo-drug Extravasated

本報告探討一位因肝癌復發，入院做經導管動脈化學藥物栓塞術，住院期間因化學栓塞藥物Adriamycin誤注入靜脈，引發藥物外滲的不良反應，針對個案於意外事件後，呈現生理上不適及心理上不安之整體健康照護過程。筆者以專科護理師的角色，利用羅氏適應模式為評估架構，確定個案的健康問題，包括皮膚完整性受損、疼痛、潛在性出血及焦慮。照護期間針對栓塞治療後提供照顧計劃外，並在意外發生的第一時間，與主治醫師等醫療團隊成立關懷小組，提供後續醫療照顧的相關訊息與服務，協助個案在最短時間內，運用問題解決法，擬定具體可行的護理措施，將藥物外滲對組織的傷害降至最低，使病患能維持良好身體功能及生活品質。

This case report was to share the nursing experience of chemotherapy drug extravasations management. A recurrent hepatoma patient was admitted for TACE (Transcatheter Arterial Chemo-Embalization). During the hospital stay, Adriamycin was accidentally dripped into wrong vessel and extravasated into peripheral tissue, caused moderate skin and tissue reactions. We used Roy's model as an assessment tool. Four nursing diagnoses were defined, and including impairment of skin integrity, acute pain, potential injury, and anxiety. Right after the accident, the whole medical and nursing staffs teamed up together and proposed an individualized treatment plan to minimize the drug damage effects to skin and tissue. As a nurse specialist, I used the specified nursing interventions to relieve the patient's physiological discomfort related to post-TACE and to drug extravasations and provided full extravasations management related information to ease the axiety about prognosis of extravasations complication. The patient completed the treatment program without any complication and complaints. This rare experience is a very good example to share with other nursing colleagues.