一位胃造口滲漏導致潮濕相關皮膚損傷病人之護理經驗

Nursing Experience With a Patient With Gastrostomy Leakage Resulting in Moisture-Associated Skin Damage

滲漏是胃造口常見合併症之一，因暴露於潮濕與化學性刺激的環境，易發生潮濕相關皮膚損傷，嚴重影響生活品質。本文旨在描述一位因胃造口滲漏導致潮濕相關皮膚損傷個案護理經驗。2015年7月29日至2015年8月20日護理期間評估發現：胃造口大量滲漏，致使個案皮膚廣泛性糜爛、潰瘍、瘜肉、表淺感染；同時面臨困難造口照護，令個案身心俱疲。經由筆者多次與醫護進行跨團隊溝通與討論，改變傳統管路及傷口護理方式，以實證文獻為基礎，提供胃造口與潮濕相關皮膚損傷照護策略。在團隊努力下，成功避免皮膚接觸胃內容物，提高個案舒適度；控制滲漏量與皮膚感染，維持體液與電解質平衡，以使皮膚損傷得以痊癒。建議未來醫護人員面對胃造口滲漏病人，應及早提供皮膚保護計畫、確認與矯正滲漏因子，收集滲漏液以及正確固定管路，以降低對病人生活品質之衝擊。同時亦提供病人管路與皮膚照護教育，以預防日後合併症再發生。

Leakage is a common complication of gastrostomy. Exposure of the skin surrounding the gastrostomy tube to moisture or chemical irritants may cause moisture-associated skin damage (MASD) and seriously affect the patient's quality of life. This case study describes a nursing experience with gastrostomy leakage that resulted in MASD. An assessment conducted from July 29, 2015 to August 20, 2015 revealed that heavy gastronomy leakage had caused extensive skin erosion, ulceration, hyperplasia, and superficial infection. Simultaneously, the patient was required to conduct complex stoma care, which resulted in physical and psychological exhaustion. Changes in traditional tube and wound care were discussed on multiple occasions with an interdisciplinary healthcare team. Based on the evidence- based literature, we provide gastrostomy and MASD management strategies. Through team collaboration, we prevented gastric contents from contacting the patient's skin directly, improved patient comfort, controlled effluent and skin infections, maintained fluid and electrolyte balances, and accelerated the healing of the damaged skin. We recommend that healthcare professionals caring for patients with gastrostomy leakage be provided with early skin protection programs to learn the standard methods for identifying and correcting leakage factors, containing effluent, and adequately stabilizing the gastrostomy tube in order to reduce the impact on the patient's quality of life. In addition, patient education on tube and skin care should be provided to prevent the reoccurrence of complications.