鼻胃管位置確認方式改善專案

Project to Increase the Nasogastric Tube Verification Practice

背景：系統性回顧呈現空氣注入後聽診腹部氣泡音、水下冒泡法，及抽出物的目視，對鼻胃管置入後位置檢測的安全性不佳。X光是驗證鼻胃管位置最可靠的方法，但若每次灌食或給藥前，皆執行X光檢測不符合經濟效益。
目的：改善醫院護理人員執行鼻胃管位置確認的方式。
解決方法：本專案分成三個階段。第一階段參酌實證文獻彙整鼻胃管位置確認方式，尋求專家意見諮詢，修正鼻胃管位置確認常規；第二階段將修正的鼻胃管位置確認常規融入臨床實務；最後階段為評值護理人員執行修正鼻胃管確認常規，與相關病歷分析。
結果：實證文獻顯示，鼻胃管位置確認應採多元方式，尤其是效度較高的胃回抽液pH值測定與X光。專案小組人員將修正的鼻胃管確認常規製成流程圖與評估記錄表，透過課程介紹向護理人員進行教育訓練後，併入鼻胃管照護程序。執行修正鼻胃管確認常規後第一季，42位護理人員共照護100位鼻胃管留置病人，鼻胃管確認措施記錄2011次，鼻胃管灌食給藥前的胃回抽液pH值測試，護理人員執行率達100%；插置鼻胃管後，則只有10位病人做過X光確認其位置。
結論：本專案實施後，護理人員徹底執行胃回抽液pH值測試的鼻胃管位置確認方式，以確保病人安全。

Background: The results of systematic reviews for nasogastric tube verification found the levels of evidence for auscultation, bubbling method, and aspirate inspection were poor. Radiology is the most reliable method to confirm the correct placement of NG tubes in adults. However, it is not a cost effective test before each oral feeding and drug administration.
Aim: This project sought to improve the NG tube verification practice among hospital nurses.
Methods: The project comprised three stages. The first stage involved an evidence review to revise the NG tube verification practice, and then consultation with experts to decide on its usefulness. The second stage incorporated the change in practice into the clinical setting. The final stage evaluated the NG tube verification practice among nurses and analyzed the related chart records.
Results: Complex methods were suggested to confirm the correct NG tube placement from the evidence in the literature, especially testing the acidity of the aspirate drawn from the NG tube and X-ray. Flowcharts and recording sheets of the revised NG tube verification were introduced and incorporated into the routine care by nurses. The initial evaluation analysis was conducted over three months to attempt to achieve a practice change. One hundred patients with NG tube were cared by 42 nurses, and the total records of NG tube verification numbered 2011. The rate of testing the acidity of the aspirate was 100% for nurses. Only ten patients (10%) received an X-ray to verify correct placement of the NG tube.
Conclusions: Nurses incorporated pH indicators of aspirates into the criteria for NG tube verification after implementing this project to ascertain patient safety.