跨團隊鼻胃管照護三部曲

Three-Step Interdisciplinary Team Program for Nasogastric Tube Care

咀嚼吞嚥障礙的病人常需藉由鼻胃管灌食獲取營養，鼻胃管留置常造成病人不適感，增加管路自拔及滑脫的發生。頻繁更換鼻胃管或錯置，可能會引發吸入性肺炎、腸胃道創傷或氣胸等合併症，衍生病人安全問題。鼻胃管置放前、中及移除階段有賴跨團隊醫護人員合作，以提供合適的鼻胃管照護，訂定鼻胃管照護標準程序，及早進行病人的吞嚥評估、吞嚥訓練、口腔照護或移除鼻胃管照護計畫。本文以神經內外科病房為例說明跨團隊鼻胃管照護的實證臨床應用。跨團隊提供病人個別化、安全及有尊嚴的鼻胃管照護，協助病人邁向無管人生，提升照護品質及病人生活品質。

"Patients with chewing disorders and dysphagia often take nutrition via nasogastric tube feeding. Patients with indwelling nasogastric tubes often experience discomfort, resulting in increased incidences of self-extubation and slippage. Frequent changes or misplacement of the nasogastric tube may also cause patient safety issues such as aspiration pneumonia, gastrointestinal trauma, and pneumothorax. Collaboration within the interdisciplinary team is needed to provide proper nasogastric tube care prior to placement, during the indwelling process, and during the removal of the nasogastric tube. Interdisciplinary teams should develop standardized procedures for nasogastric tube care, initiate swallow screening, oral care and training early, and develop a care plan for nasogastric tube removal. An evidence-based, practical example of nasogastric tube care implemented by an interdisciplinary team in a neurology unit is presented in this article. Interdisciplinary teams may assist patients to prepare to return to a normal tube-free life using individualized, safe, and dignified nasogastric tube care to improve quality of life."