降低新生兒加護病房早產兒鼻損傷之發生率

Reducing the Incidence of Nasal Injury in Premature Infants in the Neonatal Intensive Care Unit

背景：早產兒由於肺部發育不成熟，需長期使用呼吸器及抽痰處置來維持生命徵象穩定。但早產兒皮膚角質層未發育成熟，在使用經鼻式呼吸器與抽痰處置時，容易因呼吸器管路的鼻叉管壓迫、拉扯，或抽痰頻率、壓力與深度不當，及抽痰時缺氧躁動等因素造成鼻損傷，早產兒鼻損傷發生率為27.9%。
目的：本專案目的在提升護理師對預防早產兒鼻損傷照護認知正確率，降低早產兒鼻損傷發生率。
解決方案：本專案制作早產兒鼻部照護指引手冊、抽痰作業流程圖及抽痰提醒小卡，提供護理師在照護過程有所依循。同時設置呼吸器管路固定支撐工具，避免呼吸器管路下滑，拉扯早產兒鼻部。另舉辦早產兒鼻部照護教育訓練，建立專科評核機制，提升護理師照護能力及品質。
結果：護理師對預防早產兒鼻損傷照護認知正確率提升至95.3%；早產兒鼻損傷發生率由27.9%下降至18.5%。
結論：藉由此專案改善臨床作業，完整標準作業流程，提升護理人員照護能力及對早產兒照護品質，使早產兒獲得更完善及安全的照護。

Background & Problems: Due to immature lung development, premature infants require long-term ventilator support and sputum suction to maintain stable vital signs. However, as the stratum corneum in premature infants has yet to fully develop, using nasal respirators and suction introduces risks including compression and pulling of the nasal prongs of the respirator tube; improper suction frequency, pressure, and depth; and poor suction efficacy Moreover, lack of oxygen and restlessness may result in nasal injury, which was found in 27.9% of premature infants in our hospital.
Purpose: The purpose of this project was to improve the knowledge of nurses regarding nasal injury prevention in premature infants and thus reduce the incidence of these injuries in the neonatal ward.
Resolutions: A guidance manual for premature infant care and a sputum suctioning and sputum suctioning flowchart reminder card were developed and provided to nurses as references during the care process. Also, a ventilator tube fixing support tools were installed to prevent ventilator tubes from slipping and pulling on the nose of premature infants. In addition, educational training on nasal care for premature infants was organized and a specialist assessment mechanism was established to improve nursing staff capabilities and quality of care.
Results: The accuracy rate for knowledge on preventing nasal injury in premature infants among nurses increased to 95.3%, and the incidence of nasal injury in premature infants decreased from 27.9% to 18.5%.
Conclusion: This project was effective in improving clinical operations, completing standard operating procedures, enhancing nursing staff care capabilities, and improving the quality of care provided to premature infants, ensuring premature infants receive more complete and safer care.