临床技能学-留置胃管技术.pptxVIP

留置胃管技术Nasogastric Tube Insertion 主要内容一、目的二、适应症三、禁忌症四、准备五、用物六、操作程序七、注意事项八、并发症经鼻胃管置入技术Introduction是指经一侧鼻腔插入胃内，用于胃肠减压或灌注（食物、水、药物等）以达到治疗目的。By inserting a nasogastric tube, you are gaining access to the stomach and its contents. This enables you to drain gastric contents, decompress the stomach, obtain a specimen of the gastric contents, or introduce a passage into the GI tract. This will allow you to treat gastric immobility, and bowel obstruction. It will also allow for drainage and/or lavage in drug overdosage or poisoning. In trauma settings, NG tubes can be used to aid in the prevention of vomiting and aspiration, as well as for assessment of GI bleeding. NG tubes can also be used for enteral feeding initially.带导丝胃管普通胃管徒手下胃管经导丝下胃管喉镜下胃管支气管镜下胃管 一、目的Purpose鼻饲洗胃 胃肠减压施压pH值监测或胃液分析 二、适应征Indications急性胃扩张急性胰腺炎胃、十二指肠穿孔口腔颌面部、食管、胃肠手术者进行腹部较大手术者机械性或麻痹性肠梗阻早产、病情危重、昏迷、不能经口进食的患者口服中毒者消化道出血患者三、禁忌症Contraindications鼻咽部有癌肿或急性炎症者食管静脉曲张者心力衰竭者重度高血压者严重心肺功能不全者吞食腐蚀性药物者Nasogastric tubes are contraindicated in the presence of severe facial trauma (cribriform plate disruption), due to the possibility of inserting the tube intracranially. In this instance, an orogastric tube may be inserted.四、准备Preparation清洁鼻腔观察有无鼻息肉、肿瘤、鼻腔内有无粘膜问题、鼻中隔有无弯曲，有无分泌物堵塞。五、用物EquipmentAll necessary equipment should be prepared, assembled and available at the bedside prior to starting the NG tube. Basic equipment includes:Personal protective equipmentNG/OG tubeCatheter tip irrigation 60 ml syringeWater-soluble lubricant, preferably 2% Xylocaine jellyAdhesive tapeLow powered suction device OR Drainage bagStethoscope Cup of water (if necessary)/ ice chipsEmesis basinpH indicator strips 五、用物Equipment车上层治疗盘内：胃管包1个（内有胃管1根，一次性手套1副，液状石蜡油棉球）弯盘、治疗碗（内置压舌板1个）50ml注射器1个治疗巾、胶布、棉签快速手消毒液一次性手套必要时：备听诊器，手电筒汽油或松节油、酒精、清洁纸巾车下层：医用垃圾桶生活垃圾桶六、操作程序Procedure备物 Gather equipment.不需要戴无菌手套 Don non-sterile gloves查对、评估、解释 Explain the procedure to the patient and show equipment如果可能，采取患者坐位（抬高床头30度至45度） If possible, sit patient upright for optimal neck/stomach