Dabaru na Gudanar da Abinci Mai Gina Jiki na Iyaye
Abinci mai gina jiki na parenteral (NP) hanya ce ta ba da sinadarai masu gina jiki kai tsaye zuwa cikin jini ta hanyar shiga cikin jijiya lokacin da hanyar narkewar abinci ba ta iya aiki yadda ya kamata ba ko kuma tana buƙatar hutawa. A aikace, dabarun isar da NP suna buƙatar babban daidaito saboda amfani da maganin hyperosmolar, haɗarin kamuwa da cuta, rikicewar metabolism, da kuma buƙatar daidaitawa na mutum ɗaya bisa ga yanayin majiyyaci. Wannan labarin ya tattauna ƙa'idodi na asali, shiri, zaɓin shiga, hanyoyin gudanarwa, sa ido, da kuma rigakafin rikitarwa a cikin dabarun NP.
1. Alamomi da Manufofin Abinci Mai Gina Jiki na Iyaye
Ana ba da abinci mai gina jiki na parenteral idan abinci mai gina jiki na ciki (na ciki) ba zai yiwu ba, ko kuma ba shi da aminci, ko kuma bai isa ba. Alamomin da aka fi sani sun haɗa da toshewar hanji, dogon ileus, ciwon hanji na gajere, fistula na ciki mai yawan fitowa, wasu nau'ikan pancreatitis mai tsanani, tsananin shan ruwa, yanayin bayan tiyata tare da abubuwan da ba su dace ba ga ciyarwa, da kuma marasa lafiya masu fama da rashin lafiya waɗanda ba za su iya biyan buƙatunsu na abinci mai gina jiki ta hanyar ciyar da ciki ba.
Babban manufofin NP sune kiyaye yanayin abinci mai gina jiki, hana yawan kamuwa da cuta, hanzarta warkar da raunuka, kula da aikin gabobi, da kuma tallafawa murmurewa. Nasarar NP ba wai kawai ta dogara ne akan adadin adadin kuzari da aka bayar ba, har ma da daidaiton ruwa, electrolytes, glucose, protein, da micronutrients.
2. Nau'ikan Abinci Mai Gina Jiki na Iyaka: Na gefe da na tsakiya
A fasaha, an raba NP zuwa biyu:
1. Abinci Mai Gina Jiki na Peripheral Parenteral (NPP/PPN)
Ana yin sa ta hanyar jijiya ta gefe. Dole ne a iyakance osmolarity na maganin don hana phlebitis mai tsanani. Saboda ƙarancin osmolarity ɗinsa, PPN ya dace da buƙatun ɗan gajeren lokaci ko kuma a matsayin "gada" lokacin da ba a sami hanyar shiga ta tsakiya ba tukuna.
2. Jimlar Abinci Mai Gina Jiki ta Tsakiya (NPT/TPN)
Ana yin allurar ta hanyar jijiya ta tsakiya (misali, jijiyar subclavian, jijiyar jugular ta ciki, ko kuma ta hanyar catheter na tsakiya da aka saka a cikin babban vena cava), TPN yana ba da damar yin allurar osmolarity mai yawa, yana tabbatar da cewa an biya cikakken buƙatun furotin mai kalori. Yawanci ana amfani da shi don maganin matsakaici zuwa dogon lokaci ko ga marasa lafiya masu buƙatu masu yawa.
Zaɓin tsakanin PPN da TPN ya dogara da tsawon lokacin magani, buƙatun abinci mai gina jiki, yanayin jijiyoyin jiki na gefe, da kuma haɗarin rikitarwa.
3. Tsarin Maganin da Ka'idojin Lissafi Bukatu
Maganin NP gabaɗaya sun ƙunshi:
– Carbohydrates: musamman dextrose a matsayin babban tushen kuzari.
– Protein: amino acid don haɗa nama da kuma kula da yawan tsoka.
– Kitse: sinadarin lipid emulsion a matsayin tushen kuzari mai ƙarfi da kuma muhimman kitsen mai.
- Electrolytes: sodium, potassium, chloride, calcium, magnesium, phosphate idan ana buƙata.
– Bitamin da abubuwan da aka gano: don hana ƙarancin sinadarai masu gina jiki.
– Ruwa: ana daidaita girmansa gwargwadon yanayin ruwa, aikin koda, da yanayin asibiti.
A ka'ida, ana ƙididdige buƙatun kuzari da furotin bisa ga nauyin jiki, yanayin asibiti, da matakan damuwa na metabolism. A cikin marasa lafiya masu fama da rashin lafiya mai tsanani, sau da yawa ana buƙatar ƙaruwa a hankali don hana hyperglycemia da sake ciyar da abinci, musamman a cikin marasa lafiya masu fama da rashin abinci mai gina jiki mai tsanani.
4. Shiri da Asepsis: Mabuɗin Tsaro
Dole ne hanyoyin da ake amfani da su wajen gudanar da NP su bi ƙa'idodin aseptic masu tsauri domin catheters na jijiya hanya ce kai tsaye da ƙwayoyin cuta ke bi don shiga cikin jini. Wasu muhimman ƙa'idodi sun haɗa da:
– Ana shirya maganin ta hanyar da ba ta da tsafta (zai fi kyau a cikin wurin sayar da magunguna tare da iskar laminar ko ɗaki mai tsafta bisa ga ƙa'idodi).
– Lakabi da tabbatarwa: tabbatar da asalin majiyyaci, abun da ke ciki, ranar ƙarewa, da kuma kwanciyar hankali na maganin.
– Tsaftace hannu kafin a yi amfani da catheter ko jiko.
– A kashe tashar (a goge cibiyar) duk lokacin da ka shiga.
- Amfani da saitin jiko na musamman da matattara kamar yadda cibiyar ta ba da shawarar (misali, matattara don rage barbashi a wasu tsare-tsare).
Ƙananan kurakurai a cikin asepsis na iya haifar da kamuwa da cututtukan jini masu alaƙa da catheter (CRBSIs) waɗanda ke ƙara mace-mace, tsawon lokacin zama, da kuma farashi.
5. Zaɓin Hanyar Shiga da Shigar da Jijiyoyin Hanta
A. Shiga Gaɓar Hanya
Shiga ta gefen hanya yana amfani da wani bututun jijiyoyin da ke kewaye da ita tare da sa ido sosai don gano alamun phlebitis: ciwo, ja, kumburi, ko kuma jan layi a kan jijiyar. Ya kamata wurin da aka saka ya kasance a cikin jijiyar da ta dace, yana guje wa ƙurajen haɗin gwiwa duk lokacin da zai yiwu don rage haɗarin shiga.
B. Babban Hanya
Ga TPN, hanyar shiga ta tsakiya na iya zama:
- CVC mara rami (Central Venous Catheter) (wanda aka saba gani a ICU),
– PICC (Catheter na tsakiya da aka saka a gefe) don yin magani na dogon lokaci,
- Katate ko tashoshin jiragen ruwa da aka yi wa rami don buƙatu na dogon lokaci.
Ana yin aikin sanya CVC a ƙarƙashin jagorancin duban dan tayi don ƙara nasara da rage matsalolin injiniya kamar pneumothorax ko hematoma. Bayan sanyawa, dole ne a tabbatar da matsayin ƙarshen catheter (misali, ta hanyar rediyo, kamar yadda aka tsara) kafin amfani, musamman don samun damar tsakiya.
6. Dabarun Ba da Gudummawa: Manyan Matakai
Dabaru na gudanar da NP sun haɗa da:
1. Tabbatar da tsari: abun da ke ciki, yawan jiko, hanya, da tsawon lokacin da aka ɗauka.
2. Duba maganin: haske, sinadarin lipid ba ya "karya" (babu rabuwa), marufi yana nan yadda yake, kuma baya wuce ranar kwanciyar hankali.
3. Shirya saitin jiko: yi amfani da famfon jiko don daidaiton ƙimar.
4. A yi amfani da maganin da aka riga aka shirya: a cika bututun jiko da ruwan magani domin kada iska ta shiga.
5. Maganin kashe ƙwayoyin cuta: tsaftace tashar catheter bisa ga ƙa'idodi (misali barasa/chlorhexidine bisa ga ƙa'idar asibiti).
6. Fara shan magani a hankali: a cikin marasa lafiya masu haɗarin kamuwa da cutar, yawan maganin farko yakan ragu sannan ya ƙaru idan aka jure.
7. Jadawalin shan magani: Ana iya ba da maganin NP akai-akai na tsawon awanni 24 ko kuma a zagaye (misali awanni 12-18), musamman a cikin jiyya na dogon lokaci don ƙara jin daɗi da rage matsalar hanta ga wasu marasa lafiya.
8. Sauya saitin da miyar: ana maye gurbin saitin jiko, mahaɗa, da miyar catheter bisa ga ƙa'idodi don rage haɗarin kamuwa da cuta.
Bai kamata a haɗa maganin NP ba tare da la'akari da magunguna a hanya ɗaya ba tare da wata cikakkiyar jituwa ba. Magunguna da yawa ba su dace da lipid emulsions ko maganin dextrose mai ƙarfi ba kuma suna iya haifar da hazo mai haɗari.
7. Kula da Asibiti da Dakunan Gwaji
Kulawa muhimmin ɓangare ne na "dabarun" NP:
– Alamomin mahimmanci da yanayin ruwa: shigarwa-fitowar ruwa, kumburi, alamun bushewar ruwa.
- Sugar jini: yawan sukarin jini abu ne da ake yawan samu; ana iya buƙatar insulin.
– Electrolytes: potassium, magnesium, phosphate suna da matuƙar muhimmanci musamman idan suna fuskantar haɗarin sake cin abinci.
- Aikin koda da hanta: urea/creatinine, enzymes na hanta, bilirubin.
- Triglycerides: musamman lokacin amfani da emulsions na lipid, musamman a cikin marasa lafiya da ke fama da sepsis ko matsalolin metabolism na kitse.
– Alamomin kamuwa da cuta: zazzabi, sanyi, ja a wurin da aka sanya catheter, ko kuma an yi masa allurar rigakafi.
Ana daidaita yawan gwaje-gwajen da yanayin majiyyaci: kowace rana a matakin farko ko kuma a cikin marasa lafiya masu mahimmanci, sannan ana iya tsawaita lokacin da ya dace.
8. Matsaloli da Rigakafi
Za a iya raba matsalolin abinci mai gina jiki zuwa:
A. Matsalolin Inji
- Pneumothorax, matsalar wurin catheter, zubar jini yayin sakawa (fiye da shiga ta tsakiya).
Rigakafi: shigarwa ta hanyar ƙwararrun ma'aikata, jagorar duban dan tayi, tabbatar da matsayi.
B. Matsalolin Yaɗuwa
– CRBSI babbar matsala ce.
Rigakafi: kunshin rigakafin kamuwa da cuta (tsabtar hannu, maganin kashe ƙwayoyin cuta na fata, kula da sutura, ƙarancin sarrafa tashoshin jiragen ruwa, ilmantar da ma'aikata).
C. Matsalolin Metabolic
- Hawan jini, hypoglycemia (musamman idan aka daina shansa ba zato ba tsammani), matsalolin electrolyte, ciwon sake cin abinci, da kuma yawan triglycerides.
Rigakafi: rage yawan sinadarin a hankali, sanya ido sosai, gyaran electrolyte, da kuma tsarin insulin idan ya cancanta.
D. Matsalolin hanta
- Ciwon hanta, ciwon hanta, ko kuma matsalar hanta idan aka yi amfani da shi na dogon lokaci.
Rigakafi: a guji yawan cin abinci, a yi la'akari da ciyar da abinci mai zagaye, a inganta yanayin ciki idan zai yiwu, a tantance sinadarin lipid.
9. Ka'idojin Dakatar da Ciyarwa da Canjawa zuwa Ciyarwa ta Ciki/Baki
Mafi kyau, ya kamata a daina shan NP da zarar majiyyaci ya sami damar biyan buƙatun abinci mai gina jiki ta hanyar ciki ko ta baki. Yawancin lokaci ana daina shan NP a hankali, musamman idan ana amfani da sinadarin dextrose mai yawa, don guje wa hypoglycemia mai amsawa. Sauye-sauyen da suka yi nasara ya haɗa da ƙara yawan shan NP ta hanyar ciki/ baki yayin da ake rage yawan shan NP, tare da sa ido sosai kan glucose da yanayin asibiti.
Kammalawa
Dabaru na abinci mai gina jiki na iyaye sun haɗa da fiye da kawai saka layin IV mai ɗauke da adadin kuzari. Sun haɗa da jerin hanyoyin da aka tsara waɗanda suka haɗa da zaɓar majiyyaci, tantance damar shiga, haɗa sinadarai masu tsafta, ba da magani tare da famfon jiko, sa ido sosai kan dakin gwaje-gwaje, da kuma rigakafin rikice-rikicen inji, masu yaɗuwa, da na rayuwa. Tare da hanyar da ta dace da haɗin gwiwa tsakanin likitoci, ma'aikatan jinya, masu gina jiki, da masu harhada magunguna, abinci mai gina jiki na iyaye zai iya zama mafita mai aminci da tasiri don tallafawa murmurewa ga marasa lafiya lokacin da hanyoyin ciki ba za su iya aiki yadda ya kamata ba.
