Usoro Nlekọta Nri Nne na Nna
Nri Parenteral (NP) bụ ụzọ isi nye nri ndị na-edozi ahụ ozugbo n'ọbara site na ntinye aka n'ime akwara mgbe eriri afọ na-enweghị ike ịrụ ọrụ nke ọma ma ọ bụ chọọ izu ike. N'ọrụ ahụike, usoro nnyefe NP chọrọ ezigbo nkenke n'ihi ojiji nke ngwọta hyperosmolar, ihe egwu nke ibute ọrịa, nsogbu metabolic, na mkpa maka mgbanwe nkeonwe dabere na ọnọdụ onye ọrịa. Isiokwu a na-atụle ụkpụrụ ndị bụ isi, nkwadebe, nhọrọ nnweta, usoro nchịkwa, nlekota, na mgbochi nke nsogbu na usoro NP.
1. Ihe ngosi na ebumnuche nke nri nne na nna
A na-enye nri nne na nna mgbe nri enteral (eriri afọ) agaghị ekwe omume, ọ dịghị mma, ma ọ bụ ezughi oke. Ihe ndị a na-ahụkarị gụnyere mgbochi eriri afọ, ileus ogologo oge, obere eriri afọ, fistula eriri afọ na-apụta nke ukwuu, ụdị pancreatitis siri ike, nnukwu mmịpụta mmiri, ọnọdụ mgbe a wachara ahụ nke nwere ihe mgbochi inye nri, na ndị ọrịa dị oke njọ bụ ndị na-enweghị ike igbo mkpa nri ha site na inye nri enteral.
Isi ihe mgbaru ọsọ nke NP bụ ịnọgide na-enwe ọnọdụ nri, igbochi oke mmebi, ime ka ọnya gwọọ ngwa ngwa, ịnọgide na-arụ ọrụ akụkụ ahụ, na ịkwado mgbake. Ihe ịga nke ọma nke NP dabereghị naanị na ọnụọgụ kalori enyere, kamakwa na nguzozi kwesịrị ekwesị nke mmiri mmiri, electrolytes, glucose, protein, na micronutrients.
2. Ụdị Nri Parenteral: Peripheral na Central
N'ụzọ teknụzụ, a na-ekewa NP ụzọ abụọ:
1. Nri Peripheral Parenteral (NPP/PPN)
A na-enye ya site na akwara dị n'akụkụ. A ghaghị ịkpa oke osmolarity nke ihe ngwọta ahụ iji gbochie phlebitis dị njọ. N'ihi oke osmolarity ya, PPN dabara adaba maka mkpa nwa oge ma ọ bụ dị ka "akwa" mgbe ohere etiti adịghị.
2. Nri zuru oke nke Parenteral site na Central (NPT/TPN)
A na-enye ya site na akwara etiti (dịka ọmụmaatụ, akwara subclavian, akwara jugular dị n'ime, ma ọ bụ site na katetị akwara etiti nke etinyere n'ime vena cava dị elu), TPN na-enye ohere maka inye ngwọta osmolarity dị elu, na-ahụ na e mezuru mkpa kalori-protein zuru oke. A na-ejikarị ya eme ọgwụgwọ ọkara ruo ogologo oge ma ọ bụ na ndị ọrịa nwere nnukwu mkpa.
Nhọrọ dị n'etiti PPN na TPN dabere na oge ọgwụgwọ, mkpa nri, ọnọdụ venous dị n'akụkụ, na ihe egwu nke nsogbu.
3. Nhazi Ngwọta na Ụkpụrụ nke Ịgbakọ Ihe Ndị A Chọrọ
Ngwọta NP n'ozuzu ya gụnyere:
– Kabọhaịdret: karịsịa dextrose dị ka isi iyi ike.
– Protein: amino acid maka imepụta anụ ahụ na ịnọgide na-enwe oke akwara.
– Abụba: lipid emulsion dị ka isi iyi siri ike nke ike na abụba dị mkpa.
- Electrolytes: sodium, potassium, chloride, calcium, magnesium, phosphate dịka ọ dị mkpa.
– Vitamin na ihe ndị dị na ya: iji gbochie ụkọ ihe ndị na-edozi ahụ.
– Mmiri mmiri: a na-agbanwe olu ya dịka ọnọdụ mmiri mmiri si dị, ọrụ akụrụ, na ọnọdụ ahụike si dị.
Dịka iwu si dị, a na-agbakọ ihe achọrọ maka ike na protein dabere na ibu ahụ, ọnọdụ ahụike, na ọkwa nrụgide metabolic. N'ime ndị ọrịa dị oke njọ, mmụba nwayọ nwayọ dị mkpa iji gbochie hyperglycemia na ọrịa refeeding syndrome, ọkachasị na ndị ọrịa na-eri nri nke ukwuu.
4. Nkwadebe na Asepsis: Isi Ihe Maka Nchekwa
Usoro nchịkwa NP ga-agbaso ụkpụrụ aseptic siri ike n'ihi na katetị n'ime akwara bụ ụzọ kpọmkwem maka nje ndị na-abanye n'ọbara. Ụfọdụ ụkpụrụ dị mkpa gụnyere:
– A na-akwadebe ihe ngwọta ahụ n'ụzọ na-adịghị ọcha (ọ kacha mma n'ụlọ ọgwụ nwere ikuku laminar ma ọ bụ ụlọ dị ọcha dịka ụkpụrụ si dị).
– Akara na nkwenye: hụ na onye ọrịa ahụ bụ onye nwere njirimara, ihe mejupụtara ya, ụbọchị njedebe ya, na nkwụsi ike nke ngwọta ahụ.
– Ịdị ọcha aka tupu ejiri katetị ma ọ bụ ihe e ji etinye ọgwụ eme ihe.
– Jiri nje tee ọdụ ụgbọ mmiri ahụ (sachaa ebe nchekwa ahụ) oge ọ bụla ị na-abanye na ya.
– Ojiji nke ihe nzacha pụrụ iche dịka ụlọ ọrụ ahụ si kwado ya (dịka ọmụmaatụ, ihe nzacha iji belata ihe ndị dị na ya n'ụfọdụ usoro).
Njehie nta dị na asepsis nwere ike ibute ọrịa ọbara metụtara catheter (CRBSIs) nke na-eme ka ọnwụ, ogologo oge ịnọ, na ọnụ ahịa dịkwuo elu.
5. Nhọrọ nke Usoro Ntinye na Ntinye Venous
A. Ohere Mbanye n'akụkụ
Ntinye aka n'akụkụ ahụ na-eji ihe mkpuchi akwara dị n'akụkụ ya nke ọma, na-enyocha ihe ịrịba ama nke phlebitis: ihe mgbu, ọbara ọbara, ọzịza, ma ọ bụ ọbara ọbara n'akụkụ akwara ahụ. E kwesịrị itinye ya n'ime akwara siri ike, na-ezere mgbawa nkwonkwo mgbe ọ bụla o kwere mee iji belata ihe ize ndụ nke ịbanye n'ime ahụ.
B. Ebe Etiti
Maka TPN, ohere etiti nwere ike ịbụ:
- CVC na-anaghị agagharị (Central Venous Catheter) (nke a na-ahụkarị na ICU),
– PICC (Catheter Central E tinyere n'akụkụ) maka ọgwụgwọ ogologo oge,
- Katetị ma ọ bụ ọdụ ụgbọ mmiri e tinyere n'ime oghere maka mkpa ogologo oge.
A na-eme ntinye CVC nke ọma site na nduzi ultrasound iji mee ka ọ dịkwuo mma ma belata nsogbu igwe dịka pneumothorax ma ọ bụ hematoma. Mgbe etinyechara ya, a ga-akwado ọnọdụ nke isi catheter ahụ (dịka ọmụmaatụ, site na redio, dịka usoro si dị) tupu ejiri ya, ọkachasị maka ịnweta etiti.
6. Usoro Inye Ihe: Nzọụkwụ Ndị Bụ Isi
Usoro nchịkwa NP gụnyere:
1. Lelee usoro: nhazi ya, ọnụego infusion, ụzọ e si eme ya, na oge ọ ga-ewe.
2. Lelee ngwọta ahụ: doro anya, emulsion lipid anaghị "agbaji" (enweghị nkewa), ngwugwu ahụ dị ọcha, ọ naghịkwa agafe ụbọchị nkwụsi ike.
3. Nkwadebe nke set infusion: jiri mgbapụta infusion maka izi ezi nke ọnụego.
4. Ịkwanye ihe: jupụta ọkpọkọ infusion ahụ na mmiri ka ikuku ghara ịdị.
5. Njem nje: hichaa oghere kateta dịka ụkpụrụ si dị (dịka ọmụmaatụ mmanya/chlorhexidine dịka iwu ụlọọgwụ si dị).
6. Malite iji nwayọọ nwayọọ ṅụọ ya: n'ime ndị ọrịa nwere nnukwu ihe ize ndụ, ọnụego mbụ na-adịkarị ala ma mechaa mụbaa dịka a na-anabata ya.
7. Usoro ojiji: Enwere ike inye NP mgbe niile ruo awa 24 ma ọ bụ n'usoro (dịka ọmụmaatụ awa 12-18), ọkachasị n'ọgwụgwọ ogologo oge iji mee ka ahụ dịkwuo mma ma belata nsogbu imeju na ụfọdụ ndị ọrịa.
8. Ndochi nke ihe na ihe mkpuchi: a na-agbanwe ihe mkpuchi infusion, njikọ, na ihe mkpuchi catheter dịka ntuziaka si dị iji belata ohere nke ibute ọrịa.
Ekwesighi ịgwakọta ọgwụ NP n'ụzọ na-enweghị nkwekọ doro anya. Ọtụtụ ọgwụ anaghị ekwekọ na lipid emulsions ma ọ bụ ngwọta dextrose concentrated ma nwee ike ibute mmiri ozuzo dị ize ndụ.
7. Nlekota Ahụike na Ụlọ Nyocha
Nlekota bụ akụkụ dị mkpa nke "usoro" NP:
– Ihe ịrịba ama dị mkpa na ọnọdụ mmiri mmiri: ntinye - mmepụta, ọzịza, ihe ịrịba ama nke mmiri ịkpọ nkụ.
– Shuga ọbara: hyperglycemia bụ ihe a na-ahụkarị; insulin nwere ike ịdị mkpa.
– Electrolytes: potassium, magnesium, phosphate dị oke mkpa karịsịa n'ihe ize ndụ nke ịmaliteghachi nri.
– Ọrụ akụrụ na imeju: urea/creatinine, enzymes imeju, bilirubin.
- Triglycerides: karịsịa mgbe a na-eji emulsions lipid, ọkachasị na ndị ọrịa nwere nsogbu sepsis ma ọ bụ nsogbu metabolism abụba.
– Ihe ịrịba ama nke ọrịa: ahụ ọkụ, oyi, ọbara ọbara n'ebe catheter dị, ma ọ bụ ihe na-egosi na ọ dị mma.
A na-agbanwe ugboro ole a na-eme nyocha ahụ ka ọ dabara na ọnọdụ onye ọrịa: kwa ụbọchị na mbido ma ọ bụ na ndị ọrịa dị oke njọ, mgbe ahụ enwere ike ịgbatị ya mgbe ọ kwụsiri ike.
8. Nsogbu na Mgbochi
Enwere ike kewaa nsogbu nke nri parenteral n'ime:
A. Nsogbu Mekaniki
- Pneumothorax, nsogbu nke catheter, ọbara ọgbụgba n'oge ntinye (ihe ndị ọzọ metụtara ntinye etiti).
Mgbochi: ntinye site n'aka ndị ọrụ a zụrụ azụ, nduzi ultrasound, nkwenye ọnọdụ.
B. Nsogbu Ndị Na-efe efe
– CRBSI bụ nnukwu nsogbu.
Mgbochi: ngwugwu mgbochi ọrịa (nhicha aka, ọgwụ mgbochi akpụkpọ ahụ, nlekọta uwe, obere njikwa ọdụ ụgbọ mmiri, agụmakwụkwọ ndị ọrụ).
C. Nsogbu Metabolic
- Ọbara shuga dị elu, hypoglycemia (karịsịa ma ọ bụrụ na ewepụ ya na mberede), nsogbu electrolyte, ọrịa refeeding syndrome, hypertriglyceridemia.
Mgbochi: nhazi nke nta nke nta, nlekota anya nke ọma, mmezi electrolyte, na usoro insulin ma ọ bụrụ na ọ dị mkpa.
D. Nsogbu Hepatobiliary
- Cholestasis, steatosis, ma ọ bụ nsogbu imeju mgbe ejiri ya ogologo oge.
Mgbochi: zere iribiga nri ókè, tụlee iri nri okirikiri, mee ka enteral ka mma mgbe o kwere mee, nyochaa ihe mejupụtara lipid.
9. Ụkpụrụ nke Ịkwụsị na Mgbanwe gaa na Nri dị n'ime/Ọnụ
N'ụzọ kacha mma, a ga-akwụsị NP ozugbo onye ọrịa nwere ike igbo mkpa nri site n'ọnụ ma ọ bụ site n'ọnụ. A na-akwụsịkarị ya nwayọ nwayọ, ọkachasị site na usoro dextrose dị elu, iji zere hypoglycemia na-emegharị ahụ. Mgbanwe na-aga nke ọma gụnyere ịbawanye oriri n'ime/ọnụ ebe a na-ebelata NP, yana nlezianya nyochaa glucose na ọnọdụ ahụike.
Mmechi
Usoro nri nne na nna gụnyere ihe karịrị naanị itinye akara IV nwere kalori. Ha gụnyere usoro usoro ọkọlọtọ nke gụnyere nhọrọ onye ọrịa, mkpebi nnweta, ngwakọta sterile, inye ya na ọkpọkọ infusion, nlekota ụlọ nyocha nke ọma, na mgbochi nsogbu mechanical, infecting, na metabolic. Site na ụzọ ziri ezi na mmekorita dị iche iche n'etiti ndị dọkịta, ndị nọọsụ, ndị ọkachamara na nri, na ndị na-ere ọgwụ, nri nne na nna nwere ike ịbụ ihe enyemaka dị mma ma dị irè iji kwado mgbake onye ọrịa mgbe eriri afọ enweghị ike ịrụ ọrụ nke ọma.
