Njira Zoyendetsera Zakudya za Makolo
Zakudya za Parenteral (NP) ndi njira yoperekera zakudya mwachindunji m'magazi kudzera mu njira yolowera m'mitsempha pamene njira ya m'mimba sigwira ntchito bwino kapena ikufunika kupumulidwa. Muzochitika zachipatala, njira zoperekera NP zimafuna kulondola kwambiri chifukwa chogwiritsa ntchito njira zochotsera hyperosmolar, chiopsezo cha matenda, kusokonezeka kwa kagayidwe kachakudya, komanso kufunikira kosintha payekha kutengera momwe wodwalayo alili. Nkhaniyi ikufotokoza mfundo zoyambira, kukonzekera, kusankha njira yopezera, njira zoperekera, kuyang'anira, komanso kupewa zovuta mu njira za NP.
1. Zizindikiro ndi Zolinga za Zakudya Zopatsa Thanzi
Zakudya zopatsa thanzi zimaperekedwa ngati zakudya zopatsa thanzi (m'mimba) sizingatheke, zosatetezeka, kapena zosakwanira. Zizindikiro zodziwika bwino zimaphatikizapo kutsekeka kwa matumbo, kuledzera kwa nthawi yayitali, matenda a matumbo afupi, matenda a m'mimba otuluka kwambiri, mitundu ina yoopsa ya kapamba, kusayamwa bwino kwambiri, matenda obwera pambuyo pa opaleshoni omwe ali ndi zoletsa zodyetsera, ndi odwala omwe akudwala kwambiri omwe sangathe kukwaniritsa zosowa zawo za zakudya kudzera mu chakudya chopatsa thanzi.
Zolinga zazikulu za NP ndikukhala ndi thanzi labwino, kupewa kufalikira kwa kagayidwe kachakudya kwambiri, kufulumizitsa machiritso a mabala, kusunga magwiridwe antchito a ziwalo, ndikuthandizira kuchira. Kupambana kwa NP sikudalira kokha kuchuluka kwa ma calories omwe amaperekedwa, komanso pamlingo woyenera wa madzi, ma electrolyte, shuga, mapuloteni, ndi michere yaying'ono.
2. Mitundu ya Zakudya za Parenteral: Zam'mbali ndi Zapakati
Mwaukadaulo, NP imagawidwa m'magulu awiri:
1. Zakudya Zam'mimba Zam'mimba (NPP/PPN)
Amaperekedwa kudzera m'mitsempha yozungulira. Kuchuluka kwa osmolarity ya yankho kuyenera kuchepetsedwa kuti tipewe phlebitis yayikulu. Chifukwa cha kuchepa kwa osmolarity yake, PPN ndi yoyenera pazosowa za kanthawi kochepa kapena ngati "mlatho" pamene njira yolowera pakati siikupezeka.
2. Zakudya Zonse za Parenteral kudzera mu Central (NPT/TPN)
Poperekedwa kudzera m'mitsempha yapakati (monga mtsempha wa subclavian, mtsempha wamkati wa jugular, kapena kudzera mu catheter yapakati ya mtsempha yomwe imayikidwa mu vena cava yapamwamba), TPN imalola kupereka njira zothetsera vuto la high-osmolarity, kuonetsetsa kuti zosowa zonse zama calorie-protein zakwaniritsidwa. Nthawi zambiri imagwiritsidwa ntchito pochiza matenda apakati mpaka nthawi yayitali kapena kwa odwala omwe akufunikira kwambiri.
Kusankha pakati pa PPN ndi TPN kumadalira nthawi ya chithandizo, zakudya zomwe munthu amafunikira, momwe mitsempha ya m'mitsempha imakhalira, komanso chiopsezo cha mavuto.
3. Kapangidwe ka Mayankho ndi Mfundo Zowerengera Zofunikira
Mayankho a NP nthawi zambiri amakhala ndi:
– Chakudya: makamaka dextrose monga gwero lalikulu la mphamvu.
– Mapuloteni: amino acid opangidwa ndi minofu komanso kusunga minofu.
– Mafuta: mafuta osungunuka ngati gwero lamphamvu komanso mafuta ofunikira.
– Ma electrolyte: sodium, potaziyamu, kloridi, calcium, magnesium, phosphate ngati pakufunika.
– Mavitamini ndi zinthu zina: kuti apewe kusowa kwa michere yambiri m'thupi.
– Madzi: kuchuluka kwa madzi m'thupi kumasinthidwa malinga ndi momwe impso zilili, momwe impso zimagwirira ntchito, komanso momwe zimakhalira.
Mwachidule, zofunikira pa mphamvu ndi mapuloteni zimawerengedwa kutengera kulemera kwa thupi, momwe matenda alili, komanso kuchuluka kwa kupsinjika kwa kagayidwe kachakudya m'thupi. Kwa odwala omwe ali ndi vuto lalikulu, kuwonjezeka pang'onopang'ono nthawi zambiri kumakhala kofunikira kuti apewe matenda a hyperglycemia ndi matenda obwerezabwereza, makamaka kwa odwala omwe ali ndi vuto la kudya kwambiri.
4. Kukonzekera ndi Kusowa kwa Masepsis: Chinsinsi cha Chitetezo
Njira zoperekera NP ziyenera kutsatira miyezo yokhwima ya aseptic chifukwa ma catheter olowetsedwa m'mitsempha ndi njira yolunjika yomwe tizilombo toyambitsa matenda timalowera m'magazi. Mfundo zina zofunika ndi izi:
– Yankho limakonzedwa mopanda poizoni (bwino kwambiri m'malo opangira mankhwala okhala ndi mpweya wochepa kapena chipinda choyera malinga ndi miyezo).
- Chizindikiro ndi kutsimikizira: onetsetsani kuti wodwala ndi ndani, kapangidwe kake, tsiku lotha ntchito, komanso kukhazikika kwa yankho.
- Ukhondo wa manja musanagwiritse ntchito catheter kapena infusion set.
- Thirani mankhwala ophera tizilombo toyambitsa matenda pa doko (tsukani malo olumikizirana) nthawi iliyonse mukalowa.
- Kugwiritsa ntchito ma seti apadera a infusion ndi ma filter monga momwe alangizidwira ndi malo ogwiritsira ntchito (monga ma filters ochepetsera tinthu tating'onoting'ono m'njira zina).
Zolakwika zazing'ono mu asepsis zingayambitse matenda okhudzana ndi magazi m'magazi (CRBSIs) zomwe zimawonjezera imfa, nthawi yokhala, komanso ndalama.
5. Kusankha Njira Yopezera ndi Kuyika Mitsempha
A. Kulowera kwa M'mphepete mwa msewu
Kulowa m'malo olumikizirana mafupa kumagwiritsa ntchito njira yolumikizirana mafupa pogwiritsa ntchito njira yolumikizirana mafupa yomwe imayang'aniridwa mosamala kuti ione ngati pali zizindikiro za phlebitis: kupweteka, kufiira, kutupa, kapena mzere wofiira womwe uli m'mitsempha. Kulowetsa kuyenera kukhala mumtsempha wokhazikika bwino, kupewa kupangika kwa mafupa nthawi iliyonse yomwe ingatheke kuti muchepetse chiopsezo cholowa m'malo olumikizirana mafupa.
B. Malo Olowera Pakati
Kwa TPN, njira yolowera pakati ikhoza kukhala:
- CVC Yopanda Tunnel (Central Venous Catheter) (yomwe imapezeka kwambiri mu ICU),
- PICC (Peripherally Inserted Central Catheter) kuti munthu alandire chithandizo cha nthawi yayitali,
– Ma catheter kapena madoko okhala ndi ngalande kuti agwiritsidwe ntchito kwa nthawi yayitali.
Kuika CVC kumachitika bwino kwambiri motsogozedwa ndi ultrasound kuti chipambano chiwonjezeke ndikuchepetsa mavuto amakina monga pneumothorax kapena hematoma. Pambuyo poika, malo a nsonga ya catheter ayenera kutsimikiziridwa (monga, ndi radiology, malinga ndi protocol) musanagwiritse ntchito, makamaka kuti mulowe pakati.
6. Njira Yoperekera: Masitepe Aakulu
Njira zoperekera chithandizo cha NP zikuphatikizapo:
1. Tsimikizirani dongosolo: kapangidwe kake, kuchuluka kwa kulowetsedwa, njira, ndi nthawi yake.
2. Yang'anani yankho: kumveka bwino, mafuta osungunuka "sasweka" (palibe kulekanitsidwa), phukusi lake silinasinthe, ndipo silidutsa tsiku lokhazikika.
3. Kukonzekera seti ya infusion: gwiritsani ntchito pampu ya infusion kuti muone molondola.
4. Kupaka utoto: dzazani chubu chothira madzi ndi yankho kuti pasakhale mpweya.
5. Thirani mankhwala ophera tizilombo toyambitsa matenda: yeretsani cholowera cha catheter motsatira miyezo (monga mowa/chlorhexidine motsatira malamulo a chipatala).
6. Yambani kumwa pang'onopang'ono: mwa odwala omwe ali pachiwopsezo chachikulu, chiŵerengero choyamba nthawi zambiri chimakhala chotsika kenako chimawonjezeka malinga ndi momwe wodwalayo amalolera.
7. Ndondomeko ya nthawi yoperekera: NP ikhoza kuperekedwa mosalekeza kwa maola 24 kapena mozungulira (monga maola 12-18), makamaka pochiza kwa nthawi yayitali kuti awonjezere chitonthozo ndikuchepetsa kulephera kugwira ntchito bwino kwa chiwindi mwa odwala ena.
8. Kusintha ma seti ndi ma dressing: ma infusion sets, connectors, ndi catheter dressing zimasinthidwa malinga ndi malangizo kuti achepetse chiopsezo cha matenda.
Kupereka NP sikuyenera kusakanikirana mwachisawawa ndi mankhwala m'njira imodzi popanda kugwirizana bwino. Mankhwala ambiri sagwirizana ndi lipid emulsions kapena concentrated dextrose solutions ndipo angayambitse mvula yoopsa.
7. Kuyang'anira Zachipatala ndi Zachipatala
Kuwunika ndi gawo lofunika kwambiri la "njira" ya NP:
- Zizindikiro zofunika kwambiri ndi momwe madzi amakhalira: kutuluka kwa madzi m'thupi, kutupa, zizindikiro za kutaya madzi m'thupi.
– Shuga m'magazi: hyperglycemia ndi yofala; insulin ingafunike.
– Ma electrolyte: potaziyamu, magnesium, phosphate ndizofunikira kwambiri makamaka pa chiopsezo cha matenda obwerezabwereza.
- Kugwira ntchito kwa impso ndi chiwindi: urea/creatinine, ma enzyme a chiwindi, bilirubin.
- Triglycerides: makamaka pogwiritsa ntchito lipid emulsions, makamaka kwa odwala omwe ali ndi vuto la sepsis kapena mafuta metabolism.
– Zizindikiro za matenda: malungo, kuzizira, kufiira pamalo omwe paikidwa katheta, kapena kumera bwino kwa maselo.
Kuchuluka kwa mayeso kumasinthidwa kuti kugwirizane ndi momwe wodwalayo alili: tsiku lililonse mu gawo loyamba kapena kwa odwala ofunikira kwambiri, kenako amatha kuwonjezeredwa akakhala bwino.
8. Mavuto ndi Kupewa
Mavuto a zakudya za parenteral angagawidwe m'magulu awiri:
A. Mavuto a Makina
- Pneumothorax, kusakhazikika bwino kwa catheter, kutuluka magazi panthawi yoika (zokhudzana kwambiri ndi kulowa pakati).
Kupewa: kuyika ndi anthu ophunzitsidwa bwino, malangizo a ultrasound, kutsimikizira malo.
B. Mavuto Opatsirana
- CBRSI ndi vuto lalikulu.
Kupewa: njira yopewera matenda (ukhondo wa manja, mankhwala oletsa matenda a pakhungu, chisamaliro cha zovala, kuchepetsa kugwiritsa ntchito ma ducts, maphunziro a antchito).
C. Mavuto a Kagayidwe kachakudya
- Hyperglycemia, hypoglycemia (makamaka ngati yatha mwadzidzidzi), kusokonezeka kwa ma electrolyte, refeeding syndrome, hypertriglyceridemia.
Kupewa: kuchepetsa pang'onopang'ono kuchuluka kwa shuga m'magazi, kuyang'anitsitsa mosamala, kukonza ma electrolyte, ndi njira ya insulin ngati pakufunika.
D. Mavuto a chiwindi
- Kulephera kwa cholestasis, steatosis, kapena kulephera kwa chiwindi chifukwa chogwiritsa ntchito nthawi yayitali.
Kupewa: Pewani kudya mopitirira muyeso, ganizirani za kudya mozungulira, onjezerani mphamvu ya chakudya ngati n'kotheka, fufuzani kuchuluka kwa mafuta m'thupi.
9. Mfundo Zosiya Kudya ndi Kusintha Kupita Kum'mimba/Kumwa
Ndibwino kuti NP isiyidwe wodwala akatha kukwaniritsa zosowa zake za zakudya m'thupi kapena pakamwa. Kusiya kumwa mankhwalawa nthawi zambiri kumachitika pang'onopang'ono, makamaka ndi mankhwala okhala ndi dextrose yambiri, kuti apewe hypoglycemia. Kusintha bwino kumaphatikizapo kuwonjezera kumwa kwa enteral/kumwa pamene akuchepetsa NP, ndikuyang'anira bwino shuga m'magazi ndi momwe wodwalayo alili.
Mapeto
Njira zodyetsera ana zimaphatikizapo zambiri osati kungoika mzere wa IV wokhala ndi ma calories. Zimaphatikizapo njira zingapo zokhazikika zomwe zimaphatikizapo kusankha wodwala, kudziwa momwe angalowere, kuphatikiza mankhwala osawononga, kupereka ndi pampu yothira, kuyang'anira mosamala labotale, komanso kupewa zovuta zamakina, matenda, komanso kagayidwe kachakudya. Ndi njira yoyenera komanso mgwirizano wamitundu yosiyanasiyana pakati pa madokotala, anamwino, akatswiri azakudya, ndi akatswiri a zamankhwala, zakudya zodyetsera ana zingakhale njira yotetezeka komanso yothandiza yothandizira wodwala kuchira pamene njira ya m'mimba singagwire ntchito bwino.
