Maitiro Ekutarisira Zvinovaka Muviri weVabereki
Kudya kwevabereki (NP) inzira yekupa zvinovaka muviri zvakananga muropa kuburikidza nekupinda muropa kana nzira yekugaya isingashande zvakanaka kana ichida kuzorora. Mukurapa, nzira dzekutumira NP dzinoda kunyatsojeka nekuda kwekushandisa mishonga ye hyperosmolar, njodzi yehutachiona, kusagadzikana kwemetabolism, uye kudiwa kwekugadzirisa kwemunhu zvichienderana nemamiriro emurwere. Chinyorwa chino chinokurukura misimboti yekutanga, kugadzirira, kusarudza nzira yekupinda nayo, maitiro ekupa, kutarisa, uye kudzivirira matambudziko mumaitiro eNP.
1. Zviratidzo uye Zvinangwa zveKudya Kwevabereki
Kudya kwevabereki kunopihwa kana kudya kwemudumbu (mudumbu) kusingagoneki, kusina kuchengetedzeka, kana kusina kukwana. Zviratidzo zvinowanzoonekwa zvinosanganisira kuvharika kwemudumbu, kuvharika kwemudumbu kwenguva refu, chirwere chemudumbu chipfupi, fistula yemudumbu ine simba guru, mamwe marudzi epancreatitis akanyanya, kusamwisa zvakanyanya, mamiriro emudumbu mushure mekuvhiyiwa ane zvinorambidzwa pakudya, uye varwere vanorwara zvakanyanya vasingakwanise kugutsa zvinodiwa zvavo zvekudya kuburikidza nekudya kwemudumbu.
Zvinangwa zvikuru zveNP ndezvekuchengetedza hutano, kudzivirira catabolism yakawandisa, kukurumidzisa kupora kwemaronda, kuchengetedza mashandiro enhengo, uye kutsigira kupora. Kubudirira kweNP hakungobvi pahuwandu hwemacalorie anopiwa chete, asiwo pakuenzanisa kwakakodzera kwemvura, maelectrolyte, glucose, mapuroteni, uye micronutrients.
2. Mhando dzeKudya Kwevabereki: Peripheral neCentral
Nehunyanzvi, NP yakakamurwa kuita maviri:
1. Kudya Kwemwana Panze (NPP/PPN)
Inopinzwa kuburikidza netsinga yeropa. Osmolarity yemushonga inofanira kuganhurirwa kudzivirira phlebitis yakanyanya. Nekuda kwekushomeka kwayo kwe osmolarity, PPN yakakodzera zvinodiwa kwenguva pfupi kana se "bhiriji" kana nzvimbo yepakati isati yawanikwa.
2. Kudya Kwakazara Kwevabereki Kuburikidza Nepakati (NPT/TPN)
Inopiwa kuburikidza netsinga yepakati (semuenzaniso, tsinga ye subclavian, tsinga yemukati yejugular, kana kuburikidza ne catheter yepakati yetsinga inopinzwa mu superior vena cava), TPN inobvumira kupa mhinduro dze high-osmolarity, zvichiita kuti zvinodiwa nemacalorie-protein zvizere zvizadzikiswe. Inowanzo shandiswa pakurapa kwenguva yepakati kusvika kwenguva refu kana kuvarwere vane zvinodiwa zvakanyanya.
Sarudzo pakati pePPN neTPN inoenderana nenguva yekurapwa, zvinodiwa pakudya, mamiriro etsinga dziri mutsinga, uye njodzi yematambudziko.
3. Kuumbwa kweMhinduro uye Nheyo dzeKuverenga Zvinodiwa
Mhinduro dzeNP dzinowanzo kuve ne:
– Makabhohaidhiretsi: kunyanya dextrose senzvimbo huru yesimba.
– Mapuroteni: amino acids ekugadzira tissue uye kuchengetedza tsandanyama.
– Mafuta: lipid emulsion senzvimbo yakasimba yesimba uye mafuta acids akakosha.
– Maelectrolyte: sodium, potassium, chloride, calcium, magnesium, phosphate sezvinodiwa.
– Mavhitamini nezvinhu zvidiki: kudzivirira kushomeka kwezvinovaka muviri.
– Mvura: huwandu hwemvura hunogadziriswa zvichienderana nemamiriro emvura mumuviri, mashandiro eitsvo, uye mamiriro ekurapa.
Muchokwadi, zvinodiwa nesimba nemapuroteni zvinoverengerwa zvichienderana nehuremu hwemuviri, mamiriro ehutano, uye huwandu hwekushushikana kwemuviri. Muvarwere vanorwara zvakanyanya, kuwedzera zvishoma nezvishoma kunowanzodiwa kudzivirira hyperglycemia uye refeeding syndrome, kunyanya kune varwere vasina kudya zvakakwana.
4. Kugadzirira uye Asepsis: Kiyi Yekuchengetedza
Maitiro ekushandisa NP anofanirwa kutevedzera mitemo yakasimba yekusauraya utachiona nekuti macatheter anopinzwa mutsinga inzira yakananga yekuti utachiona hupinde muropa. Dzimwe nheyo dzakakosha dzinosanganisira:
– Mushonga wacho unogadzirwa usina utachiona (zvichida munzvimbo yemishonga ine mhepo yakapfava kana mukamuri rakachena zvinoenderana nezvinodiwa).
– Chiratidzo uye kusimbiswa: simbisa kuzivikanwa kwemurwere, chimiro chake, zuva rekupera, uye kugadzikana kwemushonga.
– Kuchenesa maoko usati washandisa catheter kana seti yeinfusion.
– Bvisa utachiona pachiteshi (kwesha hub) pese paunopinda.
– Kushandisa ma "infusion sets" nema "filters" akakosha sezvinokurudzirwa ne "censor" (semuenzaniso, ma "filters" ekuderedza zvidimbu mune mamwe maitiro).
Zvikanganiso zvidiki mu asepsis zvinogona kukonzera hutachiona hweropa hune chekuita ne catheter (CRBSIs) izvo zvinowedzera kufa, nguva yekugara, uye mari.
5. Kusarudzwa kweTsika yeKupinda muVenous uye Kuisa
A. Kupinda Munzvimbo Dzekunze
Kupinda kweropa mutsinga kunoshandisa nzira yekupinda mutsinga yeropa inonyatsoongororwa kuti ione kana paine zviratidzo zve phlebitis: kurwadziwa, kutsvuka, kuzvimba, kana kuti mutsetse mutsvuku uri mutsinga. Nzvimbo yekuisa inofanira kunge iri mutsinga yakanyatsogadzirwa, kudzivirira majoini kukwenya pese pazvinogoneka kuderedza njodzi yekupinda mutsinga.
B. Nzvimbo Yepakati Yekupinda
Kune TPN, nzira yekupinda pakati inogona kuva:
– Non-tunneled CVC (Central Venous Catheter) (inowanikwa muICU),
– PICC (Peripherally Inserted Central Catheter) yekurapwa kwenguva refu,
– Makatheta kana maports ane tunneled anoshandiswa kwenguva refu.
Kuiswa kweCVC kunoitwa zvakanaka pasi pekutungamirirwa neultrasound kuti kuwedzere kubudirira uye kuderedza matambudziko akadai sepneumothorax kana hematoma. Mushure mekuiswa, nzvimbo yemuromo wecatheter inofanira kusimbiswa (semuenzaniso, ne radiology, zvichienderana neprotocol) usati washandisa, kunyanya kuti usvike pakati.
6. Maitiro Ekupa: Matanho Makuru
Maitiro ekushandisa NP anosanganisira:
1. Simbisa kurongeka: kuumbwa, mwero wekuisirwa, nzira, uye nguva.
2. Tarisa mhinduro yacho: kujeka, lipid emulsion haiputsike (hapana kupatsanurwa), kurongedza kwacho hakuna kukanganiswa, uye hakupfuuri zuva rekugadzikana.
3. Kugadzirira seti yekuisira: shandisa pombi yekuisira kuti uwane kurongeka kwehuwandu.
4. Kuisa mvura muchubhu yekuisira mvura: zadza mushonga wekuisa mvura muchubhu kuitira kuti pasave nemhepo.
5. Bvisa utachiona muropa: chenesa catheter port zvichienderana nezvinodiwa (semuenzaniso doro/chlorhexidine zvichienderana nemutemo wechipatara).
6. Tanga kunwa mushonga zvishoma nezvishoma: muvarwere vane njodzi huru, mwero wekutanga unowanzova wakaderera wobva wawedzera sezvinobvumidzwa.
7. Nguva yekushandiswa: NP inogona kupiwa nguva dzose kwemaawa makumi maviri nemana kana nguva nenguva (semuenzaniso maawa gumi nemaviri kusvika gumi nemasere), kunyanya mukurapa kwenguva refu kuti kuwedzere kunyaradzwa uye kuderedza kushanda kwechiropa mune vamwe varwere.
8. Kutsiva maseti nemadressing: ma infusion sets, connectors, uye catheter dressings zvinotsiviwa zvichienderana nemirairo yekuderedza njodzi yehutachiona.
Kupiwa kweNP hakufanirwe kusanganiswa nemishonga nenzira imwe chete pasina kuenderana kwakajeka. Mishonga yakawanda haienderane nemafuta emulsions kana mishonga ine dextrose yakawanda uye inogona kukonzera kunaya kwemvura kune njodzi.
7. Kuongororwa kweKliniki neRabhoritari
Kutarisa chikamu chakakosha che "maitiro" eNP:
– Zviratidzo zvakakosha uye mamiriro emvura: kubuda kwemvura mumuviri, kuzvimba, zviratidzo zvekushaya mvura mumuviri.
– Shuga muropa: hyperglycemia inowanzoitika; insulin ingangodiwa.
– Maelectrolyte: potassium, magnesium, phosphate zvakakosha zvikuru kunyanya kana paine njodzi yekudzoka kwekudya.
– Kushanda kweitsvo nechiropa: urea/creatinine, ma enzymes echiropa, bilirubin.
– Triglycerides: kunyanya kana uchishandisa lipid emulsions, kunyanya kune varwere vane sepsis kana matambudziko e metabolism yemafuta.
– Zviratidzo zvehutachiona: fivha, dzihwa, kutsvuka panzvimbo yecatheter, kana kuti positive culture.
Kuwanda kwekuongororwa kunogadziriswa zvichienderana nemamiriro emurwere: zuva nezuva muchikamu chekutanga kana muvarwere vane dambudziko guru, uye kunogona kuwedzerwa kana kwakasimba.
8. Matambudziko uye Kudzivirira
Matambudziko ekudya kweparenteral anogona kukamurwa kuita:
A. Matambudziko eMichina
– Pneumothorax, kusamira zvakanaka kwecatheter, kubuda ropa panguva yekuiswa (zvine chekuita nekupinda pakati).
Kudzivirira: kuiswa nevashandi vakadzidziswa, kutungamirirwa neultrasound, kuongororwa kwenzvimbo.
B. Matambudziko Anotapukira
- CBRSI idambudziko guru.
Kudzivirira: mushonga wekudzivirira hutachiona (kuchena kwemaoko, mushonga wekudzivirira ganda, kuchengetedza mbatya, kushandura zvishoma ganda, kudzidzisa vashandi).
C. Matambudziko Emuviri
– Hyperglycemia, hypoglycemia (kunyanya kana ikamiswa kamwe kamwe), kusagadzikana kwema electrolyte, refeeding syndrome, hypertriglyceridemia.
Kudzivirira: kuderedzwa kweropa zvishoma nezvishoma, kutarisisa kwakanyatsojeka, kugadziriswa kwema electrolyte, uye protocol ye insulin kana zvichidikanwa.
D. Matambudziko eHepatobiliary
- Kusashanda zvakanaka kwechiropa, steatosis, kana kusashanda zvakanaka kwechiropa nekushandiswa kwenguva refu.
Kudzivirira: dzivisa kudya zvakanyanya, funga nezvekudyisa muviri nguva nenguva, gadzirisa zviri mukati medumbu kana zvichibvira, ongorora huwandu hwemafuta mumuviri.
9. Nheyo dzeKurega Kudya uye Kuchinja kuenda kuKudya Kwemudumbu/Nemuromo
Zvakakodzera kuti NP irege kushandiswa kana murwere akwanisa kugutsa zvinodiwa nemuviri wake nemuromo kana nemuromo. Kurega kushandisa NP kunowanzoitwa zvishoma nezvishoma, kunyanya kana munhu aine dextrose yakawanda, kudzivirira hypoglycemia. Kuchinja kunobudirira kunosanganisira kuwedzera kudya kwemuviri wake nemuromo ukuwo uchideredza NP, nekutarisa shuga yeropa uye mamiriro emuviri wake.
Mhedziso
Maitiro ekudya anosanganisira zvinopfuura kungoisa mutsetse weIV une macalorie. Anosanganisira nzira dzakasiyana-siyana dzinosanganisira kusarudzwa kwemurwere, kuona mukana wekuwana mushonga, kuisa mushonga wakachena, kuupa nepombi yekuisa mushonga, kutarisa kwakanyatsonaka murabhoritari, uye kudzivirira matambudziko emuchina, hutachiona, uye metabolic. Nekushandisa nzira kwayo uye kushanda pamwe chete pakati pevanachiremba, vanamukoti, nyanzvi dzezvekudya, uye varapi vemishonga, kudya kwakakodzera kunogona kuva nzira yakachengeteka uye inoshanda yekutsigira kupora kwemurwere kana nzira yemudumbu isingashande zvakanaka.
