Mekhoa ea Tsamaiso ea Phepo ea Batsoali
Phepo e nepahetseng ea bana (NP) ke mokhoa oa ho kenya limatlafatsi ka kotloloho maling ka ho li kenya ka har'a methapo ha tsela ea mala e sa sebetse hantle kapa e hloka ho phomola. Tloaelong ea bongaka, mekhoa ea ho fana ka NP e hloka ho nepahala ho hoholo ka lebaka la tšebeliso ea litharollo tsa hyperosmolar, kotsi ea tšoaetso, mathata a metabolism, le tlhoko ea liphetoho tsa motho ka mong ho latela boemo ba mokuli. Sengoloa sena se tšohla melao-motheo ea motheo, boitokisetso, khetho ea phihlello, mekhoa ea tsamaiso, tlhokomelo le thibelo ea mathata mekhoeng ea NP.
1. Lipontšo le Merero ea Phepo e Nepahetseng
Phepo e nepahetseng ea bana e fanoa ha phepo ea mala e sa khonehe, e sa sireletseha, kapa e sa lekana. Matšoao a tloaelehileng a kenyelletsa ho thijoa ha mala, ho ruruha ha lesapo la mokokotlo nako e telele, lefu la mala a makhutšoanyane, fistula ea mala e hlahisoang haholo, mefuta e itseng e matla ea pancreatitis, ho se monyehe ho matla, maemo a kamora opereishene a nang le lithibelo tsa ho fepa, le bakuli ba kulang haholo ba sa khoneng ho fihlela litlhoko tsa bona tsa phepo ka ho fepa mala.
Lipakane tsa mantlha tsa NP ke ho boloka boemo ba phepo e nepahetseng, ho thibela ho ruruha ho feteletseng, ho potlakisa pholiso ea maqeba, ho boloka tšebetso ea litho le ho tšehetsa ho hlaphoheloa. Katleho ea NP ha ea itšetleha feela ka palo ea lik'hilojule tse fanoeng, empa hape e itšetlehile ka tekanyo e nepahetseng ea metsi, li-electrolyte, tsoekere, protheine le limatlafatsi tse nyane.
2. Mefuta ea Phepo e Nepahetseng: Pel'a le Bohareng
Ha e le hantle, NP e arotsoe ka likarolo tse peli:
1. Phepo e Phepoang ea Parenteral ea Peripheral (NPP/PPN)
E tsamaisoa ka mothapo o ka thoko. Osmolarity ea tharollo e tlameha ho lekanyetsoa ho thibela phlebitis e matla. Ka lebaka la osmolarity ea eona e fokolang, PPN e loketse litlhoko tsa nako e khuts'oane kapa e le "borokho" ha phihlello e bohareng e e-so fumanehe.
2. Phepo e Felletseng ea Parenteral ka Central (NPT/TPN)
E tsamaisoa ka mothapo o bohareng (mohlala, mothapo oa subclavian, mothapo o ka hare oa jugular, kapa ka catheter e bohareng ea venous e kentsoeng ka har'a vena cava e phahameng), TPN e lumella ho tsamaisoa ha litharollo tse nang le osmolarity e phahameng, ho netefatsa hore litlhoko tse felletseng tsa protheine ea lik'hilojule lia finyelloa. Hangata e sebelisoa bakeng sa phekolo ea nako e mahareng ho isa ho e telele kapa ho bakuli ba nang le litlhoko tse phahameng.
Khetho pakeng tsa PPN le TPN e itšetlehile ka nako ea phekolo, litlhoko tsa phepo e nepahetseng, boemo ba methapo ea mali e ka ntle, le kotsi ea mathata.
3. Sebopeho sa Tharollo le Melao-motheo ea ho Bala Litlhoko
Litharollo tsa NP ka kakaretso li kenyelletsa:
– Lik'habohaedreite: haholo-holo dextrose e le mohloli o ka sehloohong oa matla.
– Protheine: li-amino acid bakeng sa ho kopanya lisele le ho boloka mesifa.
– Mafura: emulsion ea lipid e le mohloli o tiileng oa matla le li-acid tse mafura tsa bohlokoa.
– Li-electrolyte: sodium, potasiamo, chloride, calcium, magnesium, phosphate ha ho hlokahala.
– Livithamine le likarolo tse nyenyane: ho thibela khaello ea limatlafatsi tse nyenyane.
– Metsi: bophahamo ba modumo bo lokiswa ho latela boemo ba metsi mmeleng, tshebetso ya liphio, le boemo ba bongaka.
Ha e le hantle, litlhoko tsa matla le protheine li baloa ho latela boima ba 'mele, boemo ba bongaka, le maemo a khatello ea metabolism. Ho bakuli ba kulang haholo, keketseho e butle-butle hangata ea hlokahala ho thibela hyperglycemia le lefu la ho fepa hape, haholo-holo ho bakuli ba nang le phepo e mpe haholo.
4. Boitokisetso le Asepsis: Senotlolo sa Polokeho
Mekhoa ea ho fana ka NP e tlameha ho latela litekanyetso tse tiileng tsa aseptic hobane li-catheter tse kenngoang ka methapo ke tsela e tobileng eo likokoana-hloko li kenang maling ka eona. Melao-motheo e meng ea bohlokoa e kenyelletsa:
– Tharollo e lokisitsoe ka mokhoa o se nang dikokwana-hloko (haholo-holo setsing sa meriana se nang le phallo ea moea e thata kapa kamoreng e hloekileng ho latela maemo).
– Leiboleng le netefatso: netefatsa boitsebiso ba mokuli, sebopeho, letsatsi la ho fela, le botsitso ba tharollo.
– Bohloeki ba matsoho pele o sebedisa catheter kapa sete ya infusion.
– Hlatsoa kou (hlatswa setsi) nako le nako ha o e kena.
– Tšebeliso ea lisete tse khethehileng tsa infusion le lifilthara joalo ka ha ho khothaletsoa ke setsi (mohlala, lifilthara ho fokotsa likaroloana mekhoeng e meng ea phekolo).
Liphoso tse nyane ho asepsis li ka lebisa tšoaetsong ea mali e amanang le catheter (CRBSIs) e eketsang lefu, bolelele ba ho lula le litšenyehelo.
5. Khetho ea Mokhoa oa ho Fumana le ho Kenya Methapo ea Methapo
A. Phihlello ea ho kena ka thoko
Ho fihlella ka thoko ho sebedisa cannula ya methapo e ka thoko e nang le tlhokomelo e haufi bakeng sa matshwao a phlebitis: bohloko, bofubedu, ho ruruha, kapa mothapo o mofubedu o pela mothapo. Ho kenya ho lokela ho ba ka hara mothapo o tiileng hantle, ho qoba ho teteana ha manonyeletso neng kapa neng ha ho kgoneha ho fokotsa kotsi ya ho kenella.
B. Phihlello e Bohareng
Bakeng sa TPN, phihlello e bohareng e ka ba:
– CVC e sa keneng ka har'a kotopo (Central Venous Catheter) (e tloaelehileng ICU),
– PICC (Peripherally Inserted Central Catheter) bakeng sa kalafo e telele,
– Li-catheter kapa likou tse koetsoeng bakeng sa litlhoko tsa nako e telele.
Ho beoa ha CVC ho etsoa hantle tlas'a tataiso ea ultrasound ho eketsa katleho le ho fokotsa mathata a mechini a kang pneumothorax kapa hematoma. Kamora ho beoa, boemo ba ntlha ea catheter bo tlameha ho netefatsoa (mohlala, ka radiology, ho latela protocol) pele ho sebelisoa, haholo-holo bakeng sa phihlello e bohareng.
6. Mokhoa oa ho Fana: Mehato e Meholo
Mekhoa ea tsamaiso ea NP e kenyelletsa:
1. Netefatsa tatellano: sebopeho, sekhahla sa ho kenngoa ha metsi, tsela, le nako.
2. Hlahloba tharollo: ho hlaka, emulsion ea lipid ha e "robe" (ha ho karohano), sephutheloana se feletse, 'me ha se fete letsatsi la botsitso.
3. Ho lokisa sete ea infusion: sebelisa pompo ea infusion bakeng sa ho nepahala ha sekhahla.
4. Ho ntsha di-primer: tlatsa phaephe ya infusion ka tharollo e le hore ho se be le moya.
5. Hlatsoa likokoana-hloko: hloekisa koung ea catheter ho latela maemo (mohlala, joala/chlorhexidine ho latela leano la sepetlele).
6. Qala ho kenya moriana butle-butle: ho bakuli ba kotsing e kholo, sekhahla sa pele hangata sea theoha ebe sea eketseha ha ho lebelloa.
7. Kemiso ea ho fuoa: NP e ka fanoa khafetsa lihora tse 24 kapa ka potoloho (mohlala, lihora tse 12-18), haholo-holo kalafong ea nako e telele ho eketsa boiketlo le ho fokotsa ho se sebetse hantle ha sebete ho bakuli ba bang.
8. Ho nkeloa sebaka ha disete le di-dressing: disete tsa infusion, di-connectors, le di-dressing tsa catheter di nkeloa sebaka ho ya ka ditaelo ho fokotsa kotsi ya tshwaetso.
Tsamaiso ea NP ha ea lokela ho kopanngoa ntle le khethollo le meriana ka tsela e le 'ngoe ntle le ho lumellana ho hlakileng. Meriana e mengata ha e lumellane le li-emulsion tsa lipid kapa litharollo tse matla tsa dextrose 'me li ka baka pula e kotsi.
7. Tlhokomelo ea Bongaka le ea Laboratori
Tlhokomelo ke karolo ea bohlokoa ea "mokhoa" oa NP:
– Matšoao a bohlokoa le boemo ba mokelikeli: ho tsoa ha metsi, ho ruruha, matšoao a ho felloa ke metsi 'meleng.
– Tsoekere maling: hyperglycemia e atile; insulin e ka hlokahala.
– Li-electrolyte: potasiamo, magnesium, phosphate li bohlokoa haholo haholo-holo ha li le kotsing ea ho ba le lefu la ho fepa hape.
– Mosebetsi oa liphio le sebete: urea/creatinine, lienzyme tsa sebete, bilirubin.
– Triglycerides: haholo-holo ha ho sebelisoa li-emulsion tsa lipid, haholo-holo ho bakuli ba nang le mathata a sepsis kapa metabolism ea mafura.
– Matšoao a tšoaetso: feberu, serame, bofubelu sebakeng sa catheter, kapa tlhahiso e ntle ea mali.
Hangata litlhahlobo li fetoloa ho latela boemo ba mokuli: letsatsi le letsatsi mohatong oa pele kapa ho bakuli ba mahlonoko, ebe li ka atolosoa ha li tsitsitse.
8. Mathata le Thibelo
Mathata a phepo e nepahetseng ea parenteral a ka aroloa ka:
A. Mathata a Mekaniki
– Pneumothorax, ho se be teng hantle ha catheter, ho tswa madi nakong ya ho kenngwa (ho amana haholo le phihlello e bohareng).
Thibelo: ho kenngoa ke basebetsi ba koetlisitsoeng, tataiso ea ultrasound, netefatso ea boemo.
B. Mathata a Tšoaetso
– CBRSI ke bothata bo boholo.
Thibelo: sephutheloana sa thibelo ea tšoaetso (bohloeki ba matsoho, thibelo ea sepsis letlalong, tlhokomelo ea liaparo, ho se sebelise li-port tse ngata, thuto ea basebetsi).
C. Mathata a Metabolic
– Hyperglycemia, hypoglycemia (haholo-holo haeba e emisitsoe ka tšohanyetso), mathata a electrolyte, lefu la ho fepa hape, hypertriglyceridemia.
Thibelo: ho fokotsa butle-butle tekanyo ea mali, ho beha leihlo ka hloko, ho lokisa li-electrolyte, le ho laola insulin haeba ho hlokahala.
D. Mathata a Hepatobiliary
– Ho se sebetse hantle ha sebete, ho ruruha ha steatosis, kapa ho se sebetse hantle ha sebete ka lebaka la tšebeliso ea nako e telele.
Thibelo: qoba ho fepa ho feta tekano, nahana ka ho fepa ka potoloho, ntlafatsa enteral ha ho khoneha, lekola motsoako oa lipid.
9. Melao-motheo ea ho khaotsa le ho fetohela ho fepa ka mpeng/ka molomo
Ka nepo, NP e lokela ho emisoa hang ha mokuli a se a khona ho fihlela litlhoko tsa phepo ka mpeng kapa ka molomo. Ho khaotsa hangata ho etsahala butle-butle, haholo-holo ka mekhoa e nang le dextrose e ngata, ho qoba hypoglycemia e arabelang. Phetoho e atlehileng e kenyelletsa ho eketsa ho nooa ha enteral/ka molomo ha ka nako e ts'oanang ho fokotsa NP, ka ho beha leihlo tsoekere ea mali le boemo ba kliniki ka hloko.
Qetello
Mekhoa ea phepo ea bana e kenyelletsa ho feta feela ho kenya mola oa IV o nang le lik'hilojule. Li kenyelletsa letoto la mekhoa e tloaelehileng e kenyeletsang khetho ea mokuli, ho fumana phihlello, ho kopanya ho sa hloekang, ho fuoa ka pompo ea infusion, ho beha leihlo laboratoring haufi-ufi, le ho thibela mathata a mechini, a tšoaetsanoang le a metabolism. Ka mokhoa o nepahetseng le tšebelisano-'moho ea litsebi tse ngata pakeng tsa lingaka, baoki, litsebi tsa phepo e nepahetseng le litsebi tsa meriana, phepo e nepahetseng ea bana e ka ba mokhoa o sireletsehileng le o sebetsang oa ho tšehetsa ho hlaphoheloa ha mokuli ha tsela ea mala e sa sebetse hantle.
