Amasu Okuphatha Ukudla Okunomsoco Kwabazali
Ukudla okunempilo kwabazali (i-NP) kuyindlela yokunikeza izakhamzimba ngqo egazini ngokufinyelela ngemithambo lapho indlela yokugaya ukudla ingakwazi ukusebenza kahle noma idinga ukuphumula. Emtholampilo, amasu okulethwa kwe-NP adinga ukunemba okuphezulu ngenxa yokusetshenziswa kwezixazululo ze-hyperosmolar, ingozi yokutheleleka, ukuphazamiseka kwe-metabolic, kanye nesidingo sokulungiswa komuntu ngamunye ngokusekelwe esimweni sesiguli. Lesi sihloko sixoxa ngezimiso eziyisisekelo, ukulungiselela, ukukhetha ukufinyelela, izinqubo zokuphatha, ukuqapha, kanye nokuvimbela izinkinga kumasu e-NP.
1. Izinkomba Nezinhloso Zokudla Okunomsoco Kwabazali
Ukudla okunempilo kwabazali kunikezwa lapho ukudla okunempilo kwamathumbu kungenzeki, kungaphephile, noma kunganele. Izinkomba ezivamile zifaka phakathi ukuvaleka kwamathumbu, i-ileus ende, i-short bowel syndrome, i-fistula yamathumbu ephuma kakhulu, izinhlobo ezithile ezinzima ze-pancreatitis, ukungamuncwa kahle okukhulu, izimo zangemuva kokuhlinzwa ezineziphazamiso zokudla, kanye neziguli ezigula kakhulu ezingakwazi ukuhlangabezana nezidingo zazo zokudla okunempilo ngokudla kwamathumbu.
Imigomo eyinhloko ye-NP ukugcina isimo sokudla okunempilo, ukuvimbela ukuguguleka ngokweqile kwezicubu zomzimba, ukusheshisa ukuphulukiswa kwamanxeba, ukugcina ukusebenza kwezitho zomzimba, nokusekela ukululama. Impumelelo ye-NP ayixhomekile nje kuphela enanini lamakhalori anikezwayo, kodwa futhi nasekulinganiseni okufanele koketshezi, ama-electrolyte, i-glucose, amaprotheni, kanye nezakhamzimba ezincane.
2. Izinhlobo Zokudla Okunomsoco Kwabazali: Okuseceleni Nokuphakathi
Ngobuchwepheshe, i-NP ihlukaniswe kabili:
1. Ukudla Okunomsoco Kwabazali Okungaphazamisi (NPP/PPN)
Kunikezwa ngomthambo ongaphandle. I-osmolarity yesisombululo kumele ilinganiselwe ukuvimbela i-phlebitis enzima. Ngenxa ye-osmolarity yayo elinganiselwe, i-PPN ifanele izidingo zesikhashana noma "njengebhuloho" lapho ukufinyelela okuphakathi kungatholakali okwamanje.
2. Ukudla Okuphelele Kwabazali Nge-Central (NPT/TPN)
Inikezwa ngomthambo ophakathi (isb., umthambo we-subclavian, umthambo wangaphakathi we-jugular, noma nge-catheter ephakathi yemithambo efakwe ku-vena cava ephezulu), i-TPN ivumela ukuphathwa kwezixazululo ze-osmolarity ephezulu, ukuqinisekisa ukuthi izidingo ezigcwele zamakhalori namaprotheni ziyahlangatshezwa. Ngokuvamile isetshenziselwa ukwelashwa kwesikhathi esiphakathi kuya kweside noma ezigulini ezinezidingo eziphezulu.
Ukukhetha phakathi kwe-PPN ne-TPN kuncike esikhathini sokwelashwa, izidingo zokudla okunempilo, isimo semithambo yegazi engaphandle, kanye nengozi yezinkinga.
3. Ukwakheka Kwesixazululo kanye Nezimiso Zokubala Izidingo
Izixazululo ze-NP ngokuvamile zihlanganisa:
– Ama-carbohydrate: ikakhulukazi i-dextrose njengomthombo wamandla oyinhloko.
– Amaprotheni: ama-amino acid okwenziwa kwezicubu nokugcina imisipha iqinile.
– Amafutha: i-lipid emulsion njengomthombo oqinile wamandla nama-fatty acid abalulekile.
– Ama-electrolyte: i-sodium, i-potassium, i-chloride, i-calcium, i-magnesium, i-phosphate njengoba kudingeka.
– Amavithamini kanye nezinto ezilandelwayo: ukuvimbela ukuntuleka kwezakhamzimba ezincane.
– Uketshezi: ivolumu ilungiswa ngokuya ngesimo somswakama, ukusebenza kwezinso, kanye nesimo sempilo.
Ngokomthetho, izidingo zamandla namaprotheni zibalwa ngokusekelwe esisindweni somzimba, isimo somtholampilo, kanye namazinga okucindezeleka kwe-metabolic. Ezigulini ezigula kakhulu, ukwanda kancane kancane kuvame ukudingeka ukuze kuvinjelwe i-hyperglycemia kanye nesifo sokuphinda ukondle, ikakhulukazi ezigulini ezingondlekile kahle kakhulu.
4. Ukulungiselela kanye ne-Asepsis: Isihluthulelo Sokuphepha
Amasu okuphatha i-NP kumele alandele amazinga aqinile e-aseptic ngoba ama-catheter emithanjeni ayindlela eqondile yokuthi amagciwane angene egazini. Ezinye izimiso ezibalulekile zifaka:
– Isixazululo silungiswa ngendlela engenamagciwane (kungcono kakhulu endaweni yemithi enomoya ohamba kancane noma igumbi elihlanzekile ngokwezindinganiso).
– Ilebula nokuqinisekiswa: qinisekisa ukuthi isiguli singubani, ukwakheka kwaso, usuku lokuphelelwa yisikhathi, kanye nokuzinza kwesisombululo.
– Ukuhlanzeka kwezandla ngaphambi kokusebenzisa i-catheter noma isethi yokufaka.
– Hlanza imbobo (hlanza ihabhu) njalo uma uyifinyelela.
– Ukusetshenziswa kwamasethi akhethekile okufaka kanye nezihlungi njengoba kunconywa yisikhungo (isb., izihlungi zokunciphisa izinhlayiya kwezinye izindlela zokwelapha).
Amaphutha amancane ku-asepsis angaholela ekuthelelekeni kwegazi okuhlobene ne-catheter (CRBSIs) okwandisa ukufa, ubude bokuhlala, kanye nezindleko.
5. Ukukhethwa Kobuchwepheshe Bokufinyelela Nokufaka Imithambo Yemithambo
A. Ukufinyelela Okungaphandle
Ukufinyelela okungaphandle kwemithambo kusebenzisa i-peripheral venous cannula eqashwe ngokucophelela ukuze kutholakale izimpawu ze-phlebitis: ubuhlungu, ukubomvu, ukuvuvukala, noma umugqa obomvu emthanjeni. Indawo yokufaka kufanele ibe semthanjeni ozinzile, kugwenywe ukugoba kwamalunga noma nini lapho kungenzeka khona ukuze kuncishiswe ingozi yokungena.
B. Ukufinyelela Okuphakathi
Ku-TPN, ukufinyelela okuphakathi kungaba:
– I-CVC Engenamhubhe (i-Central Venous Catheter) (evame kakhulu e-ICU),
– I-PICC (i-Peripherally Inserted Central Catheter) yokwelashwa isikhathi eside,
– Ama-catheter noma ama-port afakwe emhubheni ukuze asetshenziswe isikhathi eside.
Ukubekwa kwe-CVC kwenziwa kahle ngaphansi kwesiqondiso se-ultrasound ukuze kwandiswe impumelelo futhi kuncishiswe izinkinga zemishini ezifana ne-pneumothorax noma i-hematoma. Ngemva kokubekwa, indawo ye-catheter tip kumele iqinisekiswe (isb., nge-radiology, ngokwenqubo) ngaphambi kokusetshenziswa, ikakhulukazi ukuze kufinyelelwe phakathi nendawo.
6. Indlela Yokupha: Izinyathelo Eziyinhloko
Amasu okuphatha i-NP ahlanganisa:
1. Qinisekisa i-oda: ukwakheka, izinga lokufakwa, indlela, kanye nobude besikhathi.
2. Hlola ikhambi: ukucaca, i-lipid emulsion “ayiphuki” (akukho ukuhlukaniswa), ukupakishwa kuphelele, futhi akudluli usuku lokuzinza.
3. Ukulungiswa kwesethi yokufutha: sebenzisa iphampu yokufutha ukuze uthole ukunemba kwesilinganiso.
4. Ukuthosa: gcwalisa ithubhu lokufaka ngesisombululo ukuze kungabikho moya.
5. Hlanza indawo yokungena: Hlanza imbobo ye-catheter ngokwezindinganiso (isib. utshwala/i-chlorhexidine ngokwenqubomgomo yesibhedlela).
6. Qala ukumnika kancane kancane: ezigulini ezisengozini enkulu, izinga lokuqala livame ukuba phansi bese likhuphuka njengoba kuvunyelwe.
7. Uhlelo lokuphathwa: I-NP inganikezwa njalo amahora angama-24 noma ngokujikeleza (isib. amahora ayi-12-18), ikakhulukazi ekwelashweni kwesikhathi eside ukuze kwandiswe induduzo futhi kuncishiswe ukungasebenzi kahle kwesibindi kwezinye iziguli.
8. Ukufakwa esikhundleni kwamasethi nama-dressing: amasethi okufuthwa, izixhumi, kanye nama-dressing e-catheter kuyashintshwa ngokweziqondiso zokunciphisa ingozi yokutheleleka.
Ukuphathwa kwe-NP akufanele kuxutshwe ngokungakhethi nemithi ngendlela efanayo ngaphandle kokuhambisana okucacile. Imithi eminingi ayihambisani ne-lipid emulsions noma izixazululo ze-dextrose ezigxilile futhi ingabangela imvula eyingozi.
7. Ukuqapha Kwezokwelapha Nelebhu
Ukuqapha kuyingxenye ebalulekile "yendlela" ye-NP:
– Izimpawu ezibalulekile kanye nesimo soketshezi: ukuphuma koketshezi, ukuvuvukala, izimpawu zokuphelelwa amanzi emzimbeni.
– Ushukela egazini: i-hyperglycemia ivamile; i-insulin ingadingeka.
– Ama-electrolyte: i-potassium, i-magnesium, i-phosphate zibaluleke kakhulu ikakhulukazi ezisengozini yokuphinda zidle.
– Umsebenzi wezinso nesibindi: i-urea/creatinine, ama-enzyme esibindi, i-bilirubin.
– Ama-Triglycerides: ikakhulukazi uma usebenzisa ama-lipid emulsions, ikakhulukazi ezigulini ezine-sepsis noma izinkinga ze-fat metabolism.
– Izimpawu zokutheleleka: umkhuhlane, ukubanda, ukubomvu endaweni ye-catheter, noma ukwakheka okuhle kwe-culture.
Ukuhlolwa okuvama kulungiswa ngokwesimo sesiguli: nsuku zonke esigabeni sokuqala noma ezigulini ezibucayi, bese kunwetshwa uma kuzinzile.
8. Izinkinga Nokuvimbela
Izinkinga zokudla okunempilo kwe-parenteral zingahlukaniswa zibe:
A. Izinkinga Zemishini
– I-Pneumothorax, ukungabekwa kahle kwe-catheter, ukopha ngesikhathi sokufakwa (okuhlobene kakhulu nokufinyelela okuphakathi).
Ukuvimbela: ukufakwa ngabasebenzi abaqeqeshiwe, isiqondiso se-ultrasound, ukuqinisekiswa kwesikhundla.
B. Izinkinga Zokutheleleka
– I-CRBSI iyinkinga enkulu.
Ukuvimbela: iphakheji yokuvimbela ukutheleleka (ukuhlanzeka kwezandla, ukuvimbela ukutheleleka kwesikhumba, ukunakekelwa kokugqoka, ukuphathwa okuncane kwe-port, imfundo yabasebenzi).
C. Izinkinga Zokushintshwa Kwemizimba
– I-Hyperglycemia, i-hypoglycemia (ikakhulukazi uma imiswe ngokuzumayo), ukuphazamiseka kwe-electrolyte, i-refeeding syndrome, i-hypertriglyceridemia.
Ukuvimbela: ukuthambekela kancane kancane, ukuqapha ngokucophelela, ukulungiswa kwama-electrolyte, kanye nenqubo ye-insulin uma kudingeka.
D. Izinkinga Zesibindi
– I-Cholestasis, i-steatosis, noma ukungasebenzi kahle kwesibindi ngokusetshenziswa isikhathi eside.
Ukuvimbela: gwema ukuncelisa ngokweqile, cabanga ngokudla okujikelezayo, thuthukisa i-enteral uma kungenzeka, hlola ukwakheka kwamafutha.
9. Izimiso Zokuyeka Nokushintshela Ekudleni Kwangaphakathi/Ngomlomo
Kungcono kakhulu, i-NP kufanele iyekwe uma isiguli sesikwazi ukuhlangabezana nezidingo zokudla okunempilo ngokudla noma ngomlomo. Ukuyekiswa kuvame ukwenzeka kancane kancane, ikakhulukazi ngemithi ene-dextrose ephezulu, ukuze kugwenywe i-hypoglycemia esabelayo. Ushintsho oluphumelelayo luhilela ukwandisa ukudla okudliwayo/ngomlomo ngenkathi kunciphisa i-NP, ngokuqapha ngokucophelela ushukela kanye nesimo somtholampilo.
Isiphetho
Amasu okudla okunomsoco we-parenteral ahilela okungaphezu nje kokufaka umugqa we-IV oqukethe amakhalori. Ahilela uchungechunge lwezinqubo ezijwayelekile ezifaka ukukhethwa kwesiguli, ukunqunywa kokufinyelela, ukuhlanganiswa okuhlanzekile, ukuphathwa ngepompo yokufaka, ukuqapha okuseduze kwelabhorethri, kanye nokuvimbela izinkinga zemishini, ezithathelwanayo, kanye ne-metabolic. Ngendlela efanele kanye nokubambisana okuhlukahlukene phakathi kodokotela, abahlengikazi, ochwepheshe bezokudla, kanye nosokhemisi, ukudla okunomsoco we-parenteral kungaba yindlela yokungenelela ephephile nephumelelayo yokusekela ukululama kwesiguli lapho indlela yokugaya ukudla ingakwazi ukusebenza kahle.
