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題名：早產兒氣管內管抽吸實證照護指引發展
書刊名：護理雜誌
作者：凃靜芬／高惠美／張瑩如
作者(外文)：Tu, Ching-fen／Kao, Hui-mei／Chang, Ying-ju
出版日期：2014
卷期：61:1
頁次：頁42-53
主題關鍵詞：早產兒；氣管內管抽吸；實證照護指引；Premature infants；Endotracheal tube suctioning；Evidence-based practice guidelines
原始連結：連回原系統網址new window
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  • 共同引用共同引用:4
  • 點閱點閱:17
背景:氣管內管分泌物抽吸為插管之早產兒常見的處置，抽吸中易引起低血氧與心跳過慢等症狀可能造成腦部受損，而導致神經發展障礙的不良結果，影響早產兒未來的生活品質。目的:本文之目的乃是以實證基礎方式發展早產兒氣管內管抽吸照護指引，以提供安全且適切的早產兒氣管內管抽吸照護。方法:於南部某醫學中心新生兒加護病房成立指引發展小組、分析現有的氣管抽吸指引及建構臨床問題、依臨床問題進行系統性文獻回顧與文獻評讀、撰擬臨床建議、進行共識決策程序、外部專家審核與成效評值等七大步驟完成照護指引發展。結果:早產兒氣管內管抽吸照護指引，經17位早產兒專家進行兩回合德菲法共識問卷調查達75%以上同意共識者，共13個議題，39項建議，內容包含抽吸前評估與抽吸頻率、氧氣提供、抽吸導管選擇、感染控制、抽吸壓力設定、食鹽水管路溼潤、抽吸深度、抽吸期間與抽吸次數、寧握安撫、評估與生命徵象監測、氧氣調整、恢復時間及評估與記錄等，三位方法學專家對於指引品質，綜合評價為建議使用；四位外部專家整體評估均推薦於臨床使用；新生兒加護病房29位護理人員大部分認為指引建議內容可行且容易做到，測試指引安全性方面，五位早產兒依此指引進行氣管內管抽吸時血氧飽和濃度維持在正常範圍，未發生低血氧（血氧飽和濃度<85%）及心跳遲緩現象（心跳<100次／分鐘）。結論:本研究發展之早產兒氣管內管抽吸照護指引整合文獻證據，具臨床專家共識與嚴謹度，推薦於臨床使用。
Background: Endotracheal suctioning (ETS) for mechanically ventilated premature infants is a routine practice in neonatal intensive care. However, ETS is associated with hypoxemia and bradycardia, which may cause brain damage and negatively affect neurodevelopmental outcomes.Purpose: This study develops a set of evidence-based clinical-practice ETS guidelines for premature infants.Methods: A multidisciplinary task group at a medical center in southern Taiwan was established. Team members analyzed current ETS practice guidelines, constructed foreground questions, reviewed each question systemically, drafted a new set of guidelines, established expert consensus, disseminated the developed guidelines within a hospital setting, and evaluated their efficacy in practice.Results: The developed ETS guidelines address 13 issues with 39 recommendations. The Delphi method found that 75% of experts agreed with all of the recommendations. Issues addressed in the ETS included pre-assessment, frequency of suctioning, pre-oxygenation, suction-tube selection, infection control, suction pressure and depth decision making, humidity with normal saline, suction duration and number, containment and comforting, assessment during and after suctioning, recovery time, and documentation. The panel of clinical and methodological experts recommended that ETS be used in practice and nurses in the neonatal intensive care unit evaluated the ETS as applicable and accessible. The cardiorespiratory responses to ETS of 5 premature infants were within normal ranges without episodes of hypoxemia (oxygen saturation < 85%) or bradycardia (heart rate < 100 beat/min).Conclusions: This set of evidence-based ETS guidelines for premature infants integrated recommendations from the best available literature and obtained a high consensus among clinical experts. Thus, these guidelines are recommended for clinical application.
期刊論文
1.Schiffer, C. A.、Anderson, K. C.、Bennett, C. L.、Bernstein, S.、Elting, L. S.、Goldsmith, M.、American Society of Clinical Oncology(2001)。Platelet Transfusion for Patients With Cancer: Clinical Practice Guidelines of the American Society of Clinical Oncology。J Clin Oncol，19(5)，1519-1538。  new window
2.王銘賢、顧小明(19971200)。寧握護理對早產兒抽痰的效益評估。榮總護理，14(4)，405-414。new window  延伸查詢new window
3.袁朝蓉、華一鳴、李慈音(2010)。從氧化壓力重新思考早產兒氧氣的使用。護理雜誌，56(4)，77-82。new window  延伸查詢new window
4.Ahn, Y.、Hwang, T.(2003)。The effect of shallow versus deep endotracheal suctioning on the cytological components of respiratory aspirates in high-risk infants。Respiration，70(2)，172-178。  new window
5.楊中美(19990900)。早產兒視網膜病變。臺灣醫學，3(5)，551-554。  延伸查詢new window
6.Ahn, Y.、Jun, Y.(2003)。The effects of the shallow and the deep endotracheal suctioning on oxygen saturation and heart rate in high-risk infants。International Journal of Nursing Studies，40(2)，97-104。  new window
7.American Association for Respiratory Care(2010)。AARC Clinical practice guidelines. Endotracheal suctioning of mechanically ventilated patients with artificial airways 2010。Respiratory Care，55(6)，758-764。  new window
8.Cordero, L.、Sananes, M.、Ayers, L. W.(2001)。A comparison of two airway suctioning frequencies in mechanically ventilated, very-low-birth weight infants。Respiratory Care，46(8)，783-788。  new window
9.Argent, A. C.(2009)。Endotracheal suctioning is basic intensive care or is it?: Commentary on article by Copnell et al. on page 405。Pediatric Research，66(4)，364-367。  new window
10.Gunderson, L. P.、Stone, K. S.、Hamlin, R. L.(1991)。Endotracheal suctioning-induced heart rate alterations。Nursing Research，40(3)，139-143。  new window
11.Gonzalez-Cabello, H.、Furuya, M. E.、Vargas, M. H.、Tudon, H.、Garduno, J.、Gonzalez-Ayala, J.(2005)。Evaluation of antihypoxemic maneuvers before tracheal aspiration in mechanically ventilated newborns。Pediatric Pulmonology，39(1)，46-50。  new window
12.Flynn, A. V.、Sinclair, M.(2005)。Exploring the relationship between nursing protocols and nursing practice in an Irish intensive care unit。International Journal of Nursing Practice，11(4)，142-149。  new window
13.Gardner, D. L.、Shirland, L.(2009)。Evidence-based guideline for suctioning the intubated neonate and infant。Neonatal Network: The Journal of Neonatal Nursing，28(5)，281-302。  new window
14.Gillies, D.、Spence, K.(2011)。Deep versus shallow suction of endotracheal tubes in ventilated neonates and young infants。The Cochrane Database of Systematic Reviews，7。  new window
15.Hay, W. W., Jr.、Bell, E. F.(2000)。Oxygen therapy, oxygen toxicity, and the stop-roptrial。Pediatrics，105(2)，424-425。  new window
16.Kiraly, N. J.、Tingay, D. G.、Mills, J. F.、Morley, C. J.、Copnell, B.(2008)。Negative tracheal pressure during neonatal endotracheal suction。Pediatric Research，64(1)，2933。  new window
17.Hodge, D.(1991)。Endotracheal suctioning and the infant: A nursing care protocol to decrease complications。Neonatal Network，9(5)，7-15。  new window
18.Jelic, S.、Cunningham, J. A.、Factor, P.(2008)。Clinical review: Airway hygiene in the intensive care unit。Critical Care，12(2)，209。  new window
19.Hoellering, A. B.、Copnell, B.、Dargaville, P. A.、Mills, J. F.、Morley, C. J.、Tingay, D. G.(2008)。Lung volume and cardiorespiratory changes during open and closed endotracheal suction in ventilated newborn infants。Archives of Disease in Childhood. Fetal and Neonatal Edition，93(6)，F436-F441。  new window
20.Morrow, B. M.、Argent, A. C.(2008)。A comprehensive review of pediatric endotracheal suctioning: Effects, indications, and clinical practice。Pediatric Critical Care Medicine，9(5)，465-477。  new window
21.Limperopoulos, C.、Gauvreau, K. K.、O’Leary, H.、Moore, M.、Bassan, H.、Eichenwald, E. C.、du Plessis, A. J.(2008)。Cerebral hemodynamic changes during intensive care of preterm infants。Pediatrics，122(5)，e1006-e1013。  new window
22.Linder, N.、Haskin, O.、Levit, O.、Klinger, G.、Prince, T.、Naor, N.、Sirota, L.(2003)。Risk factors for intraventricular hemorrhage in very low birth weight premature infants: A retrospective case-control study。Pediatrics，111(5)，e590-e595。  new window
23.Long, L. E.、Burkett, K.、McGee, S.(2009)。Promotion of safe outcomes: Incorporating evidence into policies and procedures。The Nursing Clinics of North America，44(1)，57-70。  new window
24.Taylor, J. E.、Hawley, G.、Flenady, V.、Woodgate, P. G.(2011)。Tracheal suctioning without disconnection in intubated ventilated neonates。Cochrane Database of Systematic Reviews，12。  new window
25.Morrow, B. M.、Futter, M. J.、Argent, A. C.(2004)。Endotracheal suctioning: From principles to practice。Intensive Care Medicine，30(6)，1167-1174。  new window
26.Ridling, D. A.、Martin, L. D.、Bratton, S. L.(2003)。Endotracheal suctioning with or without instillation of isotonic sodium chloride solution in critically ill children。American Journal of Critical Care，12(3)，212-219。  new window
27.Taheri, P.、Asgari, N.、Mohammadizadeh, M.、Golchin, M.(2012)。The effect of open and closed endotracheal tube suctioning system on respiratory parameters of infants undergoing mechanical ventilation。Iranian Journal of Nursing and Midwifery Research，17(1)，26-29。  new window
28.Ward-Larson, C.、Horn, R. A.、Gosnell, F.(2004)。The efficacy of facilitated tucking for relieving procedural pain of endotracheal suctioning in very low birth weight infants。The American Journal of Maternal/Child Nursing，29(3)，151-156。  new window
29.宋惠娟、張淑敏(2006)。臨床決策：實證實務的步驟。志為護理--慈濟護理雜誌，5(3)，73-80。  延伸查詢new window
學位論文
1.張和美(2006)。評價早產兒抽痰時包裹四肢對穩定生理指標的效果--李文能量保存護理模式之應用(碩士論文)。中國醫藥大學。  延伸查詢new window
2.黃惠滿(2001)。觸摸對早產兒抽痰後生理指標影響之探討(碩士論文)。國防醫學院。  延伸查詢new window
圖書
1.The AGREE Collaboration、臺北醫學大學、萬芳醫院實證醫學中心、陳杰峰(2006)。AGREE臨床指引評估工具。台北市：台北醫學大學萬芳醫院實證醫學中心。  延伸查詢new window
2.Bowker, R.、Lakhanpaul, M.、Atkinson, M.、Armon, K.、Macfaul,R.、Stephenson, T.、郭耿南(2009)。如何撰寫臨床指引: 從開開始到完成。台北市：台灣愛思唯爾。  延伸查詢new window
3.Melnyk, B. M.、Fineout-Overholt, E.(2010)。Evidence-based practice in nursing and healthcare。Philadelphia, PA：Lippincott Williams & Wilkins。  new window
其他
1.中央健康保險局，財團法人國家衛生研究院，財團法人醫院評鑑暨醫療品質策進會(2004)。臨床診療指引發展手冊，台北市：中央健康保險局。  延伸查詢new window
2.Eastern Regional Neonatal Benchmarking Group(2006)。ERNBG suctioning guideline，http://www. neonatal.org.uk/documents/1625.pdf。  new window
 
 
 
 
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