Home care -tracheotomy stoma care

英-氣切造口的居家照護-氣切護理


  目的 Purpose

清潔、消毒氣切口,減少浸潤造成之皮膚損傷及感染。
Cleanness and sterilization of the tracheostomy to reduce skin damage and infections caused by infiltration.

  原則及注意事項 Principles and Attention

  1. 氣管內管每日清潔1-2 次,如果痰量多,則增加清潔次數。
    Clean Endotracheal tube 1-2 times daily, increase frequency of cleaning if phlegm(sputum) increase.
  2. Y 型紗布及氣切套管固定帶濕了或髒了,需馬上更換。
    Replace Y gauze and fixing band (belt) of tracheotomy stoma casing if it becomes wet or dirty.
  3. 膠布浮貼於紗布上,避免直接貼於個案皮膚。
    Avoid place elastic tape on to skin directly and place lastictape fixed to Gauze in stead.
  4. 氣切固定帶之鬆緊約以二手指能插入為準。
    Keep two fingers margin in term of tightness for fixing band (belt)fixed for tracheotomy.
  5. 取下氣管內管清潔時,不要超過30 分鐘以上,以避免痰液形成結痂物堵住氣管徑。
    Not to take more than 30min. to perform endotracheal tube (inner tube) cleaning to avoid the formation of sputum scab to block gas tube.

    準備用物 To use of : 

清洗用的小刷子、無菌的Y型紗布、兩個杯子(分盛生理食鹽水及雙氧水)、優碘藥水、普通棉枝、氣切固定帶一條、4×4紗布一塊
Small cleaning brush, the Y-sterile gauze, two cups (for saline water and hydrogen peroxide, respectively), the gifted iodine syrup, ordinary cotton sticks, with a belt for fixed gas cut, a piece of 4 ×4 gauze.

   方法 Method:

  1. 洗手。
    Wash your hands.
  2. 固定外管後,將卡鈕上轉;輕拉出內管。
    Fix outer tube, and twist knob-button upward; lightly pulled out the inner tube.
  3. 注意有無感染:更換Y 型紗布時,請觀察造口周圍有無分泌物及發紅現象。
    Watch for infection: When replacing the Y-type gauze, please observe whether there is any exudation or redness surrounding the tracheostomy.
  4. 將內管置於雙氧水內浸泡數分鐘至痰液脫除,再用刷子清洗淨,放入生理食鹽水內。
    Place inner tube in hydrogen peroxide soaked for a few minutes to remove sputum, and then use brush to clean it, and put it to the saline solution.
  5. 拉出氣切口原有之Y 型紗布。
    Pull out of the original Y-gauze from stoma connector.
  6. 棉花棒沾優碘環狀擦拭氣切口周圍後,再以生理食鹽水環狀擦拭。
    Use cotton swab with iodine to wipe around the stoma, and then use cotton swab with saline water to wipe around the incision.
  7. 置放新的無菌Y 型紗布。
    Replace Y-sterile gauze.
  8. 氣切繫帶若鬆了、髒了應重新綁好或更換新的帶子。
    Place elastic belt(band) for stoma connector firmly without looseness and replace a new belt if it becomes dirty.
  9. 綁氣切固定帶時勿太緊或太鬆,寬度約1-2 指即可;更換固定帶時,請一手固定於氣切造口蝶翼處,並注意勿拉扯到人工氣道。
    Do not tie the tracheostomy tube holder too tight or too loose. Width of 1 to 2 fingers should be fine. When changing the tracheostomy tube holder, the caregiver should fix one hand on the wings of the tracheostomy and pay attention not to pull the artificial airway.
  10. 若無水份限制,每日應給予2000-2500 cc 的水份。
    If there is no restriction on water intake, the patient/ward should take 2000-2500 cc water every day.
  11. 鼓勵多下床活動或坐起,每日至少執行三次背部扣擊。
    The patient should be encouraged to get out of bed for an exercise or sit ups. The caregiver should tap the back of the patient/ward at least 3 times a day.

  消毒內管的方法 Disinfection of endotracheal tube (inner tube):

  1. 用小刷子將氣管內管清洗乾淨。
    Use small brushes to clean endotracheal tube.
  2. 將氣管內管浸泡於雙氧水10-15 分鐘。
    Soak endotracheal tube in hydrogen peroxide 10-15 minutes.
  3. 用生理食鹽水將氣管內管痰液沖洗乾淨。
    Use saline water to clean sputum in endotracheal tube.
  4. 將消毒好的氣切內管放回氣切管並扣緊。
    Put disinfected endotracheal tube back into the tracheotomy tube and clasped.

    Q & A 

  1. 執行氣切造口護理前需洗手?
    Should you wash your hands before performing tracheostomy care?
  2. 紗布或固定帶濕了或髒了應立即更換?
    Should gauzes and fixing bands (belts) be replaced immediately when they are wet or dirty?
  3. 氣切造口能清潔一次?
    Endotracheal tube should clean 1 times daily?

 
  1. Medical service consultation hotline : (Daytime) 04-23388766 EXT. 6367 (Night) 04-23389078

  2. References : 

    •居家外勞照顧技巧指導手冊,台灣長期照護專業協會95 年11 月出版
    •臺北市外籍看護照顧手冊,臺北市勞動力重建運用處106年4月二版