Kugurisha Ibicuruzwa Ubushinwa Bwinshi Bwuzuye Imirire Yigaburira Umufuka

Mu byukuri ni inshingano zacu guhaza ibyo usabwa no kugukorera neza. Isohozwa ryawe nigihembo cyacu gikomeye. Turimo guhiga kugirango ugenzure kugirango uteze imbere iterambere ryibicuruzwa Ubushinwa Bwinshi Bwuzuye Imirire Yigaburira Imifuka, Twakiriye abaguzi ahantu hose mwijambo ryo kuduhamagarira amashyirahamwe mato mato mato. Ibisubizo byacu nibyo hejuru. Bimaze gutorwa, bihebuje ibihe byose!
Mu byukuri ni inshingano zacu guhaza ibyo usabwa no kugukorera neza. Isohozwa ryawe nigihembo cyacu gikomeye. Turimo guhiga imbere kugirango ugenzure iterambere ryihuseUbushinwa Kugaburira Umufuka, Isakoshi yo Kugaburira ImbereIshirahamwe ryacu. Abashyitsi bari imbere mumijyi yubusabane bwigihugu, abashyitsi biroroshye cyane, imiterere yihariye yubukungu nubukungu. Dukurikirana umuryango "ugamije abantu, gukora neza, kungurana ibitekerezo, kubaka ubwiza". Hilosophy. Gucunga neza ubuziranenge bwo hejuru, serivisi nziza, igiciro cyiza muri Miyanimari nicyo gihagararo cyacu cyo guhatanira amarushanwa. Niba ari ngombwa, urakaza neza kugirango utumenyeshe kurubuga rwacu cyangwa kugisha inama kuri terefone, turateganya kwishimira kugukorera.

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Ibicuruzwa birambuye

Set Ibikoresho byacu byo kugaburira byinjira bifite ubwoko bune bwo gutegura imirire itandukanye: gushiraho pompe yimifuka, imishwarara yimifuka, pompe ya spike na spike gravit set.
√ Niba imyiteguro yintungamubiri yapakiwe cyangwa ifu yabitswe, hazatoranywa imifuka. Niba icupa / imifuka isanzwe yamazi yintungamubiri, amahitamo ya spike azatorwa.
Set Amapompe arashobora gukoreshwa mubirango byinshi bitandukanye bya pompe yo kugaburira.

Gutera isesengura no kuvura inzitizi yo kugaburira munda
Imirire yo munda ni bumwe mu buryo bwo guha umubiri w'umuntu intungamubiri zikenewe binyuze mu nzira ya gastrointestinal. Uburyo nyamukuru burimo kugaburira imiyoboro no kuyobora umunwa. Kugaburira igituba mubisanzwe birimo nasogastric / intestinal tube, percutaneous endoscopic gastrostomy, umuyoboro wa jejunostomy na Percutaneous endoscopic jejunostomy, nibindi. Ubu buryo bwo gukora buroroshye gukurikirana, umutekano nubukungu, kandi buboneka mubikorwa byubuvuzi. Byakoreshejwe cyane, ariko mugihe cyo kugaburira imiyoboro, byatewe nimpamvu zitandukanye, ikunze guhura nibibazo byo guhagarika imiyoboro, hanyuma hakavuka ibintu bitateganijwe.
Nk’uko inzobere ibivuga, impamvu zifunga umuyoboro w’imirire mu mara rusange ni izi zikurikira:

1. Ibintu bifitanye isano na Tube

Kunanirwa gukosora neza catheter nyuma yo guhindukira, bigatuma igice cyerekanwe kugoreka no kugunduka; gukorora kenshi, isesemi no kuruka bitera umuyoboro ugaburira mu kanwa, mu muhogo, cyangwa mu mara, ibyo bikaba ari ibintu bisanzwe bikoreshwa mu kugaburira imiyoboro. Mu bushakashatsi bwakozwe, byagaragaye ko igipimo cyo guhagarika umuyoboro wa naso-amara cyari hejuru ugereranije n’umuyoboro wa nasogastricique, wafatwaga nkuwifitanye isano na diameter ngufi ya naso-amara nuburebure burebure mu mubiri. Nyuma yo kugaburira umuyoboro usigaye igihe kirekire, urukuta rwimbere rwigituba ruba rukaze kubera isuri yimiti nigisubizo cyintungamubiri hamwe no kwangirika kw umutobe wigifu, bigatuma igisubizo cyintungamubiri cyoroshye kumanikwa kurukuta. Byongeye kandi, kwinjiza bihagarikwa igihe kirekire, umuvuduko wo kwinjiza uratinda cyane, kandi inzira yigifu isohora amaraso nyuma yo kubagwa, bigatuma amaraso atembera umuyoboro.

2. Ikintu gikemura intungamubiri

Ubwinshi bwumuti wintungamubiri ni mwinshi cyane, umuvuduko wo kuvoma uratinda cyane, igisubizo cyintungamubiri kirimo selile nibindi bintu bituma igisubizo cyintungamubiri cyoroha kwizirika kurukuta rwimbere rwa lumen, rugabanya lumen kandi bikongerera amahirwe yo kuziba. Ubushakashatsi bwerekanye ko umuvuduko wintungamubiri zintungamubiri zidafite ingaruka nke mubibazo byo gufunga imiyoboro, ariko byagaragaye mubuvuzi ko iyo umushyushya ukoreshwa mugushyushya igisubizo cyintungamubiri, niba umuvuduko utinda cyane, igisubizo cyintungamubiri kizashyuha cyane kandi gihindurwe kugirango kibe umwambaro. Hagarika umuyoboro. Byongeye kandi, mugihe cyigihe gito cyimirire yimbere, igisubizo cyintungamubiri mumitsi yigifu gishobora guhagarika umuyoboro wimirire kubera guhinduka bitewe no gukorora cyane, kuniha, kuruka nizindi mpamvu.

3. Umuforomo

Impamvu nyamukuru yo gufunga umuyoboro wimirire ni uko umuforomo adakora neza cyane akurikije ibisobanuro, cyangwa uburyo bwo koza nabi. Muri icyo gikorwa, abakozi b'abaforomo ntibari bafite ubumenyi bwihariye ku mirire yo mu nda. Mugihe cyo gutembera, ntibashoboraga gukora ibikorwa bitandukanye bakurikije amabwiriza, kandi igihe cyo gutemba ntigishobora kugenzurwa neza. Acide na alkalinity yo gutera inshinge byari bitandukanye. Iyo ibiyobyabwenge bidafashwe ukundi, umuyoboro uzahagarikwa. Niba abakozi b’ubuforomo badashobora gukora neza ibikorwa bitandukanye bakurikije amabwiriza ya muganga, kongeramo imiti itemewe yo kugaburira imiyoboro cyangwa kutita ku mirire yimbere yo kugaburira imiyoboro, guhagarara ku buryo butunguranye mugihe cyo gutera igisubizo cyintungamubiri nabyo bishobora kongera amahirwe yo guhagarika imiyoboro. .

4. Impamvu z'abarwayi

Umurwayi adafite ubumenyi bwabaforomo bujyanye, kandi ntashobora gukora kwiyobora no gufata neza umuyoboro ugaburira mugihe kandi neza. Kurugero, abarwayi bahagarika kuvoma intungamubiri bonyine kubwimpamvu zitandukanye.
Mu gusubiza impamvu zavuzwe haruguru zifunga umuyoboro wimirire, dushobora gufata ingamba zikurikira zo gukumira:

Hitamo igisubizo cyintungamubiri gikwiye ukurikije uko umurwayi ameze

Muburyo bwo gutera intungamubiri zintungamubiri, gerageza guhitamo ibicuruzwa bifite intumbero yo hasi. Niba ushaka gutera igisubizo cyintungamubiri hamwe nubunini bwinshi, ugomba kubishiramo mbere yo gutera inshinge. Mbere yuko imiti ikoreshwa, imiti igomba guhungabana. Mugihe cyo gukoresha, niba intungamubiri ziguye, zigomba no kunyeganyezwa. Mu gihe cyo gutera inshinge, ntishobora kuvangwa n’ibindi biyobyabwenge kugirango birinde imiti y’imiti itabaho, bigatuma igabanuka ry’imiterere y’ibintu ndetse n’imvura igwa ku ntungamubiri [4].

Guhitamo gushyira mu gaciro imirire yo kugaburira ibiryo

Niba umurwayi adashoboye gufata ibiryo kumunwa, hagomba gusesengurwa uko umurwayi ameze, imiterere ya gastrointestinal yumurwayi igomba gusesengurwa, kandi hagomba gutoranywa ubunini bukwiye bwumuyoboro kugirango hirindwe ko imiyoboro ihagarara. Izina, uburebure, nibindi byigitereko cyo kugaburira umurwayi bigomba kwandikwa, kandi umuyoboro ugomba gusimburwa mugihe kugirango wirinde ko umuyoboro udakoreshwa nyuma yo kunama no guhindura ibintu [4].

Gerageza gukoresha enteralkugaburirapompe hamwe na pompe ihuyegushirahos

Gerageza gukoresha pompe yimirire yimbere, kugenzura umuvuduko nukuri, gutabaza byikora mugihe imiyoboro ihagaritswe, byoroshye, byihuse, mugihe kandi neza. Gukoresha igihagararo cyimukanwa bizagabanya neza akazi kabaforomo kandi birinde ingaruka ziterwa no guhagarika imiyoboro nko gutinda gutinda no kugoreka umuyoboro uterwa no guhagarika imirire yimbere bitewe numurwayi ava muburiri. Uburyo nuburyo bukurikira: shyira pompe yimirire kuri stand yimukanwa yimuka, koresha ingufu za AC mugihe umurwayi aryamye muburiri, kandi urebe ko ingufu za bateri zikora bisanzwe mugihe uvuye muburiri [1].

Shimangira uburezi bwubuzima bwabakozi b’ubuforomo

Shimangira kumva inshingano z'abakozi b'abaforomo, witondere amahugurwa y'umwuga w'abaforomo bakiri bato, kandi ukomeze kunoza ireme ry'umwuga n'ubuhanga bwo gukora bw'umwuga. Reka abakozi b'abaforomo bamenye imiyoboro irwanya gukumira kandi bafate ingamba zo gukora igenzura buri gihe kugirango birinde umutwaro w'ubukungu n'ingaruka mbi z'abarwayi batewe no gutinda kwivuza [1]. Mu rwego rwo gukumira neza gufunga umuyoboro ugaburira, mbere yo guterwa intungamubiri zintungamubiri, hagomba gusesengurwa ibisubizo bitandukanye byintungamubiri, kandi hagomba gukoreshwa uburyo bunoze bwo gufata neza imiyoboro kugira ngo umuyoboro ukoreshwe mu buryo bworoshye. Gutera impiswi birashobora kandi gukoreshwa kugirango habeho akayaga gato mugihe cyo koza muri lumen, gishobora gusohora ibintu bifatanye nurukuta rwumuyoboro mugihe.

Shimangira uburezi bwubuzima bwabarwayi

Abakozi b'abaforomo bagomba gushimangira inyigisho z’ubuzima ku mirire y’imbere, bagashyiraho imiti yihariye y’ubuzima, kandi bakareka abarwayi n’imiryango yabo bakumva ubumenyi bujyanye kandi bakabigiramo uruhare rugaragara. Ku barwayi bafite ubumenyi buke mu buzima, hakwiye kwitabwaho bihagije ku bitekerezo byabo no mu mutwe. Mbere yo gushyira mubikorwa imirire yimbere, akamaro, akamaro nuburyo bwo gushyira mubikorwa imirire yimbere bigomba gusobanurwa muburyo burambuye. Mugihe cyo kubishyira mubikorwa, dukunze kuvugana nabarwayi kugirango twumve imyitwarire yabo mumitekerereze no mumubiri no gutanga ubufasha bwimitekerereze. Ukurikije urwego rwumuco nubushobozi bwo kwiga bwabarwayi nimiryango yabo, hatoranijwe uburyo bukwiye kugirango hongerwe byimazeyo ishyaka ryabarwayi nimiryango yabo mukwiga, ibyo bikaba bifasha kuzamura ireme ryubuvuzi bwimirire mvaruganda.

Kugaburira Amazuru

Iyo utera imiti, igomba kuba hasi kandi igajanjagurwa kugirango ibe ifu, hanyuma imaze gushonga burundu (kuyungurura na gaze nibiba ngombwa), iraterwa neza. Kwoza lumen n'amazi ashyushye ya 20ml mbere na nyuma yo gutera inshinge kugirango wirinde imiti nintungamubiri zintungamubiri zifata mumyanya kandi bigatera guhagarara. Urutonde rwubuyobozi ni: guhagarika igisubizo cyintungamubiri → flush → dose (form fluide) → flush nanone → ongera utangire intungamubiri zintungamubiri. Ntabwo byemewe gutanga imiti ivuye mu miyoboro ya naso-amara. Ibiyobyabwenge bimwe na bimwe (nka Losec, byagaragaye ko byoroshye guhagarika umuyoboro) birasabwa gutangwa binyuze mu muyoboro wa gastric.

Ibisigisigi byo kugaburira amazuru bisigaye biboneka kumpera igaragara yigitereko cyo kugaburira ni ikimenyetso kibi cyo guhagarika umuyoboro.

Ibipimo byo guca imanza zifunze: Umuyoboro wimirire wa gastrointestinal ntabwo ufunguye, ibiryo ntabwo byoroshye gutera, kandi ntamazi asubira inyuma mugihe cyo kugaburira. Niba ukoresheje syringe kugirango uhindure witonze ikizamini kandi haracyari ukurwanya, cyangwa niba utera 20ml y'amazi ashyushye kandi umuvuduko ukabije ntukigenda neza, umuyoboro urahagarikwa [3].

Kubuza catheter yabayeho, abakozi bacu b'abaforomo bagomba kumenya neza icyabiteye, bagasobanukirwa uburyo bwo guhagarika, bagahitamo ubuvuzi bukwiye. Uburyo bukoreshwa mubuvuzi bwa clinique burashobora kugabanywa muburyo bwumubiri nuburyo bwa chimique ukurikije amahame yabo [4].

Uburyo bwumubiri burimo gukata wongeyeho uburyo bubi bwo gukuramo igitutu no kuyobora uburyo bwo gutobora insinga.

. Bitewe nimbaraga ziva hanze, umwenda wiziritse kumuyoboro wimirire uragwa hanyuma ugakurwa mumiyoboro yimirire bitewe nigitutu kibi. Muri icyo gihe, inshinge zikoreshwa mu gutera amazi ashyushye mu muyoboro w’imirire kugira ngo umuyoboro uhindurwe, usubirwemo inshuro nyinshi kugeza igihe utabujijwe. Ubu buryo bukoreshwa cyane mubuvuzi, kubera ko umuyoboro wa nasogastric ushyizwemo imbaraga kandi igice cyerekanwe ni kirekire, bityo birakwiriye. Nyamara, umuyoboro wa naso-amara winjizwa mu mubiri kandi igice cyerekanwe ni kigufi, bigatuma gukora uburyo bwo guswera bigorana.

. Twabibutsa ko ku barwayi bafite igihe kirekire cya catheterisiyoneri, imbaraga nyinshi zishobora kwinjira mu muyoboro w’imirire, bigatuma intungamubiri ziva mu ntungamubiri ndetse bikangiza no mu gifu.

Uburyo bwa chimique bukoresha ibiyobyabwenge kugirango biveho. Ibiyobyabwenge bikunze gukoreshwa birimo enzymes zifungura nigisubizo cya sodium bicarbonate.

. Enzymes zifungura cyane cyane ibikorwa byigogora byimisemburo kugirango igogore ibiryo byafunzwe mumiyoboro yintungamubiri muri molekile nto kugirango uhagarike intungamubiri. 5% ya sodium bicarbonate ni umuti wa alkaline, kandi ibyingenzi byingenzi byintungamubiri zintungamubiri ni maltodextrin, casein, amavuta yimboga, imyunyu ngugu, lecithine, vitamine nibintu bya trike, byerekana aside irike, 5% sodium bicarbonate Umuti urashobora gutesha agaciro bimwe mubintu bya acide no gushonga ibintu nka lecithine. Hari amakuru mu bitabo avuga ko imvura iterwa n’ibiyobyabwenge ishobora guhindurwa hamwe na antagonistes (sodium bicarbonate, aside hydrochloric aside) kugirango igarure imvura ihagaze. Ubushakashatsi bwerekanye ko intungamubiri zuzuye zafunzwe burundu hamwe na 5% sodium bicarbonate. Iminota 10 irashobora kurekura intungamubiri zintungamubiri mumyanya yintungamubiri zifite uburebure bwa cm 2-3, naho iminota 20 irashobora guhanagura intungamubiri zintungamubiri mumyanya yintungamubiri zifite uburebure bwa cm 4-5. Nyamara, nta ngaruka zo kurekura iyo zihuye namazi ashyushye kuri 50 ° C muminota 20. Intambamyi yubu buryo nuko igice kinini cyugarije umuyoboro wimirire mubikorwa byubuvuzi kibaho kumpera ya kure, kuburyo bigoye kugera kumiti yamazi yatewe.

. Kubice byibiryo byafunzwe igice, umuti wa sodium bicarbonate ukoreshwa muburyo butaziguye kugirango utabangamiwe, kandi imiyoboro yimirire ifunze burundu ikoresha imiyoboro yo kwagura imitsi. Imiyoboro yo kwagura imiyoboro ikoreshwa kenshi mubuvuzi kugirango binjize ibiyobyabwenge mumapompo yimitsi. Ibikoresho biroroshye kandi bifite urwego runaka rwo gukomera. Nibyiza kwinjiza mumiyoboro yimirire nta ngaruka zo kwangiza imirire. Nyuma yo guca akayunguruzo k'imiti, uburebure ni 128cm na diameter yo hanze ni 2,1mm. Irashobora gukoreshwa mubyitegererezo no mubisobanuro bya Baitong imirire ikunze gukoreshwa mubanyeshuri barangije. Nyuma yo kwagura imiyoboro y'amaraso igeze ahantu hafunzwe, shyiramo amazi ashyushye avuye mu muyoboro mugari kugira ngo usukure lumen imbere imbere ujya hanze, ibyo bikaba bishobora kubuza umwenda kugwa ku rukuta iyo usohotse hanze ujya imbere kandi byongera ibyago byo guhagarika intungamubiri. Byongeye kandi, kubera ko ibiyobyabwenge bishobora gukora ku buryo butaziguye ku gice cyahagaritswe, igihe gisabwa cyo guhagarika ibibujijwe ni gito. Gukoresha ivuriro byerekana ko ingaruka zifatika zo kwagura imiyoboro y'amaraso hamwe na sodium bicarbonate yumuti bigabanya cyane igihe gisabwa kugirango isezererwe, kandi ifite umutekano mwinshi ningaruka zigaragara. Mugukoresha amavuriro, hagomba kwitonderwa: kubera ko sodium bicarbonate yumuti ari alkaline, amafaranga yatewe mumyanya yumubiri ntagomba kuba menshi. Umuyoboro wimirire umaze kugarurwa, urashobora kwozwa namazi ashyushye inshuro nyinshi kugirango usukure neza urukuta rusigaye. intego. Mugihe ubwinshi bwo koza ari bwinshi, witondere kuringaniza aside-ishingiro yumurwayi, kandi icyarimwe witondere niba umurwayi afite uburibwe bwinda ninda zo munda.

Imirire yo munda ntishobora gutanga gusa imirire ikenewe kubarwayi n’abarwayi barembye cyane nyuma yo kubagwa inzira yo kubaga gastrointestinal tract, ariko kandi ikora na sisitemu yo mu nda ya end-endocrine sisitemu, igatera imbere mu mara no gukura kwa mucosal, igakomeza sisitemu y’umubiri ndetse n’imikorere ya selile y’urukuta rw'amara, bityo igakomeza imikorere y’umubiri. Imirire yimbere nuburyo bwingenzi bwo kuvura. Kwirinda no gutabara guhagarika umuyoboro wimirire nicyo kintu cyambere mubikorwa byubuforomo. Mubikorwa byubuforomo byubuvuzi, tugomba kwitondera ibitera intungamubiri zintungamubiri, kandi tugakora ibikorwa bigamije, kugirango tugabanye neza ibibazo by’abarwayi, kunoza imirire mibi, no kunoza imikorere y’ubuvuzi.

Kubijyanye nibikoresho - ibikoresho byacu bidafite DEHP

1.Pasitike DEHP ntabwo ihujwe nuburyo bwa molekile ya PVC ihuza imiti, kandi biroroshye kugwa mubintu biva mumazi iyo ihuye namazi cyangwa amavuta ashonga.
2.DEHP ifite ingaruka zishobora kubaho nka kanseri ndetse n'uburozi bw'imyororokere. Ibihugu byinshi kwisi byabujije ikoreshwa rya DEHP mubicuruzwa byubuvuzi.
3.Ibikoresho byo kugaburira byinjira muri enterineti ikoresha plastike nshya, ifite imvura nkeya kandi ntizirundanya mumubiri. Yujuje ubuziranenge bwibicuruzwa byubuvuzi kandi birakwiriye abarwayi bafite imirire.

Ibicuruzwa bitandukanya ibara

Ibara rya disposable Enteral yo kugaburira ni ibara ry'umuyugubwe / ubururu. Umuyoboro w'umuhengeri / ubururu biragaragara ko utandukanye n'umuyoboro winjira mu mitsi kugirango wirinde ububi bwihishe mubuvuzi bwo gukoresha nabi imyiteguro yimbere mu mitsi.

Igishushanyo kirambuye cyindashyikirwa

Witondere ibintu byose bikoreshwa mubuvuzi
Imiyoboro y'urushinge rwo mu kirere, ihuza cyane, ihuza byihuse n’imyiteguro isanzwe y’amazi, nta mpamvu yo gukoresha urushinge ruyobora ikirere, umwobo uyobora ikirere uhujwe n’iyungurura ikirere kugirango wirinde kwanduza ikirere 3-2. Uburebure bwumuyoboro wo hejuru bugabanijemo ubwoko bubiri: cm 95 na 75cm, bikwiranye nubwoko bwa gari ya moshi yo mu kirere hamwe nubwoko bwa infusion ihagaze 3-3. Umuyoboro wo hasi ufite ibikoresho mpuzamahanga bihuza inzira-eshatu (Y-ubwoko), bifasha kunywa cyangwa gusohora umuyoboro 3-4. Ingano isanzwe ya trapezoidal yo kugaburira imiyoboro ihuza irashobora gutandukana, ibereye guhuza imiyoboro itandukanye yo kugaburira ya diameter zitandukanye.

Mu byukuri ni inshingano zacu guhaza ibyo usabwa no kugukorera neza. Isohozwa ryawe nigihembo cyacu gikomeye. Turimo guhiga kugirango ugenzure kugirango uteze imbere iterambere ryibicuruzwa Ubushinwa Bwinshi Bwuzuye Imirire Yigaburira Imifuka, Twakiriye abaguzi ahantu hose mwijambo ryo kuduhamagarira amashyirahamwe mato mato mato. Ibisubizo byacu nibyo hejuru. Bimaze gutorwa, bihebuje ibihe byose!
Ibicuruzwa bigendaUbushinwa Kugaburira Umufuka, Isakoshi yo Kugaburira ImbereIshirahamwe ryacu. Abashyitsi bari imbere mumijyi yubusabane bwigihugu, abashyitsi biroroshye cyane, imiterere yihariye yubukungu nubukungu. Dukurikirana umuryango "ugamije abantu, gukora neza, kungurana ibitekerezo, kubaka ubwiza". Hilosophy. Gucunga neza ubuziranenge bwo hejuru, serivisi nziza, igiciro cyiza muri Miyanimari nicyo gihagararo cyacu cyo guhatanira amarushanwa. Niba ari ngombwa, urakaza neza kugirango utumenyeshe kurubuga rwacu cyangwa kugisha inama kuri terefone, turateganya kwishimira kugukorera.