絆創膏による気管内チューブ固定法(II-3法)の検討 : ヘッドギアの使用と計画外抜管の視点から <ワークショップ5>

Endotracheal tube fixing by adhesive plaster (II-3) from the view points of using head-gear and unplanned extubation

広瀬 孝子

浅香 知子

長内 佐斗子

日本新生児看護学会誌

Journal of Japan Academy of Neonatal Nursing

当院の気管内チューブの固定方法はテープを2枚使用して,気管内チューブをどちらかの口角に位置させ,1本目のテープを左右どちらかの頬に貼り,チューブの上から巻きつけ鼻の下を通って反対の頬にとめる.2本目は1本目と反対の頬から貼って,チューブの下から巻きつけ鼻の下を通って頬にとめる.この方法は必ずしも気管内チューブの抜管が少ないとは言えない.この要因として,テープ固定のみの問題ではなく,呼吸器回路の固定や子どもの頭部固定用具なども影響すると考えられた.また,人工呼吸器から離脱の困難な長期挿管している子どもに使用するヘッドギアのような固定具は,子どもの頭部の動きを抑制するが子どもの欲求を阻止することになるので反発を生じさせる.その予防対策として,子どもの発達による体位の工夫をすることで,人工呼吸器の回路が動いても余裕を持たせることで引っ張られることによる抜管は予防でき,さらに子どもの成長発達にあった体位の工夫をすることで子どもの反発した行為での抜けはなくなると考えられた.

In this hospital, the way of fixing an endotracheal tube is as follows.We use two tapes. At first we put the tube to one side of the mouth, then, put one tape on one side of the cheek, then, pull this tape around the upper-side of the tube, and pass it under the nose, and put onto the other side of the cheek. The second tape, we put on the cheek (opposite side to the first tape), and make this tape go around the lower side of the tube, pass under the nose, and then attach to the cheek. However, the incidence of extubation was high. The reason was not only caused by the fixed tape, but also by the fixed respiratory organs, and the fixed implement of a child's head. Also, there were children who had used respiratory organs for a long term, so that they had had endotracheal tubes for a long time. They were sometimes offended by headgear which was good for keeping child's head stationary, but it led to the child's frustration. Also we need to put the respiratory organ in good place, otherwise, it pulled off the tube. The point was the positioning of children, which we should change along their growth path. We were able to prevent the extubation in two respects: you could make free space for respiratory organs moving, and lower the children's frustrations.

気管内チューブ

計画外抜管

ポジショニング

ヘッドギア

endotracheal tube

unplanned extubation

positioning

head-gear

医学 [ 490 ]

日本語

日本新生児看護学会

Copyright (c) 2005 日本新生児看護学会

[ISSN] 1343-9111

[NCID] AA11269499