気管内チューブ固定法の評価基準と適切な固定法

抜管予防対策として,より適切な気管内チューブ固定法を明らかにするため,平成15年度に実施した実態調査結果を基にデルファイ調査を実施した.その結果,体重が小さく体動が少ない場合に選出された上位3の方法はII-7,II-2,II-3,体重が大きく体動が多い場合はII-7,VI-1,II-2の方法であった.これら上位2の方法を検証対象とすることへの合意は66%と60%であった.これらの方法について,新生児の負担,固定力,固定の安定性,手順の簡便さ,コストや美観の観点から評価した結果,検討の余地がある方法であった.そこで,体重が小さく体動が少ない場合については,上位3に選出されなかった方法を評価し,改良を加え新たな方法を考え出し,1位の方法と比較検証することとした.また,体重が大きく体動が多い場合は,1位が同じ方法であるので,小さい場合の結果から検証方法を決定することにした.

We did Delhi process on the basis of fact-finding results from 2003. The purpose was to make clear a more appropriate way of fixing an endotracheal tube that would prevent the extubation.The results of the three higher ranks were as follows: Cases who were light weight and had not much movement were II-7, II-2, II-3. Cases who were heavy and had much movement were II-7, VI-1 and II-2. We conducted investigations into the methods of the two higher ranks, and achieved 66 0x1.e13ecp-891nd 60 0x0p+0greement with them.We evaluated these methods by the points of: the newborn's negative effect, the strength of fixing, the stability of fixing, the easy process, and the cost. The result was that we need more consideration of these factors.In the cases who were light-weight, and had not much movement, we evaluated using other ways, which were not the same as the three higher ranks. Then, we improved them, and devised a new way. Also, we compared and examined the new way. For the cases who were heavy-weight and had much movement, because the first rank was the same way as the light one, we decided to use the same examination method as was used in the light weight cases.