Hsu Mei-Yu, Hsu Hsiao-Hui, Lyu Ji-Yan
MSN, RN, Wound Ostomy Continence Nurse, Department of Nursing, Buddhist Tzu Chi General Hospital, Taiwan, ROC.
MSN, RN, Supervisor, Department of Nursing, Buddhist Tzu Chi General Hospital, Taiwan, ROC.
Hu Li Za Zhi. 2016 Oct;63(5):127-134. doi: 10.6224/JN.63.5.127.
Leakage is a common complication of gastrostomy. Exposure of the skin surrounding the gastrostomy tube to moisture or chemical irritants may cause moisture-associated skin damage (MASD) and seriously affect the patient's quality of life. This case study describes a nursing experience with gastrostomy leakage that resulted in MASD. An assessment conducted from July 29, 2015 to August 20, 2015 revealed that heavy gastronomy leakage had caused extensive skin erosion, ulceration, hyperplasia, and superficial infection. Simultaneously, the patient was required to conduct complex stoma care, which resulted in physical and psychological exhaustion. Changes in traditional tube and wound care were discussed on multiple occasions with an interdisciplinary healthcare team. Based on the evidence-based literature, we provide gastrostomy and MASD management strategies. Through team collaboration, we prevented gastric contents from contacting the patient's skin directly, improved patient comfort, controlled effluent and skin infections, maintained fluid and electrolyte balances, and acce-lerated the healing of the damaged skin. We recommend that healthcare professionals caring for patients with gastrostomy leakage be provided with early skin protection programs to learn the standard methods for identifying and correcting leakage factors, containing effluent, and adequately stabilizing the gastrostomy tube in order to reduce the impact on the patient's quality of life. In addition, patient education on tube and skin care should be provided to prevent the reoccurrence of complications.
渗漏是胃造口术的常见并发症。胃造口管周围皮肤暴露于湿气或化学刺激物中可能会导致与湿气相关的皮肤损伤（MASD），并严重影响患者的生活质量。本案例研究描述了一例因胃造口术渗漏导致MASD的护理经历。2015年7月29日至2015年8月20日进行的一项评估显示，严重的胃造口术渗漏已导致广泛的皮肤糜烂、溃疡、增生和浅表感染。同时，患者需要进行复杂的造口护理，这导致了身心疲惫。与跨学科医疗团队多次讨论了传统管道和伤口护理的改变。基于循证文献，我们提供了胃造口术和MASD的管理策略。通过团队协作，我们防止了胃内容物直接接触患者皮肤，提高了患者舒适度，控制了流出物和皮肤感染，维持了液体和电解质平衡，并加速了受损皮肤的愈合。我们建议为照顾胃造口术渗漏患者的医护人员提供早期皮肤保护方案，以学习识别和纠正渗漏因素、容纳流出物以及充分固定胃造口管的标准方法，从而减少对患者生活质量的影响。此外，应向患者提供管道和皮肤护理方面的教育，以防止并发症再次发生。
