Rothaug O, Kaltwasser A, Dubb R, Müller-Wolff T, Steinfeld E-H, Wagner S
1_122Zentrum Anaesthesiologie, Rettungs- und Intensivmedizin, Anaesthesiologie II - Operative Intensivstation 0118, Universitätsmedizin Göttingen, Robert Koch Str. 40, 37075 Göttingen, Deutschland.
2_122Akademie der Kreiskliniken Reutlingen, Klinikum am Steinenberg, Reutlingen, Deutschland.
Intensivmed Notfallmed. 2010;47(6):452-462. doi: 10.1007/s00390-009-0122-4. Epub 2009 Oct 2.
The relevance of nursing interventions for patients with fecal incontinence/defecation problems in intensive care medicine is very often underestimated. Fecal incontinence can either be a symptom of a disease, an epiphenomenon or a primary disease. Fecal incontinence negatively influences the ability of affected intensive patients to care for themselves. Fecal incontinence and diarrhea often occur together, which in return restricts the patient's mobility. Improperly treated fecal incontinence can result in infections (e.g., skin disorders, existing catheter sores), secondary healing can be delayed (e.g., bedsores, sores on the back or groin/genital area) and can also result in contamination of other areas (e.g., intestinal infection). In the past, many improvised techniques and materials have been used to drain feces for patients who are either immobile or critically ill with temporary or persistent fecal incontinence. Continuous and safe fecal drainage is often a problem. There is no basic standard nursing concept that can be recommended or verified. At present there are a number of continuous fecal drainage systems that have been launched on the market. Different indications and fields of application have been recommended when dealing with continuous fecal drainage. This article shows weaknesses and strengths of continuous fecal drainage, explains how each functions, and illustrates possible indications and contra-indications with each of these. Deployment options and limits are presented and summarized in an algorithm as a practical help for decision-making.
在重症医学中，护理干预对大便失禁/排便问题患者的相关性常常被低估。大便失禁既可以是一种疾病的症状、一种附带现象，也可以是一种原发性疾病。大便失禁会对受影响的重症患者的自理能力产生负面影响。大便失禁和腹泻常常同时出现，进而限制患者的活动能力。大便失禁若治疗不当，可能会导致感染（如皮肤疾病、现有导管疮），二次愈合可能会延迟（如褥疮、背部或腹股沟/生殖器部位的溃疡），还可能导致其他部位受到污染（如肠道感染）。过去，对于那些因临时或持续性大便失禁而行动不便或病情危急的患者，人们使用了许多临时技术和材料来引流粪便。持续且安全的粪便引流往往是个问题。目前还没有一个可以推荐或验证的基本标准护理理念。目前市场上已推出了一些持续粪便引流系统。在处理持续粪便引流时，人们推荐了不同的适应症和应用领域。本文展示了持续粪便引流的优缺点，解释了其各自的功能，并说明了每种引流方式可能的适应症和禁忌症。文中还介绍了使用方法和限制，并以算法形式进行总结，为实际决策提供帮助。
