患者插了尿管老漏尿?教你一个小技巧摆脱漏尿

2023-04-01 王爱君 中国护理管理 发表于上海

因注水方法不当导致留置尿管患者漏尿时,怎样处理?

因注水方法不当导致留置尿管患者漏尿时,怎样处理?

案例分享

患者赵某,女,65岁,马尾神经损伤,完善相关检查后行手术治疗,术后留置尿管。留置尿管第二天,发现患者导尿管漏尿。

排除多种因素后,试着将导尿管气囊中注水抽出,重新注入30ml无菌水,然后缓慢、匀速回抽15ml,采用这种“先注水再回抽”的方法,有效解决了患者导尿管漏尿问题。

案例分析

留置导尿是临床常用的护理技术,目的是缓解排尿困难、尿失禁、尿潴留问题以及监测尿量等。

老年患者由于器官出现退行性变化,留置尿管后,在安静状态或膀胱充盈情况下,很容易出现尿管未夹闭或夹闭后尿液从导尿管旁漏出。

导尿管漏尿,给治疗和护理带来较大不便,同时也加剧了患者的痛苦。

留置尿管漏尿原因复杂,且处理棘手。在复杂的漏尿原因中,导尿管本身及患者膀胱功能是最主要的根源因素。经长期临床观察发现,预冲式导尿管水囊注水时,如果无法促使水囊均匀张开,则可能成为显著的漏尿危险因素!

经验分享

导尿管气囊注水量常规要求为10~15ml,但考虑到漏尿问题,临床护士会凭经验序贯性增加注水量,因而有注水10~30ml不等的报道。

其实气囊注水量不是越多越好,关键是注水后的水囊能否形成均匀的球体而起到封闭作用。

为此,对气囊注水进行了体外实验,结果发现当注水量为10~15m1时,气囊基本呈“偏球状”畸形,在注水量达到30ml时,气囊才呈现四周均匀的圆球形,此时再缓慢、匀速回抽液体会发现球体随水量减少而慢慢缩小,但仍会保持均匀的球形,直至回抽15ml液体时,球囊仍保持着较好的均匀球形状态。

分析可能的原因为:在注入10~15ml液体时,气囊内压不够大,未能使气囊完全撑开而形成“偏球状”畸形,在注入30ml液体时才使气囊完全撑开呈球形。

当气囊完全撑开后,再缓慢匀速回抽液体,由于此时球囊内压和张力均匀下降,气囊仍然保持均匀的球体状态。因导尿管注水气囊畸形未能起到封闭作用而发生漏尿,采用这种“先注水再回抽”的方法,就能有效解决漏尿问题。

图1 先注水再回抽导尿管注水囊的状态

临床上,导致老年患者留置导尿漏尿的原因很多,通过实施先注水再回抽的方法,能有效解决因注水方法不当导致留置尿管患者漏尿的问题。

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  1. [GetPortalCommentsPageByObjectIdResponse(id=2131594, encodeId=03272131594ac, content=谢谢啦, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=0d578335266, createdName=ms7000001939458034, createdTime=Thu May 11 13:56:18 CST 2023, time=2023-05-11, status=1, ipAttribution=广东省), GetPortalCommentsPageByObjectIdResponse(id=2123231, encodeId=f3cf2123231dd, content=这个对临床很有帮助, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=2d114843943, createdName=1013100771, createdTime=Sun Apr 02 07:52:40 CST 2023, time=2023-04-02, status=1, ipAttribution=山东省), GetPortalCommentsPageByObjectIdResponse(id=2123124, encodeId=dd45212312434, content=认真学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6EF3hKja8nER8RMzxQdria9eCYFhgLTLsDOeqnvIYdeLDz5eP6EnicLuE5gibiawgno4zUA0jAR7Nbtp2llQ9fs3Mk/0, createdBy=278f1986883, createdName=医鸣惊人, createdTime=Sat Apr 01 12:48:32 CST 2023, time=2023-04-01, status=1, ipAttribution=山西省), GetPortalCommentsPageByObjectIdResponse(id=2123145, encodeId=03de2123145a5, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=23265467401, createdName=初入江湖, createdTime=Sat Apr 01 16:16:11 CST 2023, time=2023-04-01, status=1, ipAttribution=安徽省)]
    2023-05-11 ms7000001939458034 来自广东省

    谢谢啦

    0

  2. [GetPortalCommentsPageByObjectIdResponse(id=2131594, encodeId=03272131594ac, content=谢谢啦, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=0d578335266, createdName=ms7000001939458034, createdTime=Thu May 11 13:56:18 CST 2023, time=2023-05-11, status=1, ipAttribution=广东省), GetPortalCommentsPageByObjectIdResponse(id=2123231, encodeId=f3cf2123231dd, content=这个对临床很有帮助, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=2d114843943, createdName=1013100771, createdTime=Sun Apr 02 07:52:40 CST 2023, time=2023-04-02, status=1, ipAttribution=山东省), GetPortalCommentsPageByObjectIdResponse(id=2123124, encodeId=dd45212312434, content=认真学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6EF3hKja8nER8RMzxQdria9eCYFhgLTLsDOeqnvIYdeLDz5eP6EnicLuE5gibiawgno4zUA0jAR7Nbtp2llQ9fs3Mk/0, createdBy=278f1986883, createdName=医鸣惊人, createdTime=Sat Apr 01 12:48:32 CST 2023, time=2023-04-01, status=1, ipAttribution=山西省), GetPortalCommentsPageByObjectIdResponse(id=2123145, encodeId=03de2123145a5, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=23265467401, createdName=初入江湖, createdTime=Sat Apr 01 16:16:11 CST 2023, time=2023-04-01, status=1, ipAttribution=安徽省)]
    2023-04-02 1013100771 来自山东省

    这个对临床很有帮助

    0

  3. [GetPortalCommentsPageByObjectIdResponse(id=2131594, encodeId=03272131594ac, content=谢谢啦, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=0d578335266, createdName=ms7000001939458034, createdTime=Thu May 11 13:56:18 CST 2023, time=2023-05-11, status=1, ipAttribution=广东省), GetPortalCommentsPageByObjectIdResponse(id=2123231, encodeId=f3cf2123231dd, content=这个对临床很有帮助, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=2d114843943, createdName=1013100771, createdTime=Sun Apr 02 07:52:40 CST 2023, time=2023-04-02, status=1, ipAttribution=山东省), GetPortalCommentsPageByObjectIdResponse(id=2123124, encodeId=dd45212312434, content=认真学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6EF3hKja8nER8RMzxQdria9eCYFhgLTLsDOeqnvIYdeLDz5eP6EnicLuE5gibiawgno4zUA0jAR7Nbtp2llQ9fs3Mk/0, createdBy=278f1986883, createdName=医鸣惊人, createdTime=Sat Apr 01 12:48:32 CST 2023, time=2023-04-01, status=1, ipAttribution=山西省), GetPortalCommentsPageByObjectIdResponse(id=2123145, encodeId=03de2123145a5, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=23265467401, createdName=初入江湖, createdTime=Sat Apr 01 16:16:11 CST 2023, time=2023-04-01, status=1, ipAttribution=安徽省)]
    2023-04-01 医鸣惊人 来自山西省

    认真学习了

    0

  4. [GetPortalCommentsPageByObjectIdResponse(id=2131594, encodeId=03272131594ac, content=谢谢啦, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=0d578335266, createdName=ms7000001939458034, createdTime=Thu May 11 13:56:18 CST 2023, time=2023-05-11, status=1, ipAttribution=广东省), GetPortalCommentsPageByObjectIdResponse(id=2123231, encodeId=f3cf2123231dd, content=这个对临床很有帮助, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=2d114843943, createdName=1013100771, createdTime=Sun Apr 02 07:52:40 CST 2023, time=2023-04-02, status=1, ipAttribution=山东省), GetPortalCommentsPageByObjectIdResponse(id=2123124, encodeId=dd45212312434, content=认真学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6EF3hKja8nER8RMzxQdria9eCYFhgLTLsDOeqnvIYdeLDz5eP6EnicLuE5gibiawgno4zUA0jAR7Nbtp2llQ9fs3Mk/0, createdBy=278f1986883, createdName=医鸣惊人, createdTime=Sat Apr 01 12:48:32 CST 2023, time=2023-04-01, status=1, ipAttribution=山西省), GetPortalCommentsPageByObjectIdResponse(id=2123145, encodeId=03de2123145a5, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=23265467401, createdName=初入江湖, createdTime=Sat Apr 01 16:16:11 CST 2023, time=2023-04-01, status=1, ipAttribution=安徽省)]
    2023-04-01 初入江湖 来自安徽省

    学习了

    0

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