Ukuhlukanisa Ukusebenza Kwecatheter le-Foley eNye Ngamathathu

Izindlela Zokuziphatha Ezibalulekileyo Zomisela Yokufakwa Emi-3

Umisela yokufakwa emi-3 uyadibekwa ngokuphelele ukusebenzisa isiqhelo sokuhlanza isihlalo ngokuthekelwe (CBI) njengoba uyasebenzisa ukuvula isihlalo. Umisela wokwakha umthwalo wokuhlanza uyeleka umnqophiso wokuhlanza omhlophe ku-sihlalo, ngakho-ke umisela wokuvula usivula umnqophiso, ublood, kanye nezinkundla—kuphula ukuthi kubhekene nezinkundla zemithi kanye nokuthi kubhekene nokuvula kwezikhungo zokuvula isihlalo.

Izindlela zokuziphatha ezibalulekileyo ziyi- ukuphuma kwemithi okunamandla noma okuphelele , kusukela kubhekana ngezindlela zokuhlanza izihlathi zomzimba (TURP) noma kubhekana ngezindlela zokuhlanza izihlathi zemithambo yomzimba (TURBT). Ukuvutha kwemvutho emva kokwenza isikhumbuzo kumkhumbuzo wokuphakama kwe-prostate noma kumkhumbuzo wokuphakama kwe-tumor kungabangela ukuthi izihlathi zibekwe kumakhambu ase-Foley, okubangela ukuthi umzimba uphakame ngokufanele futhi ukuhlanya kwezinyawo. Ukulanda kwezikhumbuzo ezintathu zokuhlanya kuyadilutha ublood, kuyafusha izihlathi ezingaphansi kabusha ngaphambi kokuba zibekwe kumakhambu, futhi kuyasinda ubuchwepheshe ngaphandle kokubhekana kabusha.

Ngaphezu kwalokho kwenziwa emva kokwenza isikhumbuzo, leli khambu lisetshenziswa ku- ukuvutha okukhulu kwezinyawo ngokwesibhakabhaka, ukusebenzisa amadragi okuvutha, noma ukuvutha kwezinyawo ngokwesiradiyasi . Ukulanda kwezikhumbuzo kuyasiza ekuboneni ngokushesha ukuvutha: ukuvutha okubomvu-bomvu kubonisa ukuthi ukuvutha kuyasebenza futhi kudinga ukuthuthukiswa, ngakho-ke ukuguqula kubomvu-bomvu noma kubomvu-bomvu-bomvu kubonisa ukuthi ukuvutha kugcwele. Kwezinye izindawo zokuphatha izifo zezinhloso, indawo yokuhlanya eyodwa iyasiza ku- ukuphatha okuhlanganisiwe kwezinyawo , njengokuthumela umitomisini emva kwe-TURBT—ukubhekisa ukuthi isithunzi sokuthumela sibhekise kahle, asisilwanga, futhi asikho ukungafani ngezinye izinkampani zezinkampani zokugcina izinkampani zezinkampani zezinkampani zezinkampani zezinkampani zezinkampani zezinkampani zezinkampani zezinkampani zezinkampani zezinkampani zezinkampani zezinkampani zezinkampani zezinkampani zezinkampani zezinkampani zezinkampani zezinkampani zezinkampani zezinkampani zezinkampani zezinkampani zezinkampani zezinkampani zezinkampani zezinkampani zezinkampani zezinkampani zezinkampani zezinkampani zezinkampani zezinkampani zezinkampani zezinkampani zezinkampani zezinkampani zezinkampani zezinkampani zezinkampani zezinkampani zezinkampani zezinkampani zezinkampani zezinkampani zezinkampani zezinkampani zezinkampani zezinkampani zezinkampani zezinkampani zezinkampani zezinkampani zezinkampani zezinkampani zezinkampani zezinkampani zezinkampani zezinkampani zezinkampani zezinkampani zezinkampani zezinkampani zezinkampani zezinkampani zezinkampani zezinkampani zezinkampani zezinkampani zezinkampani zezinkampani zezinkampani zezinkampani zezinkampani zezinkampani zezinkampani zezinkampani zezinkampani zezinkampani zezinkampani zezinkampani zezinkampani zezinkampani zezinkampani zezinkampani zez......

I-3-way catheter iyasemthandweni kwezindlela zokugcina ngaphandle kokuthi ubunye bokuphatha okwenzeka noma ukuthi kufanele kubhekiswe. I-lumen eyengele kuyenza ukuthi amabacteria ayifikele kusukela futhi kuyenza ukuthi kungabi nesikhundla sokuhlanganisa—ngakho-ke abadokotela kufanele bakhiphe isibonelo esihlakanipha kabusha emva kokusebenzisa. Uma isebenzisa ngokulinganayo futhi ibhalwa ngokulinganayo, iyanciphisa kahle isidingo sokuthatha izinkampani zezinkampani zezinkampani zezinkampani zezinkampani zezinkampani zezinkampani zezinkampani zezinkampani zezinkampani zezinkampani zezinkampani zezinkampani zezinkampani zezinkampani zezinkampani zezinkampani zezinkampani zezinkampani zezinkampani zezinkampani zezinkampani zezinkampani zezinkampani zezinkampani zezinkampani zezinkampani zezinkampani zezinkampani zezinkampani zezinkampani zezinkampani zezinkampani zezinkampani zezinkampani zezinkampani zezinkampani zezinkampani zezinkampani zezinkampani zezinkampani zezinkampani zezinkampani zezinkampani zezinkampani zezinkampani zezinkampani zezinkampani zezinkampani zezinkampani zezinkampani zezinkampani zezinkampani zezinkampani zezinkampani zezinkampani zezinkampani zezinkampani zezinkampani zezinkampani zezinkampani zezinkampani zezinkampani zezinkampani zezinkampani zezinkampani zezinkampani zezinkampani zezinkampani zezinkampani zezinkampani zezinkampani zezinkampani zezinkampani zezinkampani zezinkampani zezinkampani zezinkampani zezinkampani zezinkampani zezinkampani zezinkampani zezinkampani zezinkampani zezinkampani zez......

Ukuthi i-3 Way Foley Catheter isebenzisa njani: I-anatomy nezindlela zokugcina

I-Foley catheter esithathu isebenzisa amalumeni amathathu okuhlanganisa: eyokuqala yenza ukususa amanzi emihlaba ne-irrigation fluid, yesibili yenza ukufaka amanzi emihlaba kubhola (ngokuvamile ngama-10–30 mL wezinkambo zomfula), kanye nesithathu esisodwa ukufaka irrigation fluid. Lokhu kuthathu kwalumene kwenza ukufika nokususa kahle—kunikeza ukufaka kahle kwamazinkambo emihlaba ngaphandle kokuguqula kwe-catheter noma ukuphakama kwezinkambo.

Isaline esikhlini esikhlini sisebenzisa kakhulu njenge-irrigation fluid. Iyafika emihlabeni ngokuphakama okuncane okuphelele (ngokuvamile <40 cm H₂O), ngakho-ke umalumeni onenkambo enkulu uyasusa izinkambo ezifakwe kanye nezinkambo zomfula, iziklhoti, kanye nezinye izinto ezingavumelekile. Lokhu kubalulekile ukungabili iziklhoti, ukunciphisa ukugwema kwe-mucosal, nokugcina ukuphambana kwe-bladder—okubalulekile ngokuphatha kwezindlela zokuphatha njenge-TURBT.

Kungasemthwini wokusebenzisa izikathitha ezimbili zokuzihamba ngokuthi kubhekwa phakathi kwe-irrigation ne-drainage, isisitemu sesithathu-sikhombisa ukukhishwa kwezindlela zokusebenzisa izikathitha, okuphepha ukunciphisa izinkinga zokugcinwa kwezinto zokusebenzisa futhi ukunciphisa ukuthi kubhekwe ngokuthi kufanele kubhekwe ngokuthi kubhekwe ngokuthi kubhekwe ngokuthi kubhekwe ngokuthi kubhekwe ngokuthi kubhekwe ngokuthi kubhekwe ngokuthi kubhekwe ngokuthi kubhekwe ngokuthi kubhekwe ngokuthi kubhekwe ngokuthi kubhekwe ngokuthi kubhekwe ngokuthi kubhekwe ngokuthi kubhekwe ngokuthi kubhekwe ngokuthi kubhekwe ngokuthi kubhekwe ngokuthi kubhekwe ngokuthi kubhekwe ngokuthi kubhekwe ngokuthi kubhekwe ngokuthi kubhekwe ngokuthi kubhekwe ngokuthi kubhekwe ngokuthi kubhekwe ngokuthi kubhekwe ngokuthi kubhekwe ngokuthi kubhekwe ngokuthi kubhekwe ngokuthi kubhekwe ngokuthi kubhekwe ngokuthi kubhekwe ngokuthi kubhekwe ngokuthi kubhekwe ngokuthi kubhekwe ngokuthi kubhekwe ngokuthi kubhekwe ngokuthi kubhekwe ngokuthi kubhekwe ngokuthi kubhekwe ngokuthi kubhekwe ngokuthi kubhekwe ngokuthi kubhekwe ngokuthi kubhekwe ngokuthi kubhekwe ngokuthi kubhekwe ngokuthi kubhekwe ngokuthi kubhekwe ngokuthi kubhekwe ngokuthi kubhekwe ngokuthi kubhekwe ngokuthi kubhekwe ngokuthi kubhekwe ngokuthi kubhekwe ngokuthi kubhekwe ngokuthi kubhekwe ngokuthi kubhekwe ngokuthi kubhekwe ngokuthi kubhekwe ngokuthi kubhekwe ngokuthi kubhekwe ngokuthi kubhekwe ngokuthi kubhek......

Ukwenza i-Continuous Bladder Irrigation nge-3 Way Foley Catheter

I-Continuous bladder irrigation (CBI) esebenzisa i-3-way Foley catheter iyindlela eyodwa yokuphatha emuva kwe-TURBT futhi emuva kwe-TURP ukuze ukunciphise ukugcina kwezinkomo futhi ukuhlinzeka kwesibhakabhaka. Ukuphumelela kuyisibonelo sokubalansisa ukufika kwe-irrigation ngokuhlinzeka kokuvuleka kwe-outflow ngaphandle kokuzimela kakhulu.

Ukuphuthumisa i-irrigation fluid, isivinini se-flow rate, nokukhangela ngokushesha

Sebenzisa isalini esiyisitoni njengesilini sokuhlanza esiphilelwe kakhulu; amanzi esihlangu senziwa ngokupheleleyo singasebenziselwa ngokufanelekile kancane kodwa kunezidingo zokuhlukaniswa kwe-erythrocytes ngekufana kahle ngokuphakeme. Qala ukuvula ngokukhula kwe-150–200 mL/hr futhi uguqule ngokugxila ngokuchaza kwezibonelo: ukubona okubhekene nokubhekene kwezibonelo ezibomvu kakhulu kusiza ukuvula kakhulu, ngakho-ke ukubona okubhekene nokubhekene okubomvu okuncane noma okucacile kusiza ukuguqula ngokugxila.

Jabula ibhagi yokudlula ngasinye isikhathi se-30 minithi. Ukubhekene kwesikhathi sokubhagwa kwezibhagi ngaphezu kwezimbili kwezintathu kusiza ukubona ukuthi ukudlula kuyasebenza kahle. Ukuphela kwezibhagi ngokushesha—noma ukungabonakali kokudlula nakuba ukuvula kuyasebenza kahle—kubonisa ukuthi ikhathetha yekhathetha iyaphakanywa, iyavulwa ngokushesha, noma iyadlula kwezibhagi. Ukujabula kwayo ngokushesha nokuhlanza ngokugcizelela (ngokusebenzisa isikhombisa se-60 mL nesalini, angabi ukubeka kakhulu kwezibhagi) kusiza ukubuyisa ukusebenza kahle.

Ukuvula Okunzima Ngaphansi Kwezinqumo Noma Okunzima Ngaphezulu Kwezinqumo Kusukela Ekupheleni Kwemisebenzi Yokuqala Yokuqala

Ukufutha okwanele kwezinye (kunye ne-<40 cm H₂O) kukuphathwa okwenzekayo ngokwemithombo yokubona ukuthi kuyinto ephathwa ngokwemithombo yokubona ngokwemithombo yokubona. Kusindisa isibonelo sokugqaza kwesibhakabhaka, kunciphisa isibonelo sokugqaza kwesibhakabhaka, nokuthuthukisa ukuzimela kwesibhakabhaka. Ukufutha okwanele kwezinye kufanele kubhekwa kuphela kuclot retention okwanele kwezinye okwanele kwezinye okwanele kwezinye okwanele kwezinye okwanele kwezinye okwanele kwezinye okwanele kwezinye okwanele kwezinye okwanele kwezinye okwanele kwezinye okwanele kwezinye okwanele kwezinye okwanele kwezinye okwanele kwezinye okwanele kwezinye okwanele kwezinye okwanele kwezinye okwanele kwezinye okwanele kwezinye okwanele kwezinye okwanele kwezinye okwanele kwezinye okwanele kwezinye okwanele kwezinye okwanele kwezinye okwanele kwezinye okwanele kwezinye okwanele kwezinye okwanele kwezinye okwanele kwezinye okwanele kwezinye okwanele kwezinye okwanele kwezinye okwanele kwezinye okwanele kwezinye okwanele kwezinye okwanele kwezinye okwanele kwezinye okwanele kwezinye okwanele kwezinye okwanele kwezinye okwanele kwezinye okwanele kwezinye okwanele kwezinye okwanele kwezinye okwanele kwezinye okwanele kwezinye okwanele kwezinye okwanele kwezinye okwanele kwezinye okwanele kwezinye okwanele kwezinye okwanele kwezinye okwanele kwezinye okwanele kwezinye okwanele kwezinye okwanele......

Izinkinga eziphambili nezindlela zokuthuthukisa okwenzekayo ngokwemithombo yokubona

Nakuba isebenzisa kwezindlela zokuhlola ezithile, i-Foley catheter enye yamathathu iyathinta izinkinga eziphambili ezidinga ukuzinikela ngokuphawula kakhulu nokuphatha ngokulandela imithombo. Izinkinga zokubhukha kwezinkampani zokugcina (CAUTI) ziyisilinganiso esiphambili—kuyalindelwa ngokudlula kwesikhathi sokugcina, ukuthi kususwe umthwalo wokuhlola okungafanele, noma ukuthi izinhlangano zokuhlanza zibhukhe. Izinkinga zokusebenza kufaka kakhulu ukuthi icatheter ibhlokile (okusheshayo kakhulu ngamaphakathi), ukuthi ubhala libhukhe ngokuhlanza, izihlangothi zomphakathi ozokubhukha futhi zizokubhukha noma zizokuphuma, nokuthi kubhukhe kwezinye izinye zemithwalo ngokusebenza kwezimithwalo eziningi noma ngokusebenza kwezimithwalo ezilandelwayo.

Ukuphula okusobala ngokwemithombo yokuqinisa kuyiqala ngokulandela ngokuphelele ukufaka kwezinto ezisemthwakathini nokuphatha kwezinhlangano ezingavamile ngokwesikhombiso se-CDC ne-SHEA. Yenza umshayelo wendlela yokuhlanza phambi kokuhambisana noma yikuphi, ungakhohlwa ukugxila, futhi qiniseka ukuthi izihluzi ziyaphakanyiswa ngokuphelele ukuze zingabekwe ngokungafanele. Jonga ngokuphindekile ukuvuleka: ukulingana okungasemthwakathini phakathi kwezinhlangano zokufaka nokuvuleka (>10–15% yokungalingani) kubalulekile ukuthi kwenziwe umbuzo ngokuthe ngokushesha ngokungafanele kwezinhlangano. Qiniseka ukuthi izilawuli zokufaka nokuvuleka zibhalwe ngokuphelele futhi ngokushesha ukuze kubonwe amasignali amancane wezinhlangano zokugcina noma ukungafanele kwezinyawo zokuhlola.

Shintsha ikathetha ngasinye isikhathi sesibili–esine ezinsuku ngokulandela umbono wendawo—izikhathi ezide kakhulu ziyabuyisa ukuthi izibhloko zezinhlobo zezinto ezingavamile ziyadlala (biofilm) nokuthi kubhekwe ngokukhula kwemiphumela yezinhlobo zezinto ezingavamile zezindawo zokugcina (CAUTI). Sivumele ukuthi akwazi ukufaka kakhulu ubhola; faka kuphela kusukela kumkhumbuzo wokufaka okuchazwa ngumthengisi (kusho kahle ukuthi kusukela ku-10–30 mL) ngamandla amancane. Ukufundisa abasebenzi kuyisisekelo esibalulekile: abaprofayili bokusebenza kusenqumeni kufanele baphinde baphekele amandla okuphula kwemiphumela (ukuchitha, ukuphuma kwemphumela emva kwezindawo zokugcina, ukuvula kwezindawo zokugcina, ukuvula kwezindawo zokugcina), ukungafani kwezinhlobo zezinto ezingavamile (ukungavumele ukuvula kwezindawo zokugcina, ukuvula kwezindawo zokugcina), nokuthi kubhekwe ngokukhula kwemiphumela yezinhlobo zezinto ezingavamile zezindawo zokugcina.

Lezi zindlela—ezihlanganiswe ngokwesifundo sika-IDSA, kuka-AUA, kanye nezindlela zokuvikela imiphumela yezinhlobo zezinto ezingavamile zezindawo zokugcina—ziyakusiza ukusebenzisa ngokuphelele ukuthi ikathetha ye-3-way Foley iyasebenza ngokuphelele kanye nokuthi iyasebenza ngokuphelele kubuhlungu bokugcina kanye nokuthi iyasebenza ngokuphelele emva kokususa izinhlobo zezinto ezingavamile.

Imibuzo Evame Ukubuzwa

Yini inkimbinkimbi yokusebenza kwekathetha ye-3-way Foley?

Iyasebenziswa ukuthi ibe yinkimbinkimbi yokuvula kwezindawo zokugcina (CBI) kanye nokuthi ibe yinkimbinkimbi yokuvula kwezindawo zokugcina. Lokhu kusiza ukuthi kungavumele ukuthi izibhloko ziyagcina kanye nokuthi kungavumele ukuthi kungavumele ukuthi kungavumele ukuthi kungavumele ukuthi kungavumele ukuthi kungavumele ukuthi kungavumele ukuthi kungavumele ukuthi kungavumele ukuthi kungavumele ukuthi kungavumele ukuthi kungavumele ukuthi kungavumele ukuthi kungavumele ukuthi kungavumele ukuthi kungavumele ukuthi kungavumele ukuthi kungavumele ukuthi kungavumele ukuthi kungavumele ukuthi kungavumele ukuthi kungavumele ukuthi kungavumele ukuthi kungavumele ukuthi kungavumele ukuthi kungavumele ukuthi kungavumele ukuthi kungavumele ukuthi kungavumele ukuthi kungavumele ukuthi kungavumele ukuthi kungavumele ukuthi kungavumele ukuthi kungavumele ukuthi kungavumele ukuthi kungavumele ukuthi kungavumele ukuthi kungavumele ukuthi kungavumele ukuthi kungavumele ukuthi kungavumele ukuthi kungavumele ukuthi kungavumele ukuthi kungavumele ukuthi kungavumele ukuthi kungavumele ukuthi kungavumele ukuthi kungavumele ukuthi kungavumele ukuthi kungavumele ukuthi kungavumele ukuthi kungavumele ukuthi kungavumele ukuthi kungavumele ukuthi kungavumele ukuthi kungavumele ukuthi kungavumele ukuthi kungavumele ukuthi kungavumele ukuthi kungavumele ukuthi kungavumele ukuthi kungavumele ukuthi kungavumele ukuthi kungav......

Iyiphi ithayipha yemithwana eyasebenzisa kuzokufakwa kwemithwana?

Imithwana yomkhosi wokuphatha okungafanele ngokupheleleyo yisikhetho esihlukileyo yokufakwa kwemithwana ngokuthi isihlukile kanye nokusebenza kahle.

Kungani kufundwa ukuthi ikathitha iyabulawa?

Ukuphela kwezinhlobo zokubuyela emthwana kusuka kwebhaghi yokuqondisa noma ukungabonakali kokubuyela ngaphandle kokubuyela kakhulu kubonisa ukuthi ibulawa. Ukufakwa kwemithwana ngokuchaza kuncedisa ukubuyela kwezinhlobo.

Izimali zokusebenzisa ikathitha yezindilingo ezintathu ziyiphi?

Izimali eziphambili zivame ukuthi zibe izinkulungwane zokugcina imithwana yamaphuzu (CAUTI), ukubulawa, ukuphula kwemphakathi, nokugcina kwesibhakabhaka. Ukuphatha kahle nokulandela ukuphatha okungafanele kuncedisa ukuphatha kwezimali lezi.

Kungani ukufakwa kwemithwana ngodonga oluncane kusho kubhekwa?

Ukufakwa kwemithwana ngodonga oluncane (<40 cm H₂O) kunciphisa ukugcina kwesibhakabhaka sokubhakabhaka futhi kuncedisa ukubuyela kwesibhakabhaka ekhuleni, ngakho-ke ukufakwa ngodonga omkhulu kusho kuphela kumazinyo amancane athi kuyadingeka.