— 降低風險 · MEDIUM · MCQ —
護理師照護一位氣切病人。抽痰時哪項操作是正確的？
A nurse is caring for a client with a tracheostomy. Which action is appropriate during suctioning?
- ASuction for at least 30 seconds to ensure clearing抽吸至少 30 秒以確保清除乾淨
- BApply suction while inserting the catheter插入導管時施加抽吸力
- CHyperoxygenate the client before suctioning✓ 正解抽痰前為病患高濃度給氧
- DUse a suction pressure of 200 mmHg使用 200 mmHg 的抽吸壓力
— Explanation · 中文詳解 —
氣切抽痰時，氧氣供應（Hyperoxygenation）對於預防抽痰造成的缺氧至關重要。A（進管時抽吸）會傷害黏膜；C（抽吸超過 15 秒）會導致缺氧與心律不整；D（壓力過高）會造成黏膜損傷，通常設定在 80-120 mmHg 之間。
During tracheostomy suctioning, hyperoxygenation is essential to prevent suction-induced hypoxia. Option B (suctioning during catheter insertion) damages the mucosa; option A (suctioning for more than 15 seconds) causes hypoxia and arrhythmias; option D (excessively high suction pressure) injures the mucosa, and the pressure is usually set between 80 and 120 mmHg.
✦ 台美臨床差異
美國各醫療院所對於氣切抽痰的 SOP 高度一致；台灣各醫院間的操作規範可能略有差異。