导尿管之选择与的护理.ppt

導尿管之選擇與護理 慈濟技術學院 江明珠 Incidence of catheterization 10% of patients in hospital（Mulhall et al,1988） 25% of patients in hospital（Saint et al,1999） 4% of patients receiving nursing services at home（Getliffe and Mulhall,1991） Indications for use of urinary catheters Short-term catheterization Urologic surgery Surgery on contiguous structures Critically ill patients requiring accurate measure of urinary output Acute urinary retention Indications for use of urinary catheters Long-term catheterization Bladder outlet obstruction not correctable medical or surgically Intractable skin breakdown caused or exacerbated by incontinence Some patients with neurogenic bladder and retention Palliative care for terminally ill or severely impaired incontinent patients for whom bed and clothing changes are uncomfortable Preference of a patient who has not responded to specific incontinence treatments 途徑 Transurethra catheterization Transvesical catheterization（ suprapubic catheterization ） What is suprapubic catheterization？ 恥骨上導尿管：在膀胱脹滿水之後由恥骨上正中央插入導引器然後插入導尿管 suprapubic catheterization suprapubic catheterization indications for suprapubic catheterizattion Urethra trauma Clients who require long-term catheterization and who are sexually active Following pelvic or urological surgery Some gynaecological conditions,e.g.colposuspension Long-term catheterization for incontinence Clients who are unable to tolerate urethral catheterization Some wheelchair-bound clients Consider suprapubic or urethral catheterization Consider suprapubic or urethral catheterization Consider suprapubic or urethral catheterization Selection of catheters Which material For short-term use （1-28days）: Latex, PVC, PTFE-coated latex foley catheter For long-term use of up to 12 weeks,select one of the following: hydrogel-coated latex foley catheter pure silicon Foley catheter silicon-coated latex Foley catheter Selection of catheters Catheter size Male:14-16Ch（length 40-45cm） Female:12-14Ch（length