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護理人員移除導尿管評估表

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護理人員移除導尿管評估表

並“無”上列任一項需續留導尿管的情況者,即由醫師或專科護理師開立移除導尿管醫囑,並移除導 尿管。

註:

尿管移除後 6 小時未自解或解尿困難,使用超音波餘尿測試。

餘尿大於 250cc->重新置放尿管。

餘尿小於 250cc->成功,繼續觀察解尿狀況。

日期 可拔

不可拔/原因第幾項目 簽名

王佩琮、林湘玉、林意純、辛文蕙、簡莉盈、林小玲(2017).依適應症提示移除尿管可降低內科病 房導尿管相關尿路感染.護理雜誌,64(1),70–79。[Wang, P. T., Lin, H. Y., Lin, Y. T., Shin, W. H., Chien, L. Y., & Lin, S. (2017). Using an indicator-based reminder of catheter removal to effectively decrease catheter-associated urinary tract infections in general medical patients. The Journal of Nursing, 64(1), 70–79.] doi:10.6224/JN.000010

Gould, C. V., Umscheid, C. A., Agarwal, R. K., Kuntz, G., & Pegues, D. A. (2010). Guideline for prevention of catheter-associated urinary tract infections 2009. Infection Control and Hospital Epidemiology, 31(4), 319–326. doi:10.1086/651091

Hooton, T. M., Bradley, S. F., Cardenas, D. D., Colgan, R., Geerlings, S. E., Rice, J. C., … Nicolle, L. E. (2010).

Diagnosis, prevention, and treatment of catheter-associated urinary tract infection in adults: 2009 International clinical practice guidelines from the infectious diseases society of America. Clinical Infectious Diseases, 50(5), 625−663. doi:10.1086/650482

置放導尿管適應症

1 需要膀胱灌洗或輸注藥物至病人的膀胱。

2 尿路阻塞(水腎或腎結石)造成急性尿滯留。

3 需要嚴密監測輸入排出量的重症病人。

4 泌尿道、攝護腺或骨盆腔手術病人。

5 尾骶骨或周圍有 3 或 4 度壓瘡的失禁病人

6 脊髓受損而留置導尿管病人。

7

其他原因,當科醫師或泌尿科醫師特別要求。

理由:______________________________________

病人姓名貼紙

參考文獻

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