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Endoscopic biliary drainage catheter care

Date2013-08-27 08:38:09

Various causes of biliary obstruction is a common clinical symptoms of hepatobiliary surgery, obstructive jaundice patients in the past using percutaneous biliary drainage (PTCD) reached relieve jaundice purposes. With the development of fiber endoscopic surgery, a new way of nasal biliary biliary drainage catheter drainage (ENBD) was born, it was implemented under direct vision duodenoscope biliary drainage catheter decompression technology, its success rate high, fewer complications, greatly improving the quality of life of patients. Since July 2003 began to implement ENBD, for the treatment of common bile duct stones and suppurative cholangitis, which is based on endoscopic retrograde cholangiopancreatography (ERCP) and then to endoscopic sphincterotomy (EST) stone, then indwelling nose biliary drainage, achieved good therapeutic effect, now nursing summarized as follows.
First, clinical data:
1, General Information: The group of 13 males and 8 females; aged 50 to 80 years old; common bile duct stones in 15 cases, six cases of suppurative cholangitis. The patients had varying degrees of jaundice, and some upper abdominal pain.
2, ENBD catheter method: Oral inserted endoscopic cholangiopancreatography first determine the site of obstruction, will be over the guide wire inserted into the bile duct obstruction, select the widest range of bile duct drainage, using a thin polyethylene tube is inserted along the guide wire , will reach a predetermined portion of the guide wire removed. Nasobiliary start mouth leads, and finally with a nasal catheter to be drawn from the nostrils, and properly fixed.
3 Results: 21 cases were successful surgery, postoperative jaundice, abdominal pain were gradually reduce or disappear. Because preoperative history of mental depression in the early postoperative extremely nervous one case; early postoperative serum amylase slightly elevated one case.
Second, care:
1, preoperative psychological care: In the preoperative preparation, we found that patients and their families are on the ENBD have varying degrees of intense fear, such as intubation process can endure, how curative effect. Therefore, you should do before surgery to patients and their families to work patiently and carefully explain, inform ENBD is more advanced technology, it is the treatment of disease through minimally invasive techniques, can rapidly alleviate the condition, in the manipulation of the process, throat discomfort by endoscopy sense, the rest of the reaction is generally able to endure, and the catheter is generally no special discomfort. Preoperative psychological care, basic patient can relieve tension, and to the stability of preoperative intramuscular injection 10mg, patients can meet the doctor, the success rate of advancement of the catheter to reduce the suffering of patients.
2, and postoperative care:
① drainage tube care: patients undergoing ENBD after returning to the ward , take a good suction drainage bag, do in vitro dual fixed , ie the side of the nose , cheek and bedside fixed , instruct patient fasting and bed rest , reduced activity to prevent catheter prolapse and surgery may be due to local effects inform the throat after swallowing and endoscopic cannulation short-term gastrointestinal discomfort, can be gradually eased, while repeatedly warned the patient to sleep in the activities and to protect the catheter , do not pull the nose bile duct , and pay attention to the length of the in vitro nasobiliary prevent prolapse , prolapse as a little suspect , not forced inside the delivery catheter , the catheter should be fixed to observe biliary drainage conditions, such as no bile flow , should be promptly reported to the doctor for processing. In short , let the patient consciously protect the catheter , active cooperation, assist in the treatment and care.
② observe the drainage of fluid to determine catheter position : Because the pancreas, bile duct opening in the duodenal papilla are , therefore , possible to insert bile duct or pancreatic duct . This requires nursing staff to observe pancreatic bile fluid or is determined , it can be determined by angiography and B-. Clinical observation of changes in fluid drainage is very important, such as drainage less (50 ~ 200ml / d), and the brilliance of light yellow to colorless , the catheter may be placed within the duct consideration should be promptly reported to the physician. Clinical observation by varying fluid drainage , help the doctor to grasp the changes in condition and adjust the treatment plan.
③ color and bile drainage changes and disease relationships : To observe changes in biliary drainage characteristics , ( 1 ) bile Color: long-term patients with bile duct obstruction , or soy sauce is dark yellow color , drainage catheter patency 2-4 days after the color gradually becomes yellow, while bloating , jaundice gradually reduced. Suppurative cholangitis , bile may have a large number of purulent yellow-white floc and sediment floating , easy to plug the catheter , to be released upon the smooth drainage obstruction , abdominal pain, fever and other symptoms were relieved . ( 2 ) the amount of bile : the patient catheter obstruction , biliary drainage up to 400 ~ 1100ml / d, even 500ml / d, with ease congestion , liver function gradually improved. Some ENBD soon after drainage , about 100ml / d, but significant improvement in symptoms , which is due to the lower bile duct obstruction after release and eliminate inflammatory edema , sphincter function was restored , may be part of the bile duct into the surrounding supporting twelve duodenum .
④ prevent cholangitis and acute pancreatitis : ENBD is an important measure to relieve biliary obstruction , but improper handling but easy to induce or aggravate infections. Routine use of antibiotics and enzyme inhibition therapy . Postoperative check blood amylase, such as abnormal blood amylase increased, accompanied by abdominal pain, acute pancreatitis may be suspected .
IV Summary:
ENBD as a minimally invasive treatment techniques have rapidly relieve biliary obstruction, biliary reduced pressure, unobstructed drainage effect, so that the patient's condition rapidly eased, infection control, improving the symptoms of systemic poisoning. In clinical care should be prepared perioperative psychological care, the patient complained of postoperative listen and understand the complications that can occur after surgery, abdominal signs and close observation of drainage characteristics, and properly fixed, to maintain drainage tube patency, prevention and timely treatment of complications.