Kāore e taea e teInsides Driver te whakahaere i ngā matotoru rawa o te chyme; heoi, kei te wāteaa The Insides Port hei whakaranu i te chyme ki tētahi matotoru ngāwari ake kiataea ai e te Driver te whakauru anō. Tirohia ngā Tohutohu Whakamahi mō te PūnahaInsides®, ngā Tohutohu Whakamahi mō te Insides Port, me ngā wāhanga WhakahaereTūroro i roto i te pokapū whakangungu.
Hei aratohuwhānui, me angiangi te putanga neke atu i te 1 Rita/24 hāora hei whakauru anō.Mena he matotoru rawa te chyme o te tūroro, mā te whakamahi i te The InsidesPort i ia rā me ēnei mahi ka angiangi te chyme ki tētahi matotoru e taea tewhakahaere. Kei roto pea i tēnei:
• Rongoā ārai-nekehangamō te whakamutu i te whāngai
• Te inu i tētahi, iētahi atu karāhe wai anō rānei
• Te inu i te kotahi kite rua kapu kawhe
Kāore he tere rereo te Insides Driver nā te mea he wai me ngā matūriki te hanganga o te chyme. Kote chyme tino angiangi/pērā i te wai ka tere ake te whakahokinga mai i te chymematotoru atu i te chyme matotoru. Ka roa ake te wā mō te chyme matotoru atu nāte mea me huri ngā matūriki e te matatini Pump kia puta he pēhanga hei neke akei te Ngongo. He pai ake te ngaungau pai i te kai kia iti ake ai te mahi a tePump. Whakamahia te tere iti rawa e neke ake ai te chyme i te Ngongo heiwhakaiti i te mamae me te reflux o te tūroro. Ka taea e te taputapu ostomy tepupuri i te 200-300ml o te chyme, ā, ka taea te papu i roto i te iti iho i te 5meneti.
Ka whakawhitihia ete tūroro te Insides Pump i ia rua, e toru rānei ngā rā, me te whakawhiti anōhoki i ā rātou taputapu ostomy.
• Tonoa he mema o tewhānau/kaitiaki kia āwhina i te tūroro ki te whakahoki mai i te chyme ki roto itōna uaua.
Hurihia te papukia anga te mata papatahi ki muri o te taputapu ostomy. Kātahi kawhakatakotoria te The Insides Driver ki runga i ōna waewae, ka honoa te TheInsides Pump ki runga. Kia kitea te mata o mua o te The Insides Driver e tetūroro, e te kaitiaki rānei. Whakanohoia te taputapu ostomy kia noho tonu techyme i runga i te The Insides Pump nā te kaha ā-papa. Me pēhi te tūroro, tekaitiaki rānei i te chyme ki runga i te The Insides Pump mēnā e tika ana.
Ko te nuinga o ngātūroro e pupuri ana i te The Insides Driver ki tō rātou ringa matua, me te angawhakarunga o te papa o mua kia kite ai rātou, ā, ka taea e rātou te pēhi i tepātene "Aratau" hei neke i roto i ngā tere. Ko tō rātou ringa kore-matuae pupuri ana i te tuara o te taputapu ostomy, e "pupuhi" ana i techyme me te pēhi ki roto i te tuara o The Insides Pump. I te "pupuhi"i te chyme, kia whakamahia e te tūroro te papa o tōna ringa ki te pēhi ki rotoi te tuara o The Insides Pump kia kore ai he mōrearea o te tapahi, te kururānei i ngā maihao mai i te macerator i roto i The Insides Pump. Whakamahia tekaha ā-papa hei āwhina i te pupuri i te The Insides Pump kia ruku ki roto i techyme. Whakatenatenahia tō tūroro kia kimi i tētahi tūranga e pai ana, e whaihua ana hoki mō rātou.
Me uru pai te PāmuInsides ki roto i te pupuri kei muri o te Atekōkiri Insides. Me hono tuatahi teAtekōkiri Insides me te Pāmu Insides, i mua i te pēhi i te pātene 'Aratau' heitīmata i te whakaurunga anō o te chyme.
Papu Ārai –Whakamātauria ēnei Tohutohu Whakatau Rapanga hei wete i te Papu Ā-roto, ki tekore, whakawhitia te Papu Ā-roto. Hei aukati i te aukati i te Papu Ā-roto, katite kai i ngā kai muka miro e aukati ana i te Papu Ā-roto.
• Te Papu Insides® – Mewhakarite kia rumakina katoatia te Papu Insides ki roto i te chyme.
Te AtekōkiriInsides® – Me whakarite kia whakamātauria ngā tere katoa o te Atekōkiri Insidesmō te iti rawa o te 30 hēkona, kia 'pūpū' ai te chyme ki runga i te NgongoInsides. I ētahi wā ka neke haere mārire te matotoru o te chyme ki runga i teNgongo Insides.
Kāore i te tika tehononga – Me whakarite kia horoia te mata papatahi o te papu o roto i ngā paru,ā, me hono ngāwari te taraiwa o roto ki te papu o roto mā te taputapu ostomy.Puritia marietia te taraiwa o roto, ā, me noho tonu te papu o roto. Mā tēnei kawhakaatu kei te pai te hononga.
• Ka peke te Atekōkiri oroto i te papu Insides® – Ka taea tēnei te tupu i te tere 5, mēnā rānei kuaāraia te papu Insides.
Kāore te ngongo ite mau i raro i te fascia – Tērā pea kua paheke te punga porotaka i raro i tefascia. Tērā pea kei te mamae te tūroro, ka kite rānei koe i te roa haere o tengongo i roto i te taputapu ostomy e tohu ana kua paheke ki waho. Ki te kore tengongo o roto e tika te whakaurunga, kāore e whai hua te whakaurunga anō o techyme.
He angiangi techyme, kua whakamātauria e au ngā mea katoa, engari kāore anō kia pupuhi – Tērāpea ka puta tēnei me te ngongo e puritia ana he poihau. Tērā pea ka mau hemirumiru hau i roto i te ngongo, ka hanga he ārai hau. 'Miraka' te ngongo mā tekōwhiri me te whakapiko i te ngongo kia pakaru ai te mirumiru hau. Me mahi peatēnei i ētahi wā. Whakahaerehia te ngongo ki roto, ki waho hoki mō te 1cm kiakore ai e neke te ngongo.
Te tūtae i te pitoo te ngongo – Mena kei te whakaatu te ngongo The Insides Tube, te ngongo rāneikua puritia ki te poihau, i te roanga ake o te ngongo i roto i te taputapuostomy, ā, kāore e mamae mō te tūroro, engari kāore te chyme e haere mā roto ite ngongo, tera pea he tūtae e kapi ana i te pito o te ngongo. Tirohia ngāwhakaahua i raro nei. Tērā pea ka puta tēnei nā te mea kāore i te tūroro tewhakarite pai o te puku i mua i te pokanga, nā te nui rānei o ngā rongoāārai-nekehanga. E taunakihia ana kia whakaurua he ngongo hou.
Mō te TūroroKotahi anake ngā taraiwa, ā, kaua e whakamahia ki te neke atu i te kotahitūroro mō ngā take ture, hauora me te haumaru. Me maka atu te taraiwa o TheInsides i te wā e hurihia ai te enterostomy, te fistula rānei o te tūroro, e aiki te mana whakahaere maka o te rohe. Tirohia te Pūnaha Insides - Ngā Tohutohume te Whakaahuatanga Hangarau kei roto i te takai mō ētahi atu aratohu.
Kāore pea i tetino tūpono te whakamahi i te taputapu ostomy, engari, ki te puta tēnei,whakapā atu ki te tīma haumanu o The Insides Company hei whakatau.
I ētahi wā, mā tetūroro he nui rawa te putanga e werohia ana neke atu i te 10-12 ngā wā i te rā,ka puta he kōhao iti ki te kirihou o te taputapu ostomy i mua tonu i te wāhi enoho ana te Papu o roto i te taputapu. Ko te nuinga o tēnei ka puta nā te meakāore te Papu o roto i te mea kua whakakīia ki te chyme, arā, kāore he chyme iroto i te taputapu ostomy i te wā e honoa ana, e mahi ana hoki te Kaitaraiwa oroto. Ka puta anō hoki tēnei nā te mea ka hono te Kaitaraiwa o roto i te wāhikotahi i ia wā, ā, mā roto i ngā wiri me te hanga waku ka puta pea, ka puta hekōhao. Taupokina te wāhi o te taputapu ostomy ki tētahi wahi iti (2cm x 2cm) ote hydrocolloid hei whakapai ake i te āhua o te kirihou.
He tikanga haumarukei te whakatūhia, arā, mēnā ka pau te pākahiko o te Kaitaraiwa o roto, kāore etaea te utu anō i te utunga kotahi. Ka tūtohu mātou kia utua te Kaitaraiwa mōngā hāora e rua (2) i ia wiki kia kore ai e pau te pākahiko. Mēnā ka pau te pākahikoo te Kaitaraiwa:
• Tuatahi, kia tika tewhakamahi i te rihi pakitara. Ka utua noa e te Atekōkiri mā tana ake rihi
• Honoa ki te rihipakitara, ka tatari mō te 15 meneti pea kia mura te uira i te papa o mua.
• Momotuhia, tatari mō te1 meneti ka hono anō ki te rihi pakitara.
• Whakahoutia te taahiraa1 me te 2 kia maha ngā wā kia taea rā anō e te Taraiwa te pupuri i te utunga mete whakaoti i te utunga katoa.
• Ki te kore tēnei e utui te Taraiwa, whakapā atu ki tō kaituku ā-rohe, ki te Kamupene The Insidesrānei.
Me whakauru tonute Ngongo o roto e te tohunga hauora kua whakangungua tika ki te whakaurungangongo whekau. Ka whakakapia te Ngongo o roto i ia 28 rā.
Ka taea te piko mete whakaroa i te roa o te puku, e tū ana i waho o te fascia, me te herniaparastomal. Me tūpato i te wā e whakauruhia ana he ngongo ki roto i te tūrorohe hernia parastomal. Me whakamahi te tātari matihiko hei ine i te roa, tepiko, te whaiti rānei me te ahunga hei whakauru haumaru i te peka tawhiti o teenterostomy. Mena he ātete, he mamae rānei mō te tūroro, kāore e tika ana kiawhakauruhia anō te chyme. Mena kāore e kitea he āhuatanga whakararuraru o tehernia mā te tātari matihiko, me whakamahi te tātari matihiko i te ngongo e tetohunga hauora kua whakangungua. E taunakihia ana kia whakamahia he ngongopupuri poihau, kaua ko te The Insides® Tube i tēnei wā.
E toru ngā NgongoĀ-roto e whakaratohia ana i roto i te Pūnaha Ā-roto hei āwhina i te whakaiti ite hinganga o ngā ngongo. E matapaetia ana ka hinga te ngongo i te iti rawakotahi i te wiki tuatahi.
E toru ngā takepea mō tēnei:
Ka unuhia noatia ete tūroro i a ia e whakawhiti ana i tā rātou taputapu ostomy.
Ko te peristalsiste pana i te ngongo ki waho. Ko te tikanga ka noho te ngongo ki roto mō te 1-2rā, kātahi ka paheke noa ki waho. Whakatenatenahia te tūroro kia pupuri i teringaringa pupuri ngongo i te wā e werohia ana, e hikoi ana rānei. I muri i tewiki tuatahi, me mutu tēnei nā te mea kua hoki mai te peristalsis tūturu. Mā teInsteriors Clip tēnei e āwhina.
He whānui rawa tetapahi pokanga i te paparanga fascial, te wāhi e puta ai te pito proximal me tepito distal, kāore e taea te pupuri i te āhua porotaka o te Tube, nō reira kapaheke noa iho. Mā te Insides Clip e āwhina ki te pupuri i te punga ki tōna wāhi.Heoi, tēnā kōrero ki te tīma haumanu o The Insides Company mēnā ka haere tonutēnei.
Ki te taka tonungā ngongo Insides ki waho, ka tūtohu mātou kia whakamātauria he ngongo whāngaie puritia ana ki te poihau.
Ki te kore etutuki ngā whakataunga katoa, ko tētahi atu huarahi hei pupuri i te ngongoInsides ki tōna tūranga ko te whakamahi i tētahi atu taputapu ostomy convex, kawhakatakotoria ki muri ki mua, ki runga tonu i te taputapu ostomy tuatahi e mauana ki te whitiki stoma. Mā te whakatakoto i tētahi taputapu ostomy katoa kirunga ka tangohia ngā pūwāhi pēhanga, ā, ka tukuna he mata whānui hei"ārai-muri" hei pupuri i te Ngongo ki tōna tūranga. Hei tauira:
Mena kāore e taeae koe te whakauru i te Ngongo Insides ki te 28 Fr, ki te 22 Fr rānei – mewhakamārama tēnei i te wā o te whakaahua rerekē, me te aromatawai i te whekautawhiti mō te whakaurunga anō o te chyme. Ko ngā take pea kāore e taea tewhakauru i te Ngongo ko ēnei e whai ake nei:
Hewhakatuwheratanga whaiti o te fascia – me whakauru pea he hihi-X/endoscopic. Meāta whakaaro ki te wāhi e wātea ana i roto i te whakatuwheratanga fascia. Meuru pai ngā peka proximal me te distal me te ngongo e whakatakotoria ana kiraro, me te kore e aukati i te rere o te toto, e whakararu rānei i te stoma.Kia whakatakotoria te ngongo, ki te huri te tae o te stoma, ki te kitea rāneiētahi atu tohu aukati, tangohia tonutia te ngongo. Kāore tēnei tūroro e tikaana kia whakauruhia anō te chyme ki te The Insides System.
Te piko/tewhakawhāiti/te whaiti o te whekau i raro tonu i te fascia - tera pea me whai ite hihi-X/te whakauru endoscopic. Mā te whakatakoto i te ngongo ka tika ake tewhekau kia kore ai e hiahiatia he hihi-X i te wā e whai ake nei. Tērā pea mewhai i tētahi ngongo iti ake ehara i te mea kei roto. Ki te kore, me whakamahii te hihi-X i ia wā hei whakakapi i te ngongo.
Te whēkau pitotawhiti kua memeha - He mea āwhina te whakawhanui mārire ki te wai mahana me tewhakamahi i te catheter Foley iti hei tīmatanga whakaora i te whēkau pitotawhiti kia taea ai te whakauru i te ngongo whāngai pito tawhiti. I runga i tetaumata o te memeha, ka taea pea e koe te whakauru i te Ngongo i taua rā anō,ka taea rānei te mahi anō i roto i ngā rā maha kia tae atu ai ki te wāhi kataea te tāuta i te Ngongo 20, 22 Fr rānei i raro iho.
Mena he fistulaenterocutaneous (ECF) tō te tūroro, tēnā whakapā atu ki te kaiwhakaora stoma oThe Insides Company mō tētahi otinga takitahi.
E mōhiotia ana hetino uaua, he tino whakararuraru hoki te whakauru i tētahi tūroro he ECF tōnaki roto i te pēke. Me whakamātau me te hapa i ngā hua me ngā tikanga maha heitiaki i te kiri peri-fistula me te whakahaere i te rere o te chyme ki roto i tetaputapu ostomy.
Ngā mea heiwhakaaroaro:
• Reflux – Mā te reretonu o te chyme ki runga i te hydrocolloid i te pūaha o te taputapu ostomy katere te pakaru o te hydrocolloid, ā, ka puta he turuturu. Arotakehia te pūtakeo te reflux.
• Whakaitihia te tere ote Atekōkiri Insides® hei whakaiti i te reflux.
• Whakaranua anō ngā inuiti ake, ngā inu auau ake hei whakaiti i te reflux.
• He rangitahi noa iho,ā, ka ea ina ora anō te puku?
• He mate kōroke tetūroro?
Nā te āhua o tepuku e piko ana, e tino taunakihia ana kia whakamahia ngā taputapu pēnei i ngāhiri hydrocolloid me te whakapiri. Whakaarohia te hanga i ngā hiri hei whakanuiake i te mimiti me te whakaiti i te pirau o te hiri.
Te matotoru o tekime – Ehara i te mea ka whakanui ake te kime angiangi i te mōrearea o tematewai anake, engari ka whakanui ake hoki i te mōrearea o te kime e paheke anai raro i te pūaha o te taputapu ostomy, ka puta he turuturu. Whakaarohia tewhakamātotoru i te kime mā te rongoā ārai-nekehanga hei whakaiti i tēneimōrearea. Heoi, me noho tonu te matotoru o te kime ki roto i te awhe noa kiahoki mai ai te mimiti. Ka taea hoki e ngā rongoā ārai-nekehanga te whakararu ite puku mārō i raro iho i te stoma.
Pūmau pupuri – Kamau te pūmau pupuri o te Ngongo i te kōhao o te taputapu ostomy? Hikihia tengongo ki te tūranga whakapae ina whakaurua te miro ki te taputapu ostomy. Mātēnei ka mārama te pūmau pupuri i te taha o te taputapu ostomy, ā, ka nohokatoa ki roto i te pēke.
Pēke pō – Heiaukati i te kohikohinga o te chyme i te pūaha o te taputapu ostomy, tāpirihiahe pēke pō ki te pito o tētahi taputapu ostomy ka taea te whakaheke i te wai.Mā tēnei ka hangaia he korehau, ka kukumea te chyme mai i te pūaha. Mena kawhakamahia tēnei kōwhiringa, kia mau te tūroro i tētahi taputapu ostomy e ruangā wāhanga, he matapihi rānei, kia taea ai te whakahoki i te chyme ki roto ite pēke kia whakaurua anō.
• Taputapu Ostomy – Mewhakarite kia whaihia ngā aratohu katoa a te kaihanga i te wā e whakamahia anate taputapu ostomy. Ko tētahi tauira o tēnei ko te whakamahana i tehydrocolloid i mua i te whakamahinga.
Āe, engari mewhakaoti e koe ēnei mahi hei mahi haumaru. Tirohia te wāhanga Whakahaere Tūroroi te pokapū whakangungu.
• Whakahokia anō ngāchyme katoa e takoto ana i roto i te taputapu ostomy i mua tonu i te whakamau ite putea moe.
Tangohia ngārongoā poto-mahi i te iti rawa i te whā (4) hāora i mua i te tāpiritanga o tepēke moe. Mā tēnei ka mōhio kua nakunaku te rongoā, ā, kua whakaurua anō kiroto i te pēke moe i mua i te tāpiritanga o te pēke moe, kia iti ai te rongoā etoe ana i roto i te pēke moe.
Me whakauru anō techyme e noho ana i roto i te pēke pō i roto i ngā hāora tekau mā rua (12). Heitauira, ki te tāpirihia e te tūroro te pēke pō i te 10pm, me whakauru anō erātou te mea e noho ana i roto i te pēke pō i waenga i te 9am ki te 10am i terā e whai ake nei. Ki te noho te chyme i roto i te taputapu ostomy mō te roaatu i te tekau mā rua (12) hāora, me maka atu.
Tirohia te wāhangaI mua i te whakatō anō ki te Pūnaha Insides. Ka taea e te tūroro te tīmata anōi te whakatō chyme mēnā ka taea te whakanoho haumaru i te ngongo whāngai ki tepeka tawhiti, tēnā whakapā atu ki te tīma Hauora Insides i mua i te whakamātau.
Ko te peka e pikoana (proximal, distal, e rua rānei) he mōrearea ā-roto o te stoma, te fistularānei nā te mea ka kawea mai ngā peka whekau mā roto i te pakitara puku. Kaputa noa mai ēnei, ka piki ohorere rānei te pēhanga o roto i te puku pēnei i temaremare, te hiki rānei i te puku. Ko te tikanga, ka taea te whakaiti i te pekae piko ana e te tohunga hauora kua whakangungua i roto i te tohungatangacolorectal mēnā ka tirotirohia i roto i ngā haora 24 o te putanga mai, engarihe nui te mōrearea o te piko anō. Ina tata te piko ki te wā e tika ana mō tepokanga kati, ka kiia tēnei he tohu pai kua heke, kua memeha rānei ngā pirimumura, nō reira he haumaru te hoki anō ki roto i te puku.
Mena kāore tetaputapu ostomy, te putea whara fistula rānei o te tūroro e roa mō te 24 hāora,e hiahiatia ana rānei he momi iti hei ārai i te turuturu tonu o te chyme i raroi te pereti turanga - Kaua e tīmata i te Pūnaha o Roto kia tae rā anō te puteaki te 24 hāora, hei whakaiti i te taumaha o te whakarerekētanga me te ngarongatonu o te chyme ki ngā turuturu o te putea kāore e taea te whakauru anō. Ngāāhuatanga hei whakaaro:
• Te wawaotanga kaha a tenēhi whakaora i te puku, te tiaki patunga rānei hei whakapai ake i te pēke.
• Ko te tikanga whānui,me pakeke ake te stoma, te fistula rānei (me te whakaora ake i te patunga o tefistula) hei āwhina i te piri o te pēke.
Mena he nui tehapa o te fistula, ā, ka pupū te chyme, inā koa kei te takoto papatahi tetangata, he wā pea tēnei hei whakamahi i te momi pakitara iti hei kukume i techyme. He pai tēnei mai i te tirohanga o te pupuri i te putea stoma, i te puteapatunga fistula rānei, engari, ka aukati i ngā nekehanga o te tūroro.Whakaarohia hoki te takai VAC ki te patunga fistula i tēnei wā hei tere ake tewhakaora.
Whakaarohia itēnei wā kia tiakina he 200ml o te chyme i ia rā, ka taea te tuku anō ā-ringaki raro iho hei tīmata i te whakaora i te puku o raro, me te whakarato i te nuio te enteric mō te hauora o te lumen. Ka taea tēnei te whakaoti i te wā tika ote rā ina whakawetohia te momi pakitara mō te 20-30 meneti hei tuku i te bolus.Pērā i te 2pm i te wā kua mutu te whakawhiti huringa.
Kāore e kiia anahe pai ngā tūroro kāore i te tino tika te tūnga o ngā stoma (i roto i ngākōpuku puku, i raro i ngā rara, i waho o te tirohanga a te tūroro, ngā stomakua hoki whakamuri, kua piko rānei), ā, he poto te wā piri o te pēke stoma (itiiho i te 24 hāora i mua i te turuturu) hei whakauru anō i te chyme ki roto i teThe Insides System. Mēnā ka taea te neke atu i te stoma, te hanga anō rānei kiaputa ake ai, kia roa ake ai te wā e mau ai te taputapu, ka taea te whakaaro anōki te whakauru anō i te chyme. Ko te ngenge me te taumaha o te whakawhitipinepine i te taputapu ostomy, me te maumau o te chyme i ngaro i ngā turuturu ote taputapu, ka whakakore i te whakamahinga whai tikanga o te taputapu.
Mena he BishopKoops stoma tō te tūroro, tērā pea kāore te Insides System e mahi nā te mea kaāraia e te ngongo te putanga anake e puta ai te chyme ki roto i te taputapuostomy. Tērā pea ka mahi te reinfusion chyme ā-ringa nā te mea ka tangohia tengongo i ia wā ka oti te bolus. Ina whakatakotohia he ngongo mō te bolusā-ringa reinfusion chyme, tera pea me whakamahi i te radiology wawao heiwhakatakoto i te ngongo, ka whakakorea te whakamahinga auau o te reinfusionchyme. He mea nui te whakamahere pokanga me te whakarite hanganga stoma tika mōte whakaora reinfusion chyme kia angitu ai te tīmatanga o te whakaorareinfusion chyme me te Inside System. He pikitia o te Bishop Kops stoma ewhakaatu ana he aha te kore e hototahi te Insides System ki tēnei momo stoma:
Tirohia te wāhangaWhakahaere Tūroro i te pokapū whakangungu.
Kāore te reflux ekino ki te tūroro engari ka roa ake te wā e pau ana ki te whakahoki mai i techyme ki roto i tōna tinana.
Tērā pea ka putate reflux:
Tere tere – Kaputa he reflux i te chyme matotoru angiangi, ka whakakīia anō ki te tautuhingateitei i runga i te The Insides Driver, ā, ka roa ake te wā e hiahiatia ana heiwhakakī anō. Me whakatakoto te Insides Driver ki te tere iti rawa e neke ai techyme mā roto i te Insides Tube.
Te kōroke – Tērāpea he kōroke te tūroro nā te nui o te rongoā ārai-nekehanga. Me whakamutu terongoā ārai-nekehanga hei whakaiti i tēnei. Me whakawātea te whekau pito o tepuku kia puta ai he urunga whai hua o te chyme.
Te whēkau pitotawhiti kua memeha – Me ata whakaora te whēkau pito tawhiti. Ka nui ake tereflux i te tīmatanga nā te mea me whānui, me whakaora anō hoki ngā pakitara ote lumen. Mā te inu i ngā inu iti i ia rā ka tutuki tēnei, ā, ka whakaiti i tereflux.
Tirohia ngāAratohu Kai kei roto i te Aratohu Tūroro ki te Whakaora Chyme Reinfusion i tepokapū whakangungu. Ko ngā mōhiohio kai e pā ana ki te whakamahinga o TheInsides System, kāore e whakarato i ngā mōhiohio kai whānui mō te tūroro.
Ka mau te kaikikokore 'miro' muka ki te tuara o The Insides Pump, ā, ka whakaiti i te pai ote pupuhi. Āta karohia, whakaranua rānei ngā kai muka kia pai ake ai te urungaanō o te chyme.
Tirohia ngāwāhanga Tohutohu Whakamahi mō te Pūnaha The Insides® me te Whakahaere Tūroro iroto i te pokapū whakangungu.
Mā te whakaora ite puku pito tawhiti kua memenge, me te tīmata i te whakaurunga anō o te chymeka totoro ngā pakitara lumen o te whekau. Ka taea e tēnei totoro te whakaputa ite mamae puku horapa, te whakapairuaki, me te ahua pupuhi mō te tūroro. Ka roaake te kore mahi, ka piki ake te taumata o te memenge me ngā tohu e whai akenei ka pā ki te tūroro. Mā te whai i te aratohu kua whakaratohia mō te whakanuiake i te manawanui ka whakaiti i ngā tohu mō te tūroro, ka whakarite kiangohengohe te tūroro, ā, ka whakaora i te puku o te tūroro i roto i te kotahiki te toru wiki. Kia oti te whakaora i te puku, me memeha ēnei tohu.
I a te tūroro ewhakanui ana i tōna manawanui ki te whakaurunga anō o te chyme, ka makahia tikaatu te chyme mai i te taputapu ostomy. Ka taea te tuhi i ēnei ngaronga kupengaki te rekoata whāngai anō a te Tūroro, ki te Pukapuka Rārangi Tūroro o te Pūnahao Roto rānei. I te whakaoranga o te puku tawhiti, ka iti ake ngā ngarongakupenga, ā, ka nui ake te whakaurunga anō o te chyme bolus. Kia oti tewhakaoranga o te puku tawhiti, me whakauru anō e te tūroro te nuinga o ānaputanga e taea ana e ia.
Ko tētahi o ngāpānga taha noa o te whakauru anō i te chyme ko te mamae, te whakapairuaki, mete pupuhi i te wiki tuatahi. Ka tere te memeha ina oti te whakaora i te puku.
Āe, tirohia tetuhinga Aratohu Whakahoki Mai i te Chyme me te Kai Parenteral mō te Whakamutu ite Utu.
Kāo, kaua tetahimea e tāpirihia ki te taputapu ostomy o te tūroro hei whakauru anō. Ko ngā meao roto o te puku e uru noa ana ki te taputapu ostomy o te tūroro me whakauruanō engari ko te wai i te wā whakamātautau tuatahi.
Tena koawhakamōhio atu ki te tūroro he wheako whakararuraru pea te whakaora i ō rātouwhekau pito, engari ka āta whakahaerea, ā, ka iti noa iho te mamae. Tena koawhakamanahia tō tūroro ka memeha haere te mamae ina oti te whakaora i ō rātouwhekau.
Tirohia ngāwāhanga Tohutohu Whakamahinga o te Pūnaha Insides® me te Whakahaere Tūroro iroto i te pokapū whakangungu. Tāpirihia anō te 50ml o te chyme kotahi i te rā,ā, āta whakanuia te auau kia eke ki te taumata e taea ai te whakamanawanui.Tērā pea ka roa pea tēnei ki te toru (3) wiki.
• Ki te tīmata te chymeki te neke ake i roto i te Ngongo i te tere 1 – 3, tata ki te 50 ml ka ringihiaanō i roto i te 15 hēkona.
• Ki te tīmata te chymeki te neke ake i roto i te ngongo i ngā tere 3 – 5, tata ki te 50 ml karingihia anō i roto i te 30 hēkona.
• E taunakihia ana kiatīmata ki te The Insides Tube 22 Fr mō ngā rā tuatahi e 28 i mua i te neke kiThe Insides Tube 28 Fr.
Kaua e tīmata kite whakamutu i te kai i ngā rongoā ārai-nekehanga, me te kai nui kia tae rā anōki te wā e ora pai ai te tūroro. Hei whakaiti i te pikinga o te putanga mai ote wai ki roto i te taputapu ostomy, me te whakanui ake i te mōrearea o te matewai.
Tirohia te wāhangaWhakahaere Tūroro i te pokapū whakangungu me tēnei pātai, Ka taea e au tewhakamahi i tētahi tāpiri putea pō hei hopu i aku putanga pō?
Tirohia te tuhingaI mua i te whakauru anō ki te The Insides System i te pokapū whakangungu. Tērāpea ka puta he mate puku mārō i te tīmatanga, engari ka taea te whakahaere māte whakamahi i te paura rongoā whakangāwari osmotic me/ranei te enema hei whakataui te mate puku (whakapā atu ki te tīma haumanu mō ētahi atu kōrero). Kia tūmotuhake te tūroro ki te The Insides System, ā, kia whakauru anō hoki i tenuinga o te chyme, tīmata ki te whakamutu i te PN me ngā rongoā ārai-nekehanga.Ka tīmata anō te whakauru anō o te chyme i ngā tukanga entero-physiological(tae atu ki te hangarua enterohepatic me te ileal brake), e whakaiti ana i ngāhunanga puku, ā, ka taea te whakanui ake i te mimiti rongoā ā-waha. Mō ētahiatu kōrero, pānuihia te blog How chyme reinfusion therapy restoresenterohepatic recycling, reinstates the ileal brake, and alters drug absorbing.
Tirohia teWhakahaere Tūroro i te pokapū whakangungu me tēnei pātai - Me aha ahau mō tereflux?
Ka taea e terongoā ārai-nekeneke te whakararu i te puku mārō, ka nui ake te reflux.Aromatawai haumanu mō te puku mārō, ā, whakatikatikahia te horopeta o te rongoāārai-nekeneke e ai ki te hiahia. Aromatawai haumanu i te hiahia mō ngā meawhakauru, ā, whakapā atu ki te tīma haumanu o The Insides Company mō ngāaratohu whakahaere.
Ki te kore e tohuae te tīma pokanga, ka taea e te tūroro te whakauru anō i tōna chyme tae noa kite rā o te pokanga.
Ko te whāngai tonuki roto i te puku i te tere ōrite e whakaata ana i ngā nekehanga peristalticnoa, ā, kāore e totoro i ngā pakitara lumen pērā i te tukunga bolus o te chymeme The Insides Driver. Ka whai wā whakatikatika mō te puku distal kia taunga kite tukunga bolus o te chyme engari ka ea pea tēnei i roto i te wiki tuatahi nāte whakaora mai i te whāngai tonu ki roto i te puku. Mena kei te mamae tonu,kei te kore whakamarie rānei i muri i ngā wiki e 2, aromatawaihia, ā, kimihiate take. Tērā pea he aukati/whaiti/stenosis kāore i te mōhiotia i puta noa mai.Ko te pokanga o mua i hua ake ai he hononga anastomotic distal, tera pea ikuiti i te wā e whakaora ana, e puta ai te mamae, te kore whakamarie rāneikāore i kitea i mua nā te whakawhiti o te tukunga mai i te tukunga tonu ki tebolus.
He pai ake tetīmata wawe tonu i te rongoā whakauru chyme, arā, i ngā wiki e rua i muri i tepokanga hanga stoma, ā, ina pakeke te putanga tawhiti o te fistulaenteroatmospheric kia uru ki te ngongo whāngai (tata ki te 8-12 wiki mai i teputanga tuatahi). Mā te tīmata wawe tonu i te rongoā:
• Ka whakaitihia temōrearea o te memeha haere o te whekau pito tawhiti,
• Ka whakahoutia tewhekau pito tawhiti, ā, ka tiakina mō te wā roa,
• Ka ako te tūroro ki tewhakahaere i tōna stoma, i tōna fistula rānei i te wā kotahi ki te whakahaerengongo me te papu. Ehara tēnei i te mahi taumaha ki te whakarite ki tētahi kuaroa e whakahaere takitahi ana i tōna ostomy
Ko te take mō tewhāinga nui kia whakahokia mai ngā mea huna/putanga o te puku hei ārahi i tetika o tēnei mahi.
• Mena he ileus tō tetūroro i muri i te pokanga, mā te whakahoki anō i ngā hinu o te puku kawhakawhanui ake te puku
Mena nā te putangapuku, te aukati rānei o te duodenum, ā, kei tawhiti te ngongo whāngai o te pitotawhiti, te whāngai jejunostomy rānei ki te aukati, āe, he mea āwhina tēnei kite whakahoki anō i ngā hinu puku hei āwhina i te mimiti matūkai ki te toenga ote whekau iti.
Āe, ka taea e koete whiwhi i ngā painga wai. Heoi, me puta te putanga proximal i te whekau iti,nō reira ko te chyme te matotoru tika hei whakauru anō. He pai ake mēnā ko teputanga colonic distal e puta mai ana i te colon ascending kia nui ake ai ngā paingawai me te whakaiti i te auau o te paru e tukuna ana mā te rectum. Tirohia ngāTohutohu Whakamahi mō te Pūnaha The Insides® i runga i te whakaurunga ngongo.
Me tūpato i tewhakamātautau i te mahi a te putea J a te tūroro, te putea ileal-analanastomosis rānei (IPAA). Me whakamōhio te tūroro ki te pānga o te whakapūpū ite chyme ki roto i te putea J. Tāpirihia anō he iti o te chyme i te tere puhoi.
Āe, ka taea e koe,engari me whakaaro ki ngā mea e whai ake nei:
• Ko te putanga ewhakahokia mai ana me hanga he chyme, e ahu mai ana i te whekau iti, kia pai aite mahi a te matotoru me te Pūnaha o roto.
• He aha te whāinga?
• Hei tiaki i te whekau iwaho o te ara iahiko e kore e tangohia i te wā e hurihia ai?
• Te whakanui ake i tekai totika?
• Te whakanui i temakuku, ngā mea e rua rānei?
• Kei te tūroro tepūkenga, te hihiri, me te tautoko a te whānau/hoa ki te whakahaere i ngā ngongoe rua, ā, nō reira, e rua ngā werohanga anō?
He aratohu mō tewhakahaere i ngā pūnaha whakauru anō e rua (neke atu rānei):
• Me arotahi ki tewhakahoki anō i te tinana ki te peka tawhiti rawa atu kia tino mimiti ai ngāmatūkai.
• Tāpirihia te werohangatuarua ina māia te tūroro ki te werohanga tuatahi. Me ata whakahaeretia tēnei iroto i te inenga āta, kia mōhio ai te tūroro kei te ora tonu ia.
• Tautokohia ngāwhakarerekētanga o ngā taputapu ostomy kia tū motuhake, kia māia hoki rātou
• Mena kei roto i tejejunum distal/ileum proximal te putanga o te rua o ngā oko/fistula (mai i tetuatahi), me werohia anō hoki ki tēnei peka distal i ngā wā katoa e taea ana.
Mena kei roto i teileum distal/colon e piki ana te putanga o te rua o ngā oko/fistula (mai i tetuatahi), whakauruhia anō te chyme ki roto i tēnei peka distal kia rite ki ngātohu haumanu hei whakarite kia whāngaihia, kia makuku hoki (Tērā pea e 2-4 ngāwā ia rā)
Kia hoki anō teileum pito whakamutunga ki te "porowhita", ka tino matotoru teputanga o te toto o te tūroro, nō reira kia mōhio te tūroro me pēhea tewhakaiti i te putanga o te toto, me mutu te tango i ngā rongoā ārai-nekehanga,me te whakaiti pea i te whakahokinga mai ki te rua i te rā (me maka atu teputanga matotoru kāore e taea te whakahoki).
• Whai muri i te tirotiroi te tūroro i ia wā kia mōhio ai kei te pai tana whakahaere. Whakamutua tewerohanga anō i te putanga tuarua o te ngongo mēnā he āwangawanga mō tewhakahaere i te mate, ā, tīmata anō ina rite te tūroro.
• Arotakehia anō ngāwhāinga o te whakaurunga anō.
Tirohia te RārangiArowhai Aromatawai Tūroro. Mena ko te tohu mō te whakaurunga anō o te chyme ko:
• Whakanuia te mimiti ongā kaora me ngā wai
• Mena kei roto te koronii te porowhita, he pai te hanga i tētahi wāhanga poto o te ileum, 15-20cm teroa. Hei karo hoki i tētahi taunekeneke i waenga i te ngongo me te takirereileocaecal.
• Ki te kore te koroni,he nui te wāhanga o te ileum, arā, 30-40cm te roa, hei whakaoti i te ileostomy
• Whakanuia te mimiti ongā wai me ngā electrolytes
• E whakaaetia ana tewhāngai tika atu ki te koroni e piki ake ana, engari he pai ake kia 15-20 peate iti rawa o te ileum hei whakauru tuatahi.
Āe, ka taea e koe.Ka taea te whakanui ake i te mimiti o ngā matūkai mā te whakauru anō i te chymekotahi kia 2-3 ngā wā i mua i te maka atu. Kāore anō tēnei chyme kia kiia hepara. He poto te roa o te puku, nō reira kāore e ranea te roa o te puku e wāteaana mō te mimiti nui o ngā matūkai i te wā tuatahi. Whakanuia te mimiti matūkaimā te whakauru anō kia 2, kia 3 rānei ngā wā, kātahi ka maka atu.
Me tirotirohia tetūroro e tā rātou tīma pokanga kia mōhio ai ki te pūtake o te raruraru.
Kāore anō kiawhakamatautauria te Pūnaha Insides i runga ake i taua teitei, nō reira kāore ite tūtohutia kia whakamahia i runga ake i te 3000m.
He ngoikore tehanganga o ngā tūroro EAF, ā, he pakarukaru pea te kiko, ā, he nui te mōreareao te herniation me te prolapse. He whaiti ake te putanga o te pito tawhiti nāte mea he poka o te whekau. Kāore hoki he fascia hei pupuri i te ngongo i muri,nō reira me whakaneke ake kia pai ake ai te pumau o te ngongo.
Tērā pea ka rerekēte ngongo e whakamahia ana mō te werohanga anō o te chyme i te wā e ora ana tetūroro. Ka taea te whakamahi i tētahi ngongo poihau e mau ana he pito hāneaneakia taea ai e te papu o roto te neke ki tōna pito. Tirohia te Aratohu Whakaurungao te Ngongo Gastrostomy me te aratohu tirohanga mō te Ngongo Cook Entuit 24Frhei aratohu mō te whakaurunga me te whakamahinga.
He pai ake tewhakauru anō o te chyme i te ngongo Foley 2-ara 22 Fr i te ngongo Foley 3-ara24 Fr. Ka taea e koe te whakapū i te paipa whakamakuku o te 24 Fr Foley, heoi,he whakahekenga pēhanga, ā, me kaha ake te mahi a The Insides Driver ki te nekei te chyme ki runga i tēnei ngongo.
• He pai ake te whakamahii te ngongo gastrostomy 24 Fr Cook, Halyard rānei mēnā koinei te mea e wāteaana ki a koe, nā te mea kāore koe e hiahia ki te takai i te nuinga o te ngongoki roto i te taputapu ostomy.
Ka taea tewhakahoki mai i te ate. Ko te āhua o te puku e pai ana, e tūpono ana hoki:
• kāore he tangata mā tewaha
• he rerenga wai i roto ite awaawa o te aukume e tango ana i te aukume,
• he fistula mucous/waetawhiti/jejunostomy whāngai pito stoma (kāore he putanga proximal))
Tērā pea kei tewhiwhi te tūroro i te kai enteral tika ki roto i te fistula mucous/waewaedistal/whāngai jejunostomy end stoma. Hei whakapai ake i te pakaru o te lipids,te whakamahi anō i te hangarua enterohepatic me te aukati ileal, me tāpiri heau ki te kai enteral/ngongo distal e whāngai ana i te fistula mucous/waewaedistal. Ko te putanga au e tumanakohia ana i ia rā kei waenga i te 200 mL –1000 mL, mā te rōrahi e ārahi te huarahi mahi pai rawa atu.
Mena he iti iho ite 500 mL te putanga o te au i te rā, whakatakotoria he taputapu ostomy kirunga i te ngongo percutaneous hei kohi i te putanga o te au. Ringihia te au kiroto i tētahi kapu ka mahi i tētahi bolus ā-ringa o te au ki roto i te ngongowhāngai distal (ki raro i te putanga rongoā). Nā te iti o te rahinga, 1-2 noaiho pea ngā wā e hiahiatia ana i te rā.
Mena he nui ake ite 500 mL te putanga o te au i ia rā, whakatakotoria he taputapu ostomy pēpihou me te The Insides Neo kua oti te whakauru ki roto (Hollister 3778,Coloplast 18700 rānei) ki runga i te ngongo percutaneous hei kohi i te au. Kataea e te taputapu ostomy pēpi hou te pupuri i te 50-100 mL, nō reirawhakaritea te auau o te whakahokinga au ki te rahinga putanga. Honoa he ngiraENFit ki te The Insides Neo Adaptor ka tangohia te au. Kātahi ka whakatakotoriate ngira ki roto i te papu ngira me te tautuhinga toronga, ka whakaritea tetere hei whakahokinga ki roto i te putanga rongoā o te ngongo whāngai distalkua whakanohoia ki roto i te fistula peka distal/hucus. Ka kohia te au hou kiroto i te taputapu ostomy pēpi hou i te wā e rere ana te whakahokinga au tonu.
He pai te tūrorohe nui te putanga o te stoma, te fistula rānei kua oti te whakaora, hei tuku kite kāinga mā te rongoā reinfusion chyme. Mā tēnei ka taea e rātou te whakahaeretika i ō rātou taumata wai, engari ko te mea nui ake, ko te noho i ō rātou rāwhakamutunga ki te kāinga me te whānau me ngā hoa, kaua ki te hōhipera.
Tirohia te wāhangaI mua i te whakauru anō ki te Pūnaha Insides i te pokapū whakangungu.
Kāo, kāore anō kiatae mai he urupare mai i ngā kiritaki mō tēnei. Ka tino taunaki mātou kiapānuihia, kia mārama hoki ngā tākuta ki te Pūnaha o roto - Ngā Tohutohu mō teWhakamahinga me ngā tuhinga kei runga i te pokapū whakangungu i mua i tetīmatanga o te taputapu me ā rātou tūroro.
He aha te mea e pātika ana ki te āwangawanga?
• Kei te mau tonu tengongo me te āwangawanga mō te āheinga ki te mahi i ngā mahi o ia rā?
Ko te huarahianake hei tino mōhio ko te whakatakoto i te Ngongo, me te aroturuki me tetautoko i te tūroro kia mahi me tēnei. Me whakarerekē pea i ngā nekehangatinana. Hei tauira, me piko ki raro hei here i te here hu; me whakatakoto pea ete tūroro tōna waewae ki runga i te paepae hei here i te here hu.
• He whaiti te urunga kite putanga tawhiti
Me whakamātau tetātai matihiko i te tuatahi. Mēnā kāore e taea te whakauru i te maihao iti rawaki raro, he mea tika kia whakawhanuitia te putanga o te stoma e te tohungahauora kua whakangungua tika ki te whakaurunga ngongo whekau kia taea ai tewhakauru i tētahi ngongo e tika ana mō te tūroro. Ka tūtohu mātou kiawhakawhanuitia ki tētahi ngongo 20 Fr kia nui ai te rahi hei uru ki te chymematotoru. A te wā e whakawhitia ai te ngongo, tirohia mēnā kua whakanuia e tewhakaora o te peka pito o raro te rahi o te putanga kia taea ai e te TheInsides 22 Fr Tube te uru inaianei.
• He piko (kāore hepūtake o te mate puku mumura) kei roto i te whekau, e tata ana ki te putangatawhiti, kāore pea e taea te neke haere mā te ngongo.
Me āta tirotiro tetinana, ā, ki te haumaru te haere tonu, e rua ngā kōwhiringa:
Whakatakotoria hengongo poka iti iho ki raro iho ka taea te neke haere i te piko. Puritia tēneiki tōna tūranga mō ētahi rā, ka tāpirihia anō ki te tote hei āwhina i tewhakanui ake i te rahi o te peka pito. Whakamātauria he ngongo poka nui ake imuri i tēnei wā.
Whakatakotoria tengongo Insides, te ngongo poihau rānei, he 20 Fr te whānui, nui ake rānei, māte endoscopic, ka pupuri ki roto mō ngā rā 28. Tērā pea ka 'whakatikatika' tengongo i tēnei wāhanga o te whekau, nō reira ka taea te tāuta i te ngongo ki tetaha o te moenga i te wā e whai ake nei.
Tēnā tukuna atuēnei mōhiohio ki te Tākuta Ngākau o ngā tūroro kia aromatawaihia ai mēnā e tikaana rātou:
Kua eke tetaputapu ki te paerewa EMI mō tētahi taputapu hiko hauora IEC60601-1-2. Engarihe kaha anō hoki ōna aukume tuturu hurihuri (hurihuri mai i te 0-5000 rpm).Kāore ēnei aukume tuturu i arotakehia motuhaketia i raro i tēnei paerewa.
Kua oti i a mātoungā rangahau mō te bacteriology i roto i te chyme i roto i te putea stoma, ā,kua whakaatuhia e ngā hua kāore ngā huakita e noho tūturu ana i roto i te chymee whakanui, e noho rānei ki roto i te putea stoma. I roto i te tangata kāore hestoma, he fistula rānei, ka haere tonu ēnei huakita mā roto i te whekau. Kāoreanō kia puta he pūrongo mō te mate i te wā i wātea ai a The Insides System,kāore anō hoki he pūrongo i roto i ngā arotake tuhinga ā-ao mō te mate mai i tetīmatanga o te whakaora chyme reinfusion i ngā tau 1970. Hei tāpiri atu kitēnei, ka whakahaerehia e The Insides System te whakaora chyme reinfusion iroto i te ara iahiko kati, hei whakaiti ake i tēnei mōrearea.
E rua ngā ngongoFr 28 me te kotahi te ngongo Fr 22 e whakaratohia ana.
Mā ēnei topenga kamau tonu te hononga o te Ngongo o Roto. Ka whakatakotoria te Topenga o Roto kiwaho o te taputapu ostomy, ki runga ake i te Ngongo (whakaarohia he titikakahu), ā, ka noho tata ki te raro o te ringaringa pupuri. Kei te pokapūwhakangungu te ataata mō te whakamahi i te Topenga o Roto me te Whakamahinga ote Topenga o Roto. He tae ngā topenga:
• Ka taea te whakamahi ite Purple Clip ki te Ngongo 28 Fr me te Ngongo 22 Fr, ā, ka whakanohoia ki tewāhanga whānui rawa o te ngongo (ko te 39 Fr tēnei), kei tawhiti atu i teringaringa pupuri.
• Ka whakamahia te OrangeClip me te ngongo 28 Fr, ā, ka whakanohoia ki te wāhanga 28 Fr o te ngongo mēnākāore e taea te whakauru katoa ki te putanga o te puku.
• Ka whakamahia te KōpakiKōwhai me te ngongo 22 Fr, ā, ka whakanohoia ki te wāhanga 22 Fr o te ngongomēnā kāore e taea te whakauru katoa ki te putanga o te puku.
Ka tūtohu mātoukia whakamahia te taputapu ostomy me ngā taputapu e tino pai ana mō te tūroro.Ka uru te Pūnaha Insides ki roto i te taputapu e pai ana ki te tūroro. Heoi, kite ngoikore te pūkenga o te tūroro, tera pea he māmā ake mā rātou te whakamahi itētahi taputapu ostomy e rua ngā wāhanga. Tirohia te I mua i te whakauru anō kite Pūnaha Insides i te pokapū whakangungu mō ētahi atu aratohu.
Tirohia te RārangiArowhai Aromatawai Tūroro, ā, hoatu te Aratohu Tūroro ki te Whakaora WhakahouChyme ki ngā tūroro katoa i mua i te tīmatanga. He mea nui te hihiri o tetūroro mō te whakahaere i te rongoā. Koinei te mea tino nui i muri i te whaitūroro he tika te hanganga tinana. Mena ka roa te wā e "whakaaro" aite tūroro mō te whakahaere i te rongoā i muri i te whiwhinga i ngā mātaurangakatoa mō ngā mahi e pā ana ki te rongoā me te wā e pau ana ki te whakahaere itēnei rongoā, tera pea kāore rātou e whakapau kaha ki te mahi i te rongoāwhakahou chyme tae noa ki te katinga o ō rātou stoma, o te fistula rānei.
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