加熱潮溼器（補充）

先前介紹了加熱潮溼器的功能，而呼吸器的加熱潮溼器有那些型式呢？在介紹加熱潮溼器的型式之前，就必須先介紹Fisher & Paykel這個廠牌，目前市面上的加熱潮溼器幾乎都是以這個廠牌為主，就小站長所知它亦是目前世界上最大的加熱潮溼器製造商（是由紐西蘭發跡的公司，沒記錯的話！），雖然許多呼吸器製造商亦有自有品牌的加熱潮溼器，但論功能的多樣化及實用程度，仍是首推Fisher & Paykel，如果以加護型呼吸器的搭配其型式，從早期的MR600(MR600至MR630咖啡色外殼)級加熱潮溼器至十年前的MR700級(MR700至MR730藍色外殼)加熱潮溼器，至目前的MR800級加熱潮溼器(MR810、MR850可點選觀看其圖片)，都是目前在醫院仍可能看到的型式，以目前仍有銷售的MR800級加熱潮溼器來說，MR810為針對居家使用，主要用於非侵襲性呼吸器及氧氣治療的病人，操作較為簡易，僅做加熱程度的設定，與先前該公司用於居家的型式HC150相似，但可連接加熱線使用(但沒使用較多)，而MR850則可針對所有的病人皆可使用(成人、孩童及嬰兒)，功能上，可提供最佳的潮溼度(37 °C, 44 mg/L)，單鍵選擇最佳的溫度和溼度控制，已可讀取溫度值，並具有警示系統等。

而目前市面上亦可看到一些台製的加熱潮溼器，若有經相關單位認證，使用上應無問題，但其功能較為簡易。

加熱潮溼器的功能設計，一般以單純加溫加熱為基礎，為安全性著想，必須有溫度過高的警告或斷電保護措施，再進階則有所謂的溫度感應線進行加熱端及潮溼瓶供氣端的溫度監測，亦即亦可顯示雙端的溫度及控制，為避免管路積水，另有加熱線設計，其原理為藉由加熱線的使用，減少呼吸管路因管路進氣端至吐氣端因溫度不同而造成水氣的凝聚，而加熱線可保持管路內的溫度一致，進而減少管路積水的問題（只是有時使用麻煩，很多都沒在使用），因為上述功能的搭配，廠商才分出不同的型號提供選擇。

而搭配加熱潮溼器使用的CHAMBER潮溼瓶（蓄水瓶），在先前文章中有介紹分為重複式及拋棄式使用，而拋棄式亦有分為自動給水式及無自動給水式兩種，市面上使用的，先前仍以Fisher & Paykel為主，只是價格較高，其重複式市場價格一般在六千元以上，除非是同行購買或醫院購買才能拿到六千元以下，而拋棄式型號為MR290自動給水式，MR210自己加水式，價格在幾百元，至於在幾百和幾百之間，還是自行問廠商吧！

也因為Fisher & Paykel原廠的潮溼瓶價格較高，因此這幾年台灣廠商亦努力的學習研發，因此有好幾家已有生產出來，不論其重複式或兩種拋棄式潮溼瓶均有，其價格亦較有競爭力，但使用上仍須注意其潮溼瓶的熱傳導效果，及其組裝是否會漏水，及自動給水式的水閥關閉方式，至於價格呢！！！！（謎之音：不要為難我了，有須要廠商資訊再問吧！）

鼻胃管餵食法（中英文版）

如果要下載英文版的長期照護居家技巧，目前提供較完整的就是桃園縣長照中心所提供的，除了英文版外還有印尼文及越南文，是個值得推薦去看的地方，您可至桃園縣長照中心下載英文衛教單，因為是全英文的衛教單，因此在這補充中文說明方便對照！

連續補充了幾篇中英文對照的衛教單，主要是針對三管照護為主（氣切管、導尿管及鼻胃管），桃園縣長照中心還有提供像傷口換藥、經口鼻抽痰、姿位引流及拍擊、噴霧治療、關節活動等英文衛教單張，推薦前往一看，之後有時間再將其中文說明補上（因為打字真的很花時間！）

GAVAGE FEEDING METHOD 鼻胃管餵食法
If your family member is unable to take in food from the mouth, his nutrition will rely entire on your careful and patient preparation and gavage feeding. Let`s try it out together.在您家人無法從口進食時，他的營養全您細心與耐心的準備及灌食，讓我們一起動手來試試看！

SUPPLIES YOU NEED TO PREPARE 您需準備的用物
Feeding formula, feeding syringe, towel and tissue paper. Feeding formula preparation:灌食物、灌食筒、毛巾和衛生紙。灌食物的準備：
●Self-made formula. Prepare it in daily amount each time and store it in refrigerator. Take out only a feeding amount for each feeding, warm it up and feed it down completely. (If you can`t finish the feeding, store it back in refrigerator immediately).若採自製，則可一次製作一天的量，冰在冰箱，每次只取出需灌的量加熱並將之灌完(若無法完全灌完，應速放回冰箱冷藏）
●Powder formula. Prepare a suitable amount each time and feed it completely. For canned formula, store the remainder portion quickly in refrigerator.若採商品為粉狀者，一次只泡適當的量全部灌入；若為罐裝，則未灌完部份應速放入冰箱中冷藏
●The formula is suitable to warm up to around 38~40℃,and not higher.食物宜加溫至約38至40℃，但不可過燙

THE GAVAGE FEEDING PROCEDURES　灌食步驟
1.Wash your hands.洗手
2.Gather the gavage equipment, and prepare for a comfortable and odorless environment (to let the patient enjoys the meal).安排灌食的用物及準備舒適、無臭的環境(讓病人好好享受這一餐)
3.Help his/her to sit up or raise the bed head up 30 to 60o(to allow formula to flow down naturally) (diagram 1).協助他坐起來或使床頭抬高30至60度(使食物容易自然流下)
4.Place towel below the chin and maintain the cleanliness of the patient and bed sheet.將毛巾置於臉頰下，保持病人或床單的清潔
5.Make sure the gavage tube is still in the stomach. This can be checked with the following methods:以下列任一方法確定胃管是否仍在胃內
◆ Check the marking on the gavage tube, if it has dislocated more than 10cm, ask for a family member to block the end and pull out the tube gradually, and notify homecare attendant to insert it back. If the marking is not dislocated more than 10cm, check the oral cavity. If the gavage tube is not entangled, gently push the tube down to its original position and refastened it.檢查鼻胃管的記號，若脫出且超過十公分則請家屬塞住一端後，緩慢將管子拔出，並通知居家護理師重插，若刻度未超過十公分，檢查口腔若無胃管纏繞，則可輕推進至原刻度位置重新固定
◆ Pull back on syringe plunger to draw as to ensure the gavage tube is still in the stomach, and check for stomach residual amount. If it is more than 50cc, then postpone feeding half or an hour later. If there is no strange appearance on the drawn-out stomach content, allow it to return to stomach naturally.以空針反抽，確定胃管仍在胃內，並檢查胃內殘餘食物量，若在50cc以上，則延緩遲半小時或一小時再灌，無異狀之反抽物，食物可讓其自然流回胃內
◆ If there is no drawn-out stomach content, first check if the gavage tube is congested in the throat. If no, re-insert the tube for about 1~2 inches and continue the suction operation. Place the stethoscope over the stomach and inject 15cc of air. If you can hear a woosh sound entering the stomach, it is confirmed that the tube is in the stomach (diagram 2).若反抽沒抽到，先檢查管子是否在喉頭打結，若無，再插入約1~2吋後再回抽，將聽診器置上腹部，注入15cc空氣，若聽到氣體進入胃內的聲音，即可確定管子在胃內（圖二）
◆ You may immerse the tube`s end in water. If bubbles appear following exhalation, it denotes that the tube is in the respiratory tract but pay attention not to suck in water.亦可將管子末端放入水中，若隨著呼氣產生氣泡，表示管子在氣管，要小心水吸入氣管內
6.Use the gavage tube to draw ou the residual or medicine, fix the gavage equipment about 30~45cm above the stomach and feed in formula gradually.以灌食筒抽食物或藥物，將灌食器的高度定在腹部上約30~45公分處，緩緩灌入食物速度不宜太快
7.When feeding is finished, flush in 30~50cc of warm water to clear up the tube and avoid residual formula to get rotten or congested in the tube.待灌完後，再抽溫開水30~50cc灌入，沖淨管內剩下食物，以免管子內的食物腐敗或造成阻塞
8.Pinch the tube closed or refolded it with a cap.將管子密閉或反摺套入
9.Record the feeding formula and amount of that meal.記錄此餐的灌食內容及量

NOTE　注意事項
1.Nurse the oral and nasal cavities everyday.每日給予口腔及鼻腔護理
2.Avoid feeding in air during gavage feeding.灌食中避免灌入空氣
3.Stop feeding immediately if the following strange phenomena occurred: non-stop coughing, breathing changes, vomiting or face turning blue. Contact homecare attendant.灌食中若出現奇怪現象，如咳嗽不止或呼吸變化、嘔吐、臉色發青現象，應立即停止灌食，並連絡居家護理師
4.Take note of prescribed medicines to be taken before meal or before sleeping. They should be fed in separately.註明飯前或睡前使用的藥物應分開灌入
5.Pay attention to the marking on nasogastric tube at any time, whether it has faded or dislocated.隨時注意鼻胃管插入的標記是否褪色或脫落
6.For patient who uses the inner cannula or tracheotomy tube, it is important to perform sputum suction before feeding, and open up the air sac to prevent formula from getting into lungs.使用氣管內管或氣管套管的病人，灌食前應先抽痰，並將氣囊打開，以避免食物灌入肺內
7.After feeding, do not turn the body or perform slap percussion within 30 minutes.灌食後三十分鐘內，不要立即翻身或拍痰
8.If there a problem in gavage feeling, it may be caused by the following reasons:灌食時若感覺不易灌入，可能的原因：
(1) The tube is congested by formula. You may draw out the formula with a syringe and then flush in 25cc of warm water.管子被食物阻塞，此時可以先將灌食空針反抽，再灌入25cc溫水
(2) The tube touches the stomach wall. You may pull out the gavage tube gently for about 1cm and flush in 25cc of warm water, or change the patient`s sleeping posture.
If it is still unable to feed in formula following the above-mentioned methods, you should notify the attendant nurse.管子碰到胃壁，此時可將胃管輕輕往外拉出1cm左右，再灌入25cc溫開水，或更換病人睡姿。若以上方法都無法再灌入食物，必須通知居家護理師處理
9.The tape for securing the gavage tube must be changed every one or two days. Cleanse and dry up the face prior to taping. This can be done by splitting the tape along the center and adhere the tube in a crisscross manner(diagram 3).固定胃管的膠帶必須一至二天更換，並先清潔臉部皮膚，擦乾再貼。方法如下：膠帶從中間剪開兩條，互相交錯纏住胃管
10.Avoid pressing and curling up the tube when turning the body or gavage feeding. You may hang the tube over the ear.翻身或灌食時，管子避免受壓或牽扯扭曲，可將管子掛在耳朶上
11.Rush feeding may cause diarrhea, in particularly for high calorie formula. Other noticeable symptoms are restless, nausea and vomiting.灌食速度太快，尤其是高熱量食物，易致腹瀉，也容易造成不適、噁心、嘔吐
12.Try not to feed in too much air.儘量不要灌入太多的空氣
13.Use the other nostril with each tube change.重插時應換另一鼻孔插入
14.Pay attention to nurse nasal and oral cavities.注意鼻腔及口腔護理
15.You may squeeze gently or rotate the nasogastric tube once every day to avoid it from sticking on to stomach wall.可每天輕柔的旋轉胃管一次，以防鼻胃管黏附在胃壁上

吞嚥訓練及餵食（中英文版）

如果要下載英文版的長期照護居家技巧，目前提供較完整的就是桃園縣長照中心所提供的，除了英文版外還有印尼文及越南文，是個值得推薦去看的地方，您可至桃園縣長照中心下載英文衛教單，因為是全英文的衛教單，因此在這補充中文說明方便對照！

THE CHAPTER ON SWALLOW TRAINING & FEEDING　吞嚥訓練及餵食篇

SWALLOW TRAINING & FEEDING 吞嚥訓練及餵食
To enjoy delicacies through the mouth is the most happiness thing in life. If your family member needs to replenish nutrients through a nasogastric tube temporary because of illness, he/she needs your help to train him/her the swallowing skill before he/she can eat through the mouth.享受由口進食的美味，是人生至大的快樂，當您的家人因病暫時以鼻胃管補充養份時，在他可以由口吃東西前，他需要您訓練他的吞嚥能力喔！

WHEN TO TRAIN HIM/HER TO SWALLOW FOOD? 何時可訓練他吞東西
If he/she starts to feel irritate while talking, let him/her swallow some water from soaked cotton wool. You can start the training if there is no coughing. For patient who is weak, unconscious or still asleep, don not rush to do the feed on training. For patient who has upper or lower respiratory tract infected, profuse sputum or is infected with aspiration pneumonia, etc, it is necessary to wait for illness to get better before performing the feed on training under agreement from the doctor.
如果他開始對語言刺激有反應，並以棉籤沾水讓他吞，無咳嗽發生，即可以開始訓練。但對體力虛弱、意識不清或睡覺未醒的病患，別急著做進食訓練。病患上、下呼吸道感染，痰很多時或吸入性肺炎等，需待病症改善，醫囑同意下始給予吞東西訓練

SUPPLIES YOU NEED TO PREPARE 您需要準備的用物
●Towel (for wrapping around the body).毛巾(圍在身上)
●Formula. It is more suitable to use jelly, vegetarian gelatin, pudding, bean curd at the beginning stage of swallow training. After succeeding, it is allowed to choose general soft or liquid formula.食物，吞嚥訓練初宜採用果凍、愛玉、布丁、豆花等，成功後可採用一般軟質或液體食物
●Container for formula and small spoon.裝食物容器及小湯匙
●To maintain the feeding environment quiet and comfortable.維持進餐環境的安靜、舒適

PROCEDURES 步驟
1.Help him/her to sit up till 60~90o, place pillow behind the head, place towel under the chin and maintain a comfortable feeding position.協助坐起至60至90度，以枕頭放頭後，毛巾置於臉頰下，維持舒適的進食姿勢
2.Allow patient to look at the formula to increase his/her appetite and enhance the secretion of digestive fluid.讓其親眼看見食物，以增加病人食慾，促進消化液之分泌
3.Command repeatedly to take in a small mouthful of formula and let him/her swallow each mouthful in two sequences.重覆以口令動作以一小口食物餵食，並請他吞嚥兩次進行
4.Command:口令
open your mouth, try the taste, lift the formula up to the palate with your tongue, contract you chin and swallow it. You can meanwhile assist the patient with your hands.(This procedure can be omitted if the patient has no swallowing problem)打開你的嘴巴，嚐一嚐，用你的舌頭將食物舉至上顎，縮下巴吞下，其間可用手協助病人。（吞嚥無問題的病人可以省去此步驟）
5.Feeding has to be done slowly, to feed in a moderate amount of formula to the patient`s mouth every time. For brain apoplectic patient, the formula has to be placed at the healthy side of the mouth. 餵食時要緩慢，每次送入病人口中食物份量應適中，如腦中風的病人應將食物放入口中健全側邊
6.The formula has to be placed accurately within the mouth, and feed the patient again when he/she has actually chewed and swallowed it.食物應準確放入於口內，需確定病人已咀嚼吞入後才可再餵
7.After eating, please cleanse the mouth and maintain its wetness.食後請清潔口腔並保持潮濕

NOTE　注意事項
1.Stop feeding if the patient coughs and let him/her rest for at least half an hour. If this happens several times, postpone the feeding for some days and try again.當病人發生咳嗽時，請停止餵食，讓病人至少休息半小時後再試，若屢次發生則可能病人需延後一些天再試
2.After feeding, adopt a sit-up position and rest for half an hour, and then lay back as to stop the backflow of formula.餵食後需採坐姿休息半小時，再臥床，以防食物逆流
3.During the training session, it is still necessary to sustain the nasogastric tube or other tube so as to replenish water and nutrients.訓練期間，仍應有鼻胃管留置或其他方式，以補充不足的水份及營養
4.After feeding soft formula for several days, carry out liquid formula feeding then.軟質食物進行一段時日，才可進行液體食物餵食
5.When chocking occurs, help the patient eject the formula immediately: Use finger to it dig out, pat the back, grab the patient`s lower xiphoid from the back and compress upward to encourage vomiting, or use a sputum suction tube to help drawing it out.若發生哽噎、嗆到情形，應立即助其將食物排出，以手挖出食物、拍背、由病人背後抱住病人於劍突下方，向上壓迫，促其嘔吐，或使用抽痰管助其排出

尿管及尿袋照顧（中英文版）

如果要下載英文版的長期照護居家技巧，目前提供較完整的就是桃園縣長照中心所提供的，除了英文版外還有印尼文及越南文，是個值得推薦去看的地方，您可至桃園縣長照中心下載英文衛教單，因為是全英文的衛教單，因此在這補充中文說明方便對照！

THE CHAPTER ON CARING OF URINARY CATHETER & URINE COLLECTION BAG 尿管及尿袋照顧篇

THE CARING OF URINARY CATHETER & URINE COLLECTION BAG 尿管及尿袋的照顧
Your attentive care and cleanliness are able to help your family member to keep the free flow of urinary catheter and to lower the chance of infection! Here we provide two methods for you to choose what you like.
您的細心照顧與清潔可以讓您家人的尿管保持暢通，也可以減低他發炎的機會哦！這裏有二種方法，可以依您喜歡的方式任意選擇

SUPPLIES YOU NEED TO PREPARE 您需要準備的用物
Method 1: rinse kettle (small tea kettle) you may use paper cup or wash-cleaned PET bottle, big cotton sticks, potty...+cloth spread, beta-iodine solution and small cotton sticks.方法一：沖洗壺(小茶壺)可用紙杯或洗淨的沙拉脫瓶、大棉棒、便盆...+布單、優碘、小棉棒
Method 2: soap, towel, water basin......方法二：肥皂、毛巾、水盆

Method 1 :方法一
1.Place cloth spread and rinse kettle underneath his/her hip.將布單及便盆放在他的臀部下
2.Take the rinse kettle with one hand, pour down water at the public place from top to bottom slowly, and meanwhile use a big cotton stick to cleanse the public place from top to bottom, and from inside to outside. Do not use a cotton stick throughout but throw it away whenever it touches the anus (diagram 1).一手拿水壺，在陰部位置由上向下慢慢將水倒出，同時以大棉花棒由上而下，由內而外清潔陰部。棉花棒勿一根到底，碰觸肛門時不可再用
3.Reconnect the urinary catheter in a proper position (place in between the thighs for female patient and at the lower abdomen for male patient).重新固定好尿管位置。(女性固定於大腿內側，男性固定於下腹)
4.Remove the cloth spread and rinse kettle.將布單及便盆移除

Method 2 :方法二
1.Place the cloth spread on the edge of the hip.將布單舖於他的臀部末
2.Wet the public place, wash and rub the area with soap.將陰部打溼，塗抹肥皂後，在陰部擦洗
3.Wipe the soap off and cleanse the public place with a wet towel.以溼毛巾擦去肥皂至清潔
4.Repeat the procedures (3) and (4) of method 1.同方法一之(3) 和 (4)步驟

NOTE 注意事項
1.Perform the above-mentioned procedures once or twice daily.上述步驟每日請執行一至二次
2.Pinch the urinary catheter at least once a day, and avoid bending or pressing it to maintain a free flow.尿管每日至少要擠壓一次，避免折到或壓到，以保持通暢
3.The urine collection bag should be placed below the bladder position (not suitable to place on the floor) or drag along the floor. Empty the urine at least three times daily and record the urinated volume.尿袋高度要低於膀胱位置(但不可置於地面上)或在地上拖曳，每日至少要倒尿三次，並記錄尿量
4.Let the patient drink 2500~3000cc of water daily in order to dilute the urine to aid natural flushing, and to lower the chance of urethra infection.每日讓病人喝水2500~3000cc，以稀釋尿液及自然沖洗力，以減少尿路感染
5.If there is a fever, urinated volume less than 500cc,hematuresis, uncontrollable lose of urine, or dislocation of urinary catheter and congestion, please call the medical staff as soon as possible.如有發燒，尿量每日少於500cc、血尿、滲尿、或尿管脫出和阻塞，請儘快與醫護人員聯絡
6.Turn the body and move around often to lower the chance of cloudy urine. Change urine collection bag once a week and change it more often if it gets cloudy and congested.應常翻身及活動，可減少尿液混濁，蓄尿袋宜一週更換，或有混濁阻塞時，則必需時時更換
7.Close the opening of urine collection bag at any time to avoid contamination.尿袋開口處隨時關閉，勿受污染
8.Change the diaper or cotton pad wrapping the urethra opening whenever it is wet.包裹尿道口的尿片或棉墊滲濕時，應隨時更換
9.Change the securing tape on urinary catheter every day but do not tape on same spot consistently(as in diagram 2).固定尿管的膠布應每天更換，並勿連續黏貼於同一位置（如圖二）
10.If the urinary catheter is congested, you can pinch and release the tube alternatively with both hands quickly, starting from six inches away and advancing the procedure toward the body (as in diagram 3). It is recommended to drink cranberry juice as it is rich in Vitamin C, and capable to convert uric acid to hippuric uric acid to reduce the chance of infection. Drink high unit (1000mg) Vitamin C instead if it is not available on the market. If diabetic patient drinks 100cc of cranberry juice twice daily, he/she has to take in sugar-free Vitamins.如果尿管阻塞，可以一手捏住其離身體六吋處，並用另一手很快的一擠一鬆，以擠向近身體的一段（如圖三）可建議長期飲用小紅莓果汁，因含有豐富的維他命C，可將尿液內尿酸轉變，促使尿液酸化，而降低感染機率，若市面買不到，可食用高單位維他命C(1000mg)；若糖尿病患者服用小紅莓果汁每次100cc，一天二次，並選擇無糖分的維他命

膀胱訓練（中英文版）

因為在網路上所能找到的中英文衛教單張較少，之前所推薦一些不錯的中英文衛教單張網站又已無法連結，因此補充一些中英文對照的衛教單張於部落格上提供參考，您可至桃園縣長照中心所下載英文衛教單，因為是全英文的衛教單，因此在這補充中文說明方便對照！

THE CHAPTER ON URINARY BLADDER CONTROL TRAINING 膀胱訓練篇

HOW TO HELP HIM/HER TO CONDUCT URINARY BLADDER CONTROL TRAINING?
如何幫助他膀胱訓練
The aim of urinary bladder control training is to train up the bladder function of your family member. This helps him/her to perform self-urination preparation before taking away the urinary catheter.
膀胱訓練的目的，是訓練您的家人在拔除尿管前的膀胱功能以讓他做好自解小便的準備

TWO METHODS OF URINARY BLADDER CONTROL TRAINING　膀胱訓練有二種方法
(1) For urinary incontinence patient:小便失禁者
Amid regular time interval, assist the patient to the bathroom, use the potty chair, or bed pan and urinal. Allow him/her to start urinate 15 to 20 minutes afterward.
Pay attention to his/her privacy, and help him/her to sit up to ease emptying the bladder by gravity mean.
在規律的間隔時間中，協助他到浴室或使用便盆椅，或床上用便盆及尿壺；而且允許他在15至20分鐘後才開始解尿，應注意他的隱私，並協助他坐起，較易利用重力幫忙排空膀胱
(2) Insertion of catheter containing urine residual:插有存留導尿管者
1.Use a clamp or rubber band to tie up urinary catheter at the position as shown in diagram 1.利用管夾或橡皮筋將尿管綁緊，位置如圖一
2.The clamp-on time of catheter is about an hour. At the end, the patient may be able to tolerate clamp-on time two to three hours, or perhaps three to four hours.導尿管夾緊的時間約一小時，到最後他可能忍受夾的時間二至三小時，甚至三至四小時
3.The second clamp-on time is 20 to 30 minutes, and then release catheter to urinate.二次夾緊時間，可放開尿管20至30分鐘，讓小便排出
4.Pay attention to him/her training reaction and discuss with homecare attendant .隨時注意他訓練時的反應，並與居家護理師討論

NOTE　注意事項
1.Stop the training if the following situations happen: Urethra infection, cloudy urine, hematuresis or fever(higher than 38℃).當有下列情況時停止訓練：泌尿道感染、小便呈白色混濁、血尿、發燒 (38℃以上)
2.Stop the night training temporary to prevent urination time delay, resulting in urine retention to affect the bladder function.夜間暫停訓練，以防時間延遲致尿瀦留，影響膀胱功能
3.Encourage the patient to take in enough water to reduce the chance of urethra infection or the formation of urethra calculus. Unless there is water restriction due to illness, if not the water intake amount is at lease 3000cc daily.鼓勵攝取足夠水份，以減少泌尿道發炎，或泌尿道結石的發生，除非有限水的疾病禁忌，否則每天至少攝取3000cc的水份

洗頭（中英文版）

因為在網路上所能找到的中英文衛教單張較少，之前所推薦一些不錯的中英文衛教單張網站又已無法連結，因此補充一些中英文對照的衛教單張於部落格上提供參考，您可至桃園縣長照中心所下載英文衛教單，因為是全英文的衛教單，因此在這補充中文說明方便對照！

THE CHAPTER ON HAIR CLEANLINESS 洗頭篇

HAIR WASHING 洗頭
Hair washing is simple; washing the hair will make him/her feel comfortable for a long time! 洗頭，一點也不難，為他洗個頭，會讓他舒服好一陣子喔！
If he/she can get off the bed, please wash his/her hair in the bathroom once or twice weekly.如果他可以下床，請每週到浴室洗頭一至二次
If he/she is inconvenient to get off the bed, then wash his/her hair in bed but you need to prepare the following items: Two buckets (for holding clean and dirty water separately),a pail, big towel, big plastic bag or hair washing cushion, shampoo, comb and a hair dryer, don`t forget to test the water temperature with the back of your hand first!如果他不方便下床，則床上洗頭您需準備下列用物：兩個水桶(分別裝清水與髒水)、水瓢、大毛巾、大型塑膠袋或洗頭墊、洗髮精、梳子、吹風機，裝水前別忘了先用手背測試水溫喔！
●Get ready with a hair washing cushion or a self-made hair washing pillow (roll up the towel in a cylindrical form→place it underneath the big plastic bag→shape it like a horseshoe and station it with adhesive tape).備好洗頭墊或自製洗頭槽(大毛巾捲成長筒狀→放入大塑膠袋底部→做成馬蹄型以膠帶固定)
●Lay him/her down, shift his/her head to the bed edge→place the hair washing cushion (or pillow) under the neck, and place the bucket on the floor directly underneath the head.助他平躺，頭移到床沿→洗頭墊(槽)放在頭頸部，其下擺放在預裝髒水的桶中
●Scrub and scratch the hair with shampoo and ease the itches, and then wash the shampoo off with clean water, you may repeat the procedure till the hair is clean, and be careful to avoid water and foam from getting into the eyes and ears.以洗髮精搓洗頭髮，抓抓癢，再以清水沖洗，可重覆此步驟直到乾淨為止，注意水或泡沫勿跑到眼睛及耳朵
●Wrap around the hair with a dry towel, tidy up the place, prepare a comfortable bed, and take out the big towel in the plastic bag to rub the hair dry, or dry the hair with a hair dryer, and finally comb the hair neatly.以乾毛巾包裏頭髮，移去用物，安排好舒適臥位後，再取出塑膠袋中的大毛巾來擦乾頭髮，也可以使用吹風機將頭髮吹乾，之後梳理整齊即可
Now see if he/she is in high spirit! Don’t forget to give yourself a big cheer too!
看看他現在是否神清氣爽？別忘了也給自己一個大大的喝采！

身體清潔（中英文版）

因為在網路上所能找到的中英文衛教單張較少，之前所推薦一些不錯的中英文衛教單張網站又已無法連結，因此補充一些中英文對照的衛教單張於部落格上提供參考，您可至桃園縣長照中心所下載英文衛教單，因為是全英文的衛教單，因此在這補充中文說明方便對照！

THE CHAPTER ON BODY CLEANLINESS　身體清潔篇

BODY CLEANLINESS身體清潔
A clean body brings us comfortable feeling, and similarly, we must also pay attention to the comfort of our family member!
乾淨的身體，帶給我們舒適的感覺，同樣的我們也要注意家人的舒適哦！
If he/she can get off the bed → take a shower or tub bath every day or every two days.如果他可以下床→每日或每兩日淋浴或盆浴
If he/she is inconvenient to get off the bed → take a sponge bath on bed every day and at least take a shower thorou-ghly every week.
如果他不方便下床→每日床上擦澡每週至少淋浴一次徹底清潔
Tell you secretly, your service will touch his/her heart deeply!
偷偷告訴您，您的服務會讓他倍感貼心喔！

PREPARATION & NEEDED ITEMS 您需要準備的用物
A wash basin, two small towels, clean shirt and trousers, big towel, plastic mat and a piece of soap (better be neutral version).臉盆、毛巾兩條、乾淨衣褲、大毛巾、塑膠襯墊、肥皂(中性為佳)
Keep in mind of these important notes prior to cleaning: water temperature, privacy and safety: the showering or tub bathing method is the same as you do; you need to wash every part of his/her body.別忘了開始進行事前要注意：水溫、隱私、安全：淋浴或盆浴的洗洗像您在洗澡一樣，要洗身體的每一部位

BED BATHING　臥床的擦澡
Eye→Ear→Neck→Both Hands→Front Chest→Stomach→Both Legs→Turn Over for Back
Cleaning→the Back→Buttock, after changing water, clean the Public Area and Anus.
眼→耳→頸→雙手→前胸→肚子→雙腳→翻身後擦→背部→臀部，換水後，洗會陰及肛門

LAST REMINDER 最後提醒您
1.Start cleaning from the clean parts.從乾淨的地方開始洗
2.Take special care in cleaning the joints and areas where the skin folds.關節彎曲、皮膚皺摺的地方，要特別清潔
3.Bed bath the body first and tender the urethra wound later.先擦澡再做尿管傷口護理
4.You may shower the patient in the bathroom, but under certain circumstances and safety precaution, you need to keep the connection sealed and clean should there be any connecting tube on his/her body so as to prevent infection.身上若有任何管路，均可視情況及安全考量下，到浴室淋浴，只要維持管路的密閉及清潔，預防感染
5.Look if your family member`s fingernails are trimmed after the shower, you should cut the fingernails flat and short to prevent the edges from growing into the nail bed, and please be careful not to hurt the skin!浴後順便看看您家人的指甲是否該修剪了，修剪指甲應修平、修短以防兩端長入趾肉內，要小心不要傷到他的皮肉哦！
6.After tendering, don t forget to ask your family member if he/she is comfortable!完成後記得問問您的家人，是不是覺得很舒服呢！

氣管內管及氣切口的清潔（中英文版）

因為在網路上所能找到的中英文衛教單張較少，之前所推薦一些不錯的中英文衛教單張網站又已無法連結，因此補充一些中英文對照的衛教單張於部落格上提供參考，您可至桃園縣長照中心所下載英文衛教單，因為是全英文的衛教單，因此在這補充中文說明方便對照！

THE CHAPTER ON CLEANLINESS OF THE INNER CANNULA & TRACHEOTOMY 氣管內管及氣切口的清潔篇

CLEANLINESS OF THE INNER CANNULA & TRACHEOTOMY 氣管內管及氣切口的清潔
Odorless of the tracheotomy is able to keep our family member more comfortable!
Let`s try it out!
您一定沒想到使氣切口維持乾淨及無味可以讓我們的家人更感舒適喔!我們來試一試吧!

PREPARATION & NEEDED ITEMS 您需準備的用物
●A small cleaning brush 清潔用的小刷子
●A sterilized Y-shaped dressing 已消毒的Y型紗布
●Hydrogen peroxide solution 雙氧水
●A lunch box with a lid (after being sterilized in boiling water, use it to hold solution) 有蓋小便當盒 (煮沸消毒後用來裝溶液)
●Normal saline solution (germ-free) 生理食鹽水 (無菌的)
●Beta-iodine solution 優碘藥水
●Cotton swabs 棉花棒
●Two neck straps for the tracheotomy connector 氣切套管固定帶兩條
●A 4x4 inch dressing (sterilized) 4x4 紗布一塊 (消毒)

PROCEDURE 步驟
1.Wash your hands.洗手
2.After fixing the exterior tube, turn the release knob and pull out the inner cannula slowly.固定外管後，將卡鈕上轉，輕拉出內管
3.Dip the inner cannula in hydrogen peroxide solution for several minutes till the respiratory secretion drops off, then clean it with a brush, boil it for 15~20 minutes and dip it in normal saline solution.將內管置於雙氧水內浸泡數分鐘至痰液脫除，再用刷子清洗乾淨，煮沸15~20分鐘後放入生理食鹽水內
4.Dry it with a dressing, and insert it back on the tracheotomy and secure it.以紗布擦乾後，置入並固定
5.Pull out the Y-shaped dressing from the tracheotomy.拉出氣切口原有的Y型布
6.Use the cotton swab dipped with beta-iodine solution to clean the tracheotomy opening for 30 seconds, and rub the surrounding area with normal saline solution.綿花棒沾優碘，塗抹切口周圍30秒後，再以食鹽水擦拭一圈
7.Replace it with a new Y-shaped dressing.置放新的Y型紗布
8.If the neck strap of the connector is loosened or dirtied, please retighten it or replace it with a new one.套管固定帶若鬆了、髒了，請重新綁緊或更換新的帶子

NOTE　注意事項
1.Clean the inner cannula once or twice daily, and more cleaning sequences if the respiratory secretion intensified.清潔氣管內管，每日需一至二次，如果痰量多，則須增加清潔次數
2.After cleaning the inner cannula with the small brush, dip it in hydrogen peroxide solution, or further boil it for 20 minutes.內管取出，用小刷子清洗後，泡入雙氧水沖洗乾淨，可煮沸20分鐘
3.If the Y-shaped dressing and the neck strap are soaked or dirtied, they must be changed immediately. Y型紗布及氣切套管固定帶濕了或髒了，須馬上更換
4.With permission from the doctor, the conscious patient with a long-term tracheotomy opening can be taught to cover up the opening with a finger and trained to talk, but normally he/she is advised to communicate with paper and pen.意識清楚者需經由醫師許可下，才可教導長期有氣切造廔口者用手指蓋住氣口訓練說話，平常可用紙筆文字表達
5.Be careful not to allow water from getting into the patient lungs while bathing or showering in the bathroom: put on a scarf or wrap the tracheotomy opening with a 4x4 inch dressing to prevent irritation caused by dust and foreign objects.到浴室洗澡或沐浴者小心勿讓水進入肺內；外出時可戴圍巾或者4x4吋紗布圍住，避免塵埃及外物刺激氣切造廔口
6.You may cut a central hole on a small plastic pharmaceutical cup and place on top of it with a 2x2 inch dressing dipped with normal saline solution. Use this as a cover to cap over the tracheotomy connector, and drip normal saline solution or cold drinking water on the dressing to keep it damp constantly.可利用塑膠小藥杯，中間剪開一個洞口，上面放置生理食鹽水紗布2x2吋，將準備好的罩子，蓋在氣切套管口上面，為保持紗布潮濕，應常滴生理食鹽水或冷開水在紗布上面
7.Beware of blanket and shirt sleeve while sleeping at night, never let it cover the tracheotomy to prevent blockage of the opening.夜晚睡眠時需注意被子及領口，勿蓋住氣切口，以防呼吸道氣切口被阻塞