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