ACE SPACER噴藥助吸腔

先前在霧氣治療介紹的簡報中，有提及MDI定量噴霧器的使用，而MDI的輔助裝置之一ACE SPACER，簡報中只能以圖片介紹，現在原廠已提供影音說明，因有提供部落格內嵌，因此在這與大家分享，並提供簡單說明。

 

ACE SPACER噴藥助吸腔主要用於噴藥治療過程中，霧氣粒子會撞及腔壁，加上滯留腔內部份藥物因蒸發使粒子變小，可使藥物沉積於口咽及上呼吸道的機率減少，降低藥物副作用；而且讓霧氣儲存於腔內，可舒緩手按噴霧器，需即時間同步配合吸入的要求，病人可慢慢的吸入，增加療效。

PEP吐氣正壓咳痰器

今天找到了一個很棒的網站smiths medical，先前逛時，僅有產品的資訊，現在新增加了不少呼吸治療的視訊影片，雖然仍以該公司的產品介紹為主，但因該類產品的功能使用大同小異，因此仍以該公司影片作介紹，因為該站有提供部落格影片內嵌，因此在這與大家分享，方便做些簡單的說明。

Positive Expiratory Pressure（PEP）屬於正壓呼吸治療之一（PEP、EPAP、CPAP），所謂正壓呼吸治療就是給予正壓去維持肺的壓力，使肺擴張，可用於大部分肺擴張不全的病人。

PEP主要是用於氣道清除，利用吐氣阻力（固定式彈簧阻力等方式）產生一吐氣正壓，配合橫隔膜放鬆吐氣，可排出氣道分泌物，清潔呼吸道，並預防吐氣氣道塌陷。使用時可配合呼吸運動中的ＨＵＦＦ咳嗽技術（呼吸運動一、呼吸運動二），可得到更好的效果。

肺塌陷的原因
(一) Resorption atelectasis再吸收性的肺塌陷：黏液填塞氣道，受影響的區域會阻斷氣體交換。
(二) Passive atelectasis被動性的肺塌陷：病患沒有定期的深呼吸及讓肺完全擴張。

抽痰（中英文版）

如果要下載英文版的長期照護居家技巧，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！（終於完成最後一篇，至此已補上桃園縣長照中心所提供的英文衛教單的所有中文說明）

THE CHAPTER ON MOUTH / NOSE SPUTUM SUCTION　經口鼻抽痰篇

HOW TO PERFORM MOUTH /NOSE SPUTUM SUCTIONING　如何進行口鼻抽痰
We feel quite uncomfortable with sputum in our throat. If the respiratory tract of our family member is congested, he/she is unable to breathe freely. Therefore, we need to help him/her to draw out sputum to let him/her breathe more efficiently and more comfortably.當我們有痰時會不太舒服，而您家人的呼吸道如果被痰所堵塞，將無法順暢的呼吸，因此，我們需要幫他抽痰，使他能呼吸得更有效、更舒服

SUPPLIES YOU NEED TO PREPARE　您需要準備的用物
A sputum suction machine, several pieces of germ-free suction tubes, germ-free gloves used in sputum suctioning, a bottle or container filled with water, germ-free normal saline solution (the valid time is 24 hours placed in refrigerator after being opened).抽痰機一台、無菌抽痰管數條、無菌抽痰用手套、裝有清水的瓶子或容器、無菌生理食鹽水（開瓶後置冰箱二十四小時為有效時間）

PROCEDURE　步驟
1.Wash your hands before operating sputum suction.抽痰前先洗手
2.Open up the packages of suction tube and connector. Do not take out the suction tube initially.打開抽痰管連接管的包裝，抽痰管不要先抽出
3.With suction tube in the package, connect its end to the hose of suction machine.抽痰管置於包裝內，將其一端接於抽痰機的橡皮管上
4.Using the gloved hand to draw out the suction tube from the package and pay, attention not to touch other things.一手戴上手套將抽痰管抽出，注意管子不可碰觸其他物品
5.Use the other hand to turn on suction machine, and meanwhile adjust the pressure. The pressure should be : 120~150 mmHg and not exceeding 200mmHg (as in diagram 1).以另一手打開抽痰機，並調好壓力，壓力為：120~150mmHg 不超過200mmHg。(如圖一)
6.Insert the suction tube to a suitable depth in nostril : 6~8 inches (15~20cm) (as in diagram 2).將抽痰管輕輕插入適當深度，鼻子：6~8吋 (15~20公分)(如圖二)
7.Use the other glove-free hand to manually control the suction pressure.以未戴手套之手控制使產生壓力抽吸
8.Use the fingers of the gloved hand to rotate suction tube 360 degrees to perform sputum suction intermittently (do not exceed 15 seconds for each therapy).戴手套之手指360度轉動抽痰管，施行間歇抽痰（每次不可超過15秒）
9.After releasing the pressure, draw out suction tube and continue to suck in clean water to wash off sputum in the tube.解除壓力後將管子抽出續抽吸清水以清潔管中之痰
10.Take off the glove, wrap suction tube within the glove and dispose them. Tidy up the surrounding and wash your hands.脫下手套，將抽痰管包在手套內丟棄，整理環境後洗手

NOTE　注意事項
1.During sputum suction therapy, do not touch other things with the suction tube and the gloved hand, or cough, talk or other acts directly to these supplies.抽痰時不可將抽痰管及戴上手套之手碰觸其他物品，或對其咳嗽、講話等
2.After using the suction tube once, change a new one and never use it again (so is the glove).抽痰管每用一次應更換勿重覆使用（抽痰手套也是）
3.In the present of tracheotomy, perform suction on tracheotomy tube first and later on mouth and nostrils. When suction is finished on mouth and nostrils do not use the suction tube on tracheotomy tube again.若有氣切應先抽氣切套管再抽口鼻，抽完口鼻後不可再用該管抽氣切套管
4.When sucking on the right (left) bronchia, tilt the patient face to the left (right) and lower his/her left (right) shoulder.抽右(左)支氣管，病患臉偏左(右)、左(右)肩向下
5.The suction interval between two therapies is 2~3 minutes.兩次抽痰時間應間隔二至三分鐘
6.If the patient face turns blue during sputum suction therapy, stop and supply the patient with oxygen. If the suction time for each therapy is too long, it will result in oxygen deficiency of tissues, and in the case of severe suffocation may even lead to heart failure. Other conditions like oversized suction tube, suction force too hight and too short interval time between two suction therapies are easy to cause oxygen deficiency.抽痰時若有臉色發青現象，應馬上停止並給氧氣，一次抽痰時間太久，會造成組織缺氧，窒息嚴重者可能導致心臟衰竭：其他如抽痰管徑太大、抽痰吸力太大、兩次抽痰時間太近，均易造成缺氧
7.Perform sputum suction therapy 30 minutes before meal or one hour after meal to avoid vomiting.可在進餐前三十分鐘或餐後一小時抽痰，以防嘔吐
8.The water level of suction bottle should not exceed 2/3 bottle to influence suction efficiently.抽吸瓶的液面不可超過2/3瓶，以免影響抽吸效果
9.In the present of tracheotomy or profuse sputum, first drip normal saline solution in suction tube several times, about 3~5ml on each sequence and then start sputum suction therapy.若有氣切及濃痰，可先用生理食鹽水緩慢分數次滴入管內，每次約3~5ml，再抽吸痰液
10.The suction machine cup must be rinsed every day and immersed in bleaching water as stated in the instruction manual. Wipe the outer surface of suction machine and clean the rubber hose with water every day.抽痰機之抽痰瓶，必須每天清洗，並以漂白水清潔液，按說明浸泡，抽痰機器外表每日以清水擦淨，橡皮管以清水洗淨
11.While inserting suction tube, do not use great force in suctioning to avoid damaging the mucus on respiratory tract.插入抽痰管時勿用力過猛的進行抽吸，以免損傷黏膜

 

復健協助關節活動（中英文版）

如果要下載英文版的長期照護居家技巧，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 JOINT REHABILITATION　復健協助關節活動篇
Apart from being comfortable, the chapter on maintaining good mobility of joints is also able to increase our conveniences in taking care of our family member!
讓您的家人關節保持好的活動度，除了可以讓他感覺舒適外，也可以增加我們照顧時的方便！
If his/her certain joints are movable, please encourage and supervise him/her to exercise them to the utmost limit. And for those joints that are not movable (such as the hand or leg due to stroke or spinal cord injury), please help him/her to conduct joint exercise. It only takes 10 minutes of your time, and two times daily is able to achieve unexpected result!
當他的某些關節還可自行活動時，請鼓勵並督促他每日能自己活動到最大的範圍，對於他所不能活動的關節（如中風後或脊髓損傷後的手或腳），請你為他執行關節活動，每次費時十分鐘，一日二次便有意想不到的效果喔！

THE PRINCIPLES OF JOINT EXERCISE　關節活動原則
1.Before moving the joints, use a moderate hot towel or hot compress mat to hot compress on different joints to relax the muscles. After then, they are more easily to do the exercises.關節活動前，可適當的以熱毛巾或熱敷墊，熱敷各關節，使肌肉放鬆後，會較容易進行
2.Start from the hand, shoulders to legs, from the near section of every part to the far end of joints. Pay attention that every movable joint must do the exercise.可由手、肩到腳，從各部位的近端到遠端關節，注意每個可以活動的關節都要做
3.While doing joint exercising, do not force to bend or extend the joints when met with resistance to avoid bone breakage or damage. Take a gradual approach method on every joint by increasing the angle and performance. Watch out for facial expression and reaction of the family member!做關節活動時遇到阻力勿強行彎曲或拉直，以免造成骨折或傷害，每個關節採漸進式的角度增加操作，隨時注意您家人的表情反應哦！
4.Joint exercise has to be done disciplinary and consistently. Do not stop from time to time as this yields no result. It is best to perform a session each in the morning and evening and 3~5 sequences on each joint.關節運動要規律、持續執行，不要做做停停等於沒效果，最好是每天早晚各一次，每個關節做3~5次
5.Be careful of own postures while doing the exercises to make sure they are correct. Do not bend the waist excessively to avoid muscle sore.操作時注意自己的姿勢要正確，勿過度彎腰，以免造成自己的酸痛

傷口換藥（中英文版）

如果要下載英文版的長期照護居家技巧，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 WOUND DRESSING　傷口換藥篇

HOW TO HELP HIM/HER ON WOUND DRESSING如何幫助他傷口換藥
If your love one has a skin wound, are you worry that you are incapable to help him/her?
Let’s join together to help take care of his/her wound!當您所愛的人一旦皮膚有傷口發生時！您是否會擔心不知如何照顧呢？讓我們一起來幫他照顧傷口吧！

THE GOAL　目的
Change dressing is able to get rid of different substances such as pus, secretion and death flesh that may influence wound healing. To keep the wound clean is able to enhance healing.換藥可以清除傷口上影響癒合的各種物質（膿、分泌物、死肉）！使傷口保持清潔，傷口會好的很好！

SUPPLIES YOU NEED TO PREPARE　您需要準備
●Germ-free cotton sticks or cotton swabs (for brushing the wound)　無菌棉枝或棉棒（擦傷口）
●Germ-free normal saline solution (for washing the wound)無菌生理食鹽水（洗傷口）
●Liquid medicine or ointment (following the instructions of homecare attendant)藥水或膏（依居家護理師指示使用）
●Germ-free gauzes or surgical tapes (for covering over wound)　無菌紗布或透明膠片（蓋傷口）
●Fastening tapes（膠帶）

PROCEDURES　步驟
1.Wash your hands. 洗手
2.Tear off old medicated dressing (wet it first with normal saline solution if it still sticks to wound)撕下舊敷料(沾黏時先用生理食鹽水沖濕)
3.Observe changes on wound : Big or small changes? The amount of secretion? Color changes? Record the phenomena down. 觀察傷口的變化：大小改變？分泌物多少?顏色變化?記錄下來
4.Dip cotton stick or cotton swab with normal saline solution, rub the wound from the middle to the outside until it is clean.以棉枝或棉棒沾生理食鹽水，從傷口的中間往外塗擦至傷口清潔為止

NOTE　注意
1.Use only once for each sticks.一枝只能用一次
2.The cleaning area should be extended 2~3cm around the wound.清潔範圍至傷口外圍二至三公分的地方
3.If necessary, repeat the above-mentioned methods with liquid medicine or ointment.必要時以上述方式塗上藥水或藥膏
4.Cover up the dressing and secure it with tape.蓋上敷料，貼上膠布

NOTE　注意事項
1.The change dressing sequences depend on wound conditions (the intensity of secretion and size of wound). Please discuss with homecare attendant on the changing sequences.換藥的次數與傷口的狀況有關(分泌物多少、傷口大小)，請與居家護理師討論換藥次數
2.The supplies or cotton sticks that work on the wound must be germ-free. Please be very careful of the sterilized date of the supplies and the technique of change dressing.接觸傷口的物品或棉枝必須完全無菌，請您千萬注意物品的消毒日期及換藥技術
3.If there is a need for other supplies such as therapy bowl, please use it according to instructions from homecare attendant.如需其他特殊物品，如治療碗，請依居家護理師指示使用
4.part from cleanliness of the dressing, the following two procedures are able to enhance healing:傷口要好得很快，除了靠換藥保持清潔外，下面兩項也很有幫助
(1)Turn the body more often to reduce pressure exerting time on the wound.勤於翻身，減少傷口受壓力的時間
(2)Pay attention to nutrition. Eat more meat, fish, beans, eggs, milk and Vitamin A.注意營養，多吃肉、魚、豆、蛋、奶類及維他命A
By merely practicing a few times, you will notice that change dressing is not a difficult job at all.熟能生巧，只要多換幾次，您便覺得換藥不是很難的事

姿位引流及拍擊（中英文版）

如果要下載英文版的長期照護居家技巧，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 POSTURAL DRAINAGE & CLAPPING 姿位引流及拍撃篇

POSTURAL DRAINAGE & CLAPPING 姿位引流及拍撃
If our family member is bedridden for a long time, we can`t help but worry about his/her breathing function to go worse. Now you must attentively help him/her to pay attention to the following agenda.當我們的家人長期臥床時，我們很擔心他的呼吸功能變差，這時您一定要細心的幫他注意下列事項哦！

IMPROVE LUNG FUNCTION　增加肺功能
● If he/she is conscious, encourage him/her (3 times daily,10~15 times for each) to do deep breathing and hard coughing activities.如果他是清醒的，請鼓勵他（每天三次，每次十至十五下）做深呼吸及用力咳嗽的活動
●Try your best to encourage or help him/her to get out of bed to do some exercises.儘可能鼓勵或協助他坐起下床活動

CLEAR AWAY SPUTUM　清除痰液
● If his/her body has no edema and not restricted to take in water, he/she should consume 2000~2500cc of water (including the gavage fluid) so as to dilute the
sputum to ease coughing it out.如果他沒有水腫及限量飲水，每日應喝2000~2500的水份（包括灌入的水份），使痰變稀較易咳出
● If sputum volume has intensified or become too sticky and not easy to cough out, it is necessary to take sputum reduction medical preparation and conduct nebulization.如果痰量增加或太黏不易咳時，需配合使用化痰劑及蒸氣吸入
● If he/she has been installed with tracheotomy, you should learn the sputum suction method of tracheotomy to cleanse the exterior tube and inner cannula.如果他有氣切造口，您需學會如何從此造口抽痰的方法，並每日清潔氣切外管和內套管
●Help him/her to turn the body, and perform back slapping and postural drainage 3 times daily to ease coughing out the sputum.經常幫他翻身，每天執行三次背部叩撃及姿位引流，使痰容易咳出

NOTE　注意事項
1.When performing hand clapping postural drainage, it should be done an hour after meal to prevent food from getting into lungs.施行姿位引流、拍擊時，需於進食後一小時才可做，以避免食物吸入肺部
2.After clapping each position for 5 minutes, maintain that position for 5~10 minutes. Now ask you family member to coordinate doing deep breathing in order to cough out the sputum.每一部位拍撃五分鐘後，維持此姿位五至十分鐘，此時請你的家人配合做深呼吸，咳嗽才能將痰液排出If he/she is unable to cough out, use the sputum suction method to help draw out the sputum.若無法咳出者，以抽痰協助將痰液抽出
3.If your family member tells you he/she gets dizzy during the therapy, such as the phenomena of asthma, heart beat increase, cyanosis...etc, stop postural drainage or clapping immediately!若治療中您的家人告訴您頭暈、氣喘、心跳加速、發紺等現象要馬上停止姿位引流及拍撃！

噴霧治療（中英文版）

如果要下載英文版的長期照護居家技巧，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 NEBULIZATION THERAPY 噴霧治療篇
HOW TO ASSIST YOUR FAMILY MEMBER TO CONDUCT NEBULIZATION?如何協助家屬作噴霧治療
Your family member may be bedridden for a long time or has lung illness, so he/she may have problems in coughing out sputum or even have breathing difficulties due to profuse sputum in lungs. At this moment, he/she needs nebulization therapy to breath in mist and medicine to dilute the sticky fluid and secretion. This will ease coughing out sputum and lightening stimulation, cramp, hyperemia, inflammation, pain and other uncomfortable illnesses of those localized areas. (as in diagram 1)
您的家人可能因長期臥床或肺部疾病，所以肺部痰量多且黏稠，不易咳出，甚至呼吸困難；這時他需要藉助噴霧吸入治療，利用水分子或藥物，稀釋呼吸道黏液及分泌物，使痰容易咳出，並減輕局部刺激、痙攣、充血、發炎腫痛等不舒服的症狀

SUPPLIES YOU NEED TO PREPARE (Diagrams 2, 3)您需要準備的用物(圖二、三)
●Plastic scarf or big towel 塑膠圍巾或大浴巾
●Nebulizer 噴霧器
●Mouthpiece or mask 口咬器或面罩
●Doctor prescribed sputum reduction medical preparation or distilled water 醫師指定化痰藥物或蒸餾水
●Tissue paper 衛生紙

PROCEDURE 步驟
1.Wash your hands and supplies. 洗手準備用物
2.Help him/her to sit up or raise bed head up 30~45o.協助他坐起或抬高床頭30至45度角
3.Place plastic scarf or big towel over the chest.將塑膠圍巾或大毛巾置於胸前
4.Drip liquid medication or distilled water in nebulizer cup and connect the pipe to nebulizer.藥物或蒸餾水滴入小量噴霧杯內，並連接管子至機器上
5.Connect T-shaped tube and mouthpiece with nebulizer. T型管及口咬器均與噴霧器連接完成
6.Place the mouthpiece between teeth, breathe in slowly when you see the beginning of mist formation, and hold breath for about 10 seconds before breathing out through mouthpiece.把口咬器置於牙齒中，見到霧化開始，慢慢地吸入，然後閉氣約10秒再將由口咬器吐出
7.If you choose to use the mask, remove T-shaped tube and mouthpiece first before putting it on.使用面罩者，可將T型管及口咬器移除後接上
8.The therapy is finished when the nebulizer cup is emptied and mist formation has stopped.小量噴霧杯內無藥物，霧化即可停止
9.Turn off and nebulizer and tidy up the supplies.關閉噴霧器和清理用物
10.If necessary, offer back slapping postural drainage, and meanwhile cleanse the mouth.必要時，給予拍背姿位引流並清潔口腔