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

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