| Objective: Tracheal intubation is an important means of rescuing and esuscitating the critically ill patients in clinical practice, and secure fixation of tracheal tube is the key to guarantee effective mechanical ventilation. In clinical practice, the tape used for tube fixation may cause facial flush, blister, lesion and other skin damage of varying degrees. By analyzing the observed incidence rate of facial skin damage, the severity of skin, the displacement of tube, patients’ comfort level, time of each facial care, duration of each facial care, and frequency of facial care, it is expected to find safer and more effective facial care method, reduce the incidence rate of facial skin damage, and improve patients’ comfort level.Methods: In the hospital where the author works, qualified patients that were admitted into the ICU(Intensive Care Unit) from November 2013 to October 2014 were divided into group A, B, and C randomly(Group A:Sterile gauze28 cases, Group B: Transparent dressing33 cases and Group C: Skin protective membrane29 cases). The groups received same basic facial care and tube fixation, but different skin care methods. Specifically, the three methods are:1 Group ASterile gauze. Have two pieces of sterile gauzes and cut them into the size of 2cm*3cm for use. After basic facial care, when the skin is dry, apply a piece of 2cm by 3cms gauze on the corners of the mouth, while one nurse is holding the gauzes in place, the other is applying tape on the tracheal tube for fixation, and the apply a piece of 2cm wide cotton tape to stabilize bite block. Upon fixation, the gauze will separate the tape and mucous membrane at the corners of mouth.2 Group BTransparent Dressing. Cut the transparent dressing according to patients’ facial feature, wait until the skin is dry after basic facial care, have one nurse hold the tracheal tube in position while the other one apply the transparent dressing in the direction from ears to the corners of the mouth so as to cover the skin where the tape will be applied, then apply the tape to fix the tracheal tube.3 Group CSkin protecting membrane. When the skin is dry after basic facial care, spray 3m painless skin protecting membrane on face from a distance of 10-15 cm, and cover patients ’eyes while spraying. Wait for 30 seconds till the membrane is dry, and then apply tape to fix the tracheal tube. If the spray is not even, repeat as needed.Record the incidence rate of skin damage, severity of skin damage, patients’ comfort level, the displacement of tracheal tube, duration of skin care, and frequency of skin care.Results:1 Incidence rate comparison of facial skin injuryThe control group with sterile absorbent cotton gauze: 28 cases, facial skin injury 14 cases, incidence rate: 50%; The control group with transparent dressing: 33 cases, facial skin injury 5 cases, incidence rate: 15.15%; The control group with skin protective membrane: 29 cases, facial skin injury 2 cases, incidence rate: 6.89%.Statistical significance was found among the three control groups, asχ2=16.75,P=0.000<0.05. The comparison result between sterile absorbent cotton gauze and transparent dressing was as follows, χ2=8.58,P=0.003<0.05; The comparison result between sterile absorbent cotton gauze and skin protective membrane was as follows,χ2=13.11,P=0.00<0.05. The result between transparent dressing and skin protective membrane was as follows,χ2=1.05,P=0.31>0.05.2 Severity comparison of patients’ facial skin injuryStatistical significance was found among the three control groups, and the result was as follows. Hc=17.13,P=0.00<0.05.The control groups between sterile absorbent cotton gauze and transparent dressing were proved with statistical significance, as P=0.004<0.017. The groups between sterile absorbent cotton gauze and protective membrane were found to be statistically significant, as P=0.000<0.017. The groups between transparent dressing and protective membrane were found without statistical significance, as P=0.298>0.017.3 Comfort level comparison for patientsThe statistical results of comfort level comparison among the three control groups turned out to be statistical significance with the difference, as Hc=22.42,P=0.000<0.05.The groups between sterile absorbent cotton gauze and transparent dressing were proved to be statistical significance with the difference, as P=0.015<0.017. The groups between sterile absorbent cotton gauze and protective membrane were found to be statistically significant, as P=0.000<0.017. The groups between transparent dressing and protective membrane were found to be statistical significance, as P=0.008<0.017.4 Displacement comparison of tracheal cannulaThe statistical results of comfort comparison among the three control groups turned out to be statistical significance with the difference, as Hc=20.64,P=0.000<0.05.The groups between sterile absorbent cotton gauze and transparent dressing were proved to be statistical significance with the difference, as P=0.015<0.017. The groups between sterile absorbent cotton gauze and protective membrane were found to be statistically significant, as P=0.000<0.017. The groups between transparent dressing and protective membrane were found to be statistical significance, as P=0.009<0.017.5 Time consumption comparison for one-time facial skin nursingTime consumption of one-time facial skin nursing under various situations was as follows: sterile absorbent cotton gauze, 12.35±1.28 minutes/time; transparent dressing, 14.09±1.27 minutes/time; protective membrane, 10.40±1.35 minutes/time. The statistical results among the tree control groups were turned out to be significant with the difference, as F=85.87,P=0.00<0.05. The time consumption of sterile absorbent cotton gauze and protective membrane were found to be less than transparent dressing, and proved to be statistically significant, as P<0.05. The groups between sterile absorbent cotton gauze and protective membrane were found out with no statistical significance, as P>0.05.6 Operation time comparison of facial skin nursingThe operation time difference of facial skin nursing was proved out to be statistically significant, as Hc=32.65,P=0.00<0.05. The groups between sterile absorbent cotton gauze and transparent dressing were proved to be statistical significance with the difference, as P=0.000<0.017. The groups between sterile absorbent cotton gauze and protective membrane were found to be statistically significant, as P=0.000<0.017. The groups between transparent dressing and protective membrane were found without statistical significance, as P=0.223 >0.017.Conclusions: The following conclusion was reached through the above preliminary research1 Skin protective membrane and can effectively reduce the incidence and severity of facial skin injury on patients with orotracheal incubation.2 Skin protective membrane can improve patients ’comfort level, and reduce the incidence of displacement of tracheal cannula.3 Skin protective membrane can guarantee better skin protection and greatly reduce operation time for nurses through its easer operation and less time consumption. |
PDF Full Text Request