NÜTRİSYON HEMŞİRELİĞİNDE ENFEKSİYON KONTROLÜ
Özet
Sağlığın bozulduğu durumlarda nütrisyonel destek, multidisipliner ekip yaklaşımı ile uygulanan tedavinin vazgeçilmez bir parçasıdır. Nütrisyon desteği, sindirim sistemi kullanılarak sağlanan enteral beslenme ve beslenme ürünlerinin damardan verilmesi esasına dayanan parenteral beslenme olarak ikiye ayrılmaktadır. Bu süreçte hemşirelerin hastaları yakın izleme, bakımı yönetme ve olası komplikasyonları önlemede önemli sorumlulukları bulunmaktadır. Enteral beslenmede enfeksiyon kontrolü, ürünlerin aseptik teknikle hazırlanması, setlerin 24 saatte bir değiştirilmesi, stoma bakımı ve tüplerin yıkanması adımlarını kapsar. Perkütan endoskopik gastrostomi (PEG) uygulamalarında ise en sık karşılaşılan sorun peristomal yara enfeksiyonlarıdır. Parenteral beslenmede ise yüksek ozmolarite nedeniyle geniş çaplı damarlardan santral venöz kateter (SVK) kullanımı tercih edilmektedir. Ancak kateter kullanımı, kateter kaynaklı kan dolaşımı enfeksiyonları (KK-KDE) gibi ciddi mortalite ve morbidite unsurlarını beraberinde getirir. Bu enfeksiyonların önlenmesinde el hijyeni, cilt antisepsisi, kapama örtülerinin yönetimi, set bakımı ve rutin kateter değişiminden kaçınılması kritik rol oynamaktadır. Risklerin azaltılması için SVK’nin kan örneği alma işlemlerinde ideal olarak kullanılmaması ve sağlık profesyonelleri ile hasta yakınlarına teorik/pratik taburculuk eğitimlerinin verilmesi hayati önem taşımaktadır.
Nutritional support is an indispensable component of medical treatment managed with a multidisciplinary team approach when natural intake is impaired. Nutritional therapy is categorized into two main methods: enteral nutrition, which utilizes the digestive tract, and parenteral nutrition, which involves intravenous administration of nutrients. Nurses hold comprehensive responsibilities in monitoring patients closely, delivering appropriate care, and preventing potential complications throughout this process. Infection control in enteral feeding encompasses the aseptic preparation of products, changing administration sets every 24 hours, proper stoma care, and systematic tube flushing. Peristomal wound infection stands out as the most frequent complication associated with percutaneous endoscopic gastrostomy (PEG). Conversely, due to high solution osmolarity, parenteral nutrition requires central venous catheters (CVC) inserted into major blood vessels. However, catheterization introduces critical risks, primarily catheter-related bloodstream infections (CRBSI), which elevate morbidity and mortality. Preventing these systemic infections depends heavily on strict hand hygiene, skin antisepsis, appropriate dressing management, administration set care, and avoiding routine catheter replacements. To minimize contamination risks, CVCs should ideally not be used for routine blood sampling, and structured theoretical and practical discharge training must be systematically provided to healthcare professionals and family caregivers.
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