リハビリテーション医学会研修施設における胃瘻カテーテル交換に対する実態調査

Questionnaire Survey about Gastrostomy Catheter Replacement in Training Facilities of the Japanese Association of Rehabilitation Medicine

要旨：胃瘻カテーテル交換（以下，胃瘻交換）での事故は明るみに出にくく大規模調査もまったくなされていない．今回，全国のリハビリテーション研修施設415施設に対し郵送にて胃瘻交換に関するアンケート調査を行い，221施設から有効回答を得た．交換用胃瘻カテーテルの種類はバンパー・ボタン型が40％と最も多かった．誤挿入予防対策としては「胃内容物の確認」「内視鏡での確認」「送気音の確認」が多かったが，施設間でかなりばらつきがみられた．221施設中51施設で何らかの合併症があり，なかでも誤挿入の事故が20件含まれていた．約40％の施設では胃瘻交換のマニュアルや同意書がなかった．今回の大規模調査から胃瘻交換におけるさまざまなリスクが再確認された．胃瘻交換マニュアルや胃瘻交換同意書のない施設も多いことが明らかになり，より安全な胃瘻交換の方法，事故の予防法について再検討の余地があることが示唆された．

Abstract : The factors that influence the risk of accidents during the replacement of gastrostomy catheters remain unknown and therefore have not yet been thoroughly investigated. We conducted a nationwide questionnaire survey of 415 rehabilitation-training facilities for the replacement of gastrostomy catheters. We received 221 valid responses. Among the catheter replacement methods submitted, the bumper button replacement method was the most widely chosen, comprising 40％ of the valid responses. The measures used to prevent accidental erroneous catheterization included examination of the stomach contents, endoscopic examination of the stomach, and the detection of insufflation sounds, although these measures varied widely among the facilities. Fifty-one out of the 221 facilities that responded to the survey experienced various mishaps, of which 20 were due to erroneous catheterization. In approximately 40％ of the facilities, there was no operative manual for the replacement nor was the patient's consent taken before performing the procedure. This investigation elucidates the risks involved in the replacement of gastrostomy catheters. This survey also suggests that the methods used for catheter replacement should be re-examined to prevent accidents during the replacement.