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The issue of central venous catheter treatment in intensive and metabolic care
Zatočilová, Jana ; Petrášková, Hana (advisor) ; Novotná, Jindra (referee)
The present thesis deals with the issue of central venous catheter treatment in intensive and metabolic care, as well as the complications, which can accompany central venous cannulation and thus affect the possible period of using central venous catheter. The theoretical part tries to summarize the information concerning the issues of central venous catheters and their treatment. It also contains essential physiological and anatomical notes concerning central venous cannulation and a historical summary with regard to the present knowledge. The first part of the empirical section of the research follows the medical approach in various departments of the 4th Department of Internal Medicine of the General Teaching Hospital in Prague, as well as their influence on prevention and the rise of complications. The goal of the second part of the research is to make suggestions for treatment of central venous catheters, which could help to improve nursing care and the using period of catheter. The conclusion evaluates, whether the recommendations have at least partially become a part of the nursing care and if they have helped to resolve the areas of concern or not. Key words Central venous catheter, nursing care, complications of central venous catheter, central venous access.
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Comparison of the Vascular Access Care in the Intensive Care Unit and Standart Departement
Vašková, Marcela ; Tomanová, Alena (advisor) ; Petrášková, Hana (referee)
Abstaract(thesis) In my thesis, I decided to take the issue of treatment of vascular input in surgical department and surgical intensive care units. This nursing problem can be found practically on every inpatient department and each nurse meets with vascular access dutiny her career. The work is divided into theoretical part and empirical part. The first theoretical part deals with the history of vascular input, a list of basic vascular entries and the educational process. Of the vascular inputs, the work focuses especially on central venous catheter and peripheral venous catheter. The second empirical part focuses on the evaluation of collected data and their statistical analysis. Before the research 4 hypotheses were provided. These hypothesis were confirmed by statistical evaluation of questionnaires. The questionnaires were filled in by sisters from the surgical department and intensive care units. At the end of the thesis is work evaluation. Keywords Vascular access, peripheral venous cannula, central venous cannula, nursing, dressing, asepsis, infections, nurse, patient
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Problem of sepsis in the intensive care unit
Škrabánková, Hana ; Marková, Eva (advisor) ; Jankovcová, Kateřina (referee)
The aim of the thesis was to determine the microbial colonization at the injection site of central venous catheter and its possible influence to maintain the lowest incidence of catheter sepsis. The culture results of skin swabs and taken blood cultures from two groups of patients were compared with each other using qualitative analysis methods. Those were Intensive Care Unit patients with established central venous catheter. The result was the discovery of microbial colonization of the skin and the representation of different pathogenic strains at the site of a central venous catheter for both established groups. Further showed that the higher the risk of microbial colonization with symptoms of catheter sepsis was seen where patients have central venous catheter established for longer period of time and have been treated under home parental nutrition program with stoma. The recommendation is the continuous education of health professionals to act in accordance with the latest preventive treatment recommendations, and the emphasis is mainly placed on hands cleaning and disinfecting as the hands of health professionals are one of the most common and risky way of transmission of pathogenic strains with potential nosocomial infection formation. Aseptic principles must be repeatedly communicated to all...
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The prevention of nosocomial infections at central venous catheters in standard inpatient departments and intensive care units.
PAŽOUTOVÁ, Petra
Nosocomial infections are one of serious problems of modern medicine and nursing also nosocomial infections mean real serious problems for future. Prevention of nosocomial infections, applied together with pointed and meaningful antimicrobial therapy is the only causal solution now. This work was aimed primarily at a comparison of knowledge of common nurses working in intensive care wards and common nurses in standard wards. In general, it could be said that the aim of this work was to map the scope of knowledge of common nurses as for nosocomial infections as well as aseptic care for central venous catheters including catheter sepses. The found deficit in knowledge of common nurses pointed out the occurrence of mistakes in nursing practices. Quality of nursing is connected closely with standardisation of nursing procedures. Quantitative research inquiry was realised in 4 medical facilities: Regional hospital Liberec, a.s., Masaryk city hospital in Jilemnice, Hospital České Budějovice, a.s. and Hospital with polyclinic in Semily. As the research method there was chosen a non-standardised questionnaire. The sample of respondents was chosen as an intentional selectionand and in to statistic processing included 290 relevantly filled out forms. The research investigation also included a comparison and quantification of nursing standards. In view of the performed comparison of standards in nursing we concluded that creation of incomplete or even inconsistent standards occurs here. We have prepared a "Proposal on a standard of nursing care for inserted venous catheter", of which form could enable to implement it in medical care facilities within the Czech Republic and define clearly basic nursing procedures within the scope of these problems.
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Current possibilities of laboratory diagnosis of staphylococcal infections
CHRTOVÁ, Lucie
Laboratory diagnostics of Staphylococccal infections is based on direct evidence, like microscopy and cultivation, eventually on molecular genetics methods. The objective of this thesis is the presentation of nowadays possibilities in laboratory diagnostics of coagulase - negative staphylococcal infections and comparsion of two methods of identification used in the routine laboratory practice. First part of the thesis presents the genus Staphylococcus and the difference between it and the genuses Micrococcus and Peptococcus. The following part of this thesis shows the distribution of genus Staphylococcus in two main groups (Staphylococcus coagulase - positive and coagulase - negative), based on the ability to coagulate plasma. The description of these two main groups contains their morphological and cultivation features, antigen structure, virulence factors, pathogenesis and laboratory diagnostics. In the methodical part the pre-analytic and analytic phase is mentioned. The focus of the pre-analytic part the general priciples of collection and transport for microbiological analysis and the collection of material itself. The methodical part was performed in the České Budějovice Hospital - Laboratory of Medical Microbiology - Department of Bacteriology. This part of the thesis presents the differentiation of staphylococci by latex agglutination (PROLEX TM STAPH LATEX KIT) and then specific identification of 52 strains of coagulase-negative staphylococci isolated from central venous catheters , hemocultures and other clinical important materials is following. The specific identification of all the 52 strains of coagulase-negative staphylococci was performed by biochemical identification by STAPHYtest 16 (ErbaLachema) and parallel by mass spectrometry MALDI-TOF (system VITEK MSTM). The correct identification reached 96,2 % by the method of mass spectrometry MALDI-TOF and 67,3 % by biochemical identification STAPHYtest 16. The most frequent species isolated was Staphylococcus epidermidis (64 %), then Staphylococcus hominis ssp. hominis (10 %), Staphylococcus capitis (6 %), Staphylococcus warneri (6 %), Staphylococcus lugdunensis (4 %), Staphylococcus haemolyticus (4 %), Staphylococcus hominis (4 %), Staphylococcus caprae (2 %). The comparsion of both named methods shows the mass spectrometry more reliable, faster and simpler method, and more suitable for routine laboratory work.
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The problems of the central venosus catheter in the point of view of a nurse and a patient
KOVÁŘOVÁ, Miroslava
At present, nurses working in the acute medicine often meet patients who have had introduced a central venous catheter. In the acute medicine this catheter is essential for its wide-spread utilization. It also needs an intensive nursing care due to its invasiveness and an easy importation of an infection. Every hospital has its own standards developed for its treatment as well as successes in a prevention of the catheter infection. The patients often perceive an introduction of the central venous catheter as an inconvenience and they do not understand restrictions which are necessary when the catheter is going to be introduced. An aim of the bachelor thesis was to determine the problems that nursing staff meet in the care of the central venous catheter, which methods they use in the prevention of the infection and what are the feelings of patients with the introduced central venous catheter. In order to achieve the defined aims a qualitative method of a semi-structured interview was used. Interviews were made with nurses working in intensive care wards and in departments of anaesthesiology and resuscitation and a semi-structured interview with the patients who have had an experience with the inserted central venous catheter as well. Results were described in the interviews and interesting facts were entered into tables. The research showed that a frequent problem for nurses was the infection. Another finding showed that nurses have used available means to prevent an onset of the infection and they followed the nursing care standards while taking care of the central venous catheter. The interviews with the patients showed that they had perceived problems especially with a re-bandage of the central venous catheter.
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