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Key competences of a nurse in extracorporeal membrane oxygenation
HOLKUPOVÁ, Klára
The aim of this thesis is to map the specifics of work in intensive care of a critically ill patient on extracorporeal membrane oxygenation and to find out what knowledge and skills an intensive care nurse caring for a critically ill patient connected to extracorporeal membrane oxygenation must have. Three research questions were established to meet the objectives: What are the key competencies of a critical care nurse in caring for a critically ill patient on extracorporeal membrane oxygenation? What activities does a critical care nurse perform in intensive care when caring for a critically ill patient on extracorporeal membrane oxygenation? What is a critical care nurse's role in a multidisciplinary team when caring for a critically ill patient on extracorporeal membrane oxygenation? The theoretical part of the thesis focuses on the ECMO device itself, its history and components. It also describes the risks and complications that may occur as a result of this method. Last but not least, the necessary education and competence of nurses who can provide care for a critically ill patient on ECMO is described. A part of the thesis is also dedicated to the nursing management of care for such a patient. Qualitative research was used to achieve the objectives. The empirical part of the thesis was drawn up on the basis of semi-structured interviews with nine informants providing highly specialised nursing care for patients on extracorporeal membrane oxygenation working throughout the Czech Republic. The open coding method was used to analyse the data. Analysis of the data gave us a comprehensive view of care for patients on extracorporeal membrane oxygenation. Intensive care nurses provide comprehensive highly specialised nursing care, and it is essential that they have sufficient knowledge of the matter and the ability to work collaboratively in a team. The output of the thesis is a manual with basic information for nurses who encounter extracorporeal membrane oxygenation for the first time.
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Pathophysiological consequences of different cardiac support regimens in cardiorespiratory insufficiency
Lacko, Stanislav ; Kittnar, Otomar (advisor) ; Havránek, Štěpán (referee) ; Rohn, Vilém (referee)
Introduction: Veno-arterial extracorporeal membrane oxygenation (VA ECMO) is a rapidly applicable type of mechanical circulatory support that overcomes acute hemodynamic breakdowns, whether in acute or chronic heart failure or cardiac arrest. In recent years, the method has seen a very significant increase in use. VA ECMO can fully replace the function of the heart and lungs, delivering about 5 l / min of fully saturated blood. However, the method is burdened with a number of risks. Currently much-discussed issue is the effect of circulatory support on left ventricular residual function as VA ECMO increases its work and the risk of developing left ventricular distension and subsequent pulmonary edema. A detailed analysis of these pathophysiological mechanisms is a key objective of this work. Methods: The focus of the work is three series of experiments on a large biomodel (domestic pig). First, we developed a new model of acute hypoxic-ischemic heart failure by proximal occlusion of one of the main branches of the left coronary artery with a balloon catheter with a lumen for controlled perfusion of deoxygenated venous blood behind the balloon. Furthermore, we monitored the hemodynamic response and energy parameters in detail in the porcine biomodel of acute and chronic heart failure with a gradual...
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Regional flow and number of microembolisms in the common carotid artery at different levels of hemodynamics controlled by VA-ECMO.
Janák, David ; Kittnar, Otomar (advisor) ; Danzig, Vilém (referee) ; Bešík, Josef (referee)
Extracorporeal membrane oxygenation (ECMO) is a method that allows extracorporeal life support in potentially reversible life-threatening conditions affecting the heart or lungs which are refractory to conventional treatment. Depending on the parameters of its setting, this method affects the haemodynamics of the cardiovascular system and the perfusion of the target organ. From the point of view of its character, the necessity for invasive application, and the function thereof in the conditions of the cardiovascular system, ECMO is regarded as a risky method accompanied by a number of complications. Among the critical complications are thromboembolic complications affecting the central nervous system (CNS) and haemorrhagic complications. The goal of this paper is to present and verify the prerequisites for the formation of periprocedural embolisms affecting the CNS and to evaluate the regional haemodynamics of the CNS. This is done by analysing the presence of embolisms and by analysing the parameters of blood flow rates in the right common carotid artery (arteria carotis communis-ACC) and the corresponding oxygenation of the brain tissue during various flow rate parameters generated by the ECMO support on induced heart failure in a biological porcine model. In the first section of the paper, 8...
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