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The use of thromboelastography (TEG) in the evaluation of coagulation in patients on intensive care unit (ICU)
Durila, Miroslav ; Cvachovec, Karel (advisor) ; Stříteský, Martin (referee) ; Kovářová Kudrnová, Zuzana (referee)
Patients in the intensive care unit are in critical condition which is often accompanied by a coagulation disorder. Sepsis as a leading cause of death in critically ill patients may be associated with both hypercoagulable state with microtrombi formation in microcirculation and with increased production of endogenous heparinoids with inhibitory effects on blood clotting. Central venous catheter and arterial catheter are established in patients for hemodynamic monitoring and these are flushed with heparin to prevent their closure. Both inputs are used for blood sampling for laboratory tests such as blood count and coagulation parameters, including thromboelastography (TEG). In the first step of the work, arterio-venous differences in coagulation parameters were investigated in patients with sepsis. Higher concentration of D-dimers and lower antithrombin activity were found in venous blood. This finding can be explained by increased antithrombin consumption in hypercoagulable state and reactive hyperfibrinolysis. Inconsistency in the site of blood sampling may then lead to misinterpretation of the pathophysiological processes in the body. No significant differences were found in TEG parameters. In the second step of the work we examined how heparin commonly used for catheter flushing affects TEG-assessed...
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The use of thromboelastography (TEG) in the evaluation of coagulation in patients on intensive care unit (ICU)
Durila, Miroslav ; Cvachovec, Karel (advisor) ; Stříteský, Martin (referee) ; Kovářová Kudrnová, Zuzana (referee)
Patients in the intensive care unit are in critical condition which is often accompanied by a coagulation disorder. Sepsis as a leading cause of death in critically ill patients may be associated with both hypercoagulable state with microtrombi formation in microcirculation and with increased production of endogenous heparinoids with inhibitory effects on blood clotting. Central venous catheter and arterial catheter are established in patients for hemodynamic monitoring and these are flushed with heparin to prevent their closure. Both inputs are used for blood sampling for laboratory tests such as blood count and coagulation parameters, including thromboelastography (TEG). In the first step of the work, arterio-venous differences in coagulation parameters were investigated in patients with sepsis. Higher concentration of D-dimers and lower antithrombin activity were found in venous blood. This finding can be explained by increased antithrombin consumption in hypercoagulable state and reactive hyperfibrinolysis. Inconsistency in the site of blood sampling may then lead to misinterpretation of the pathophysiological processes in the body. No significant differences were found in TEG parameters. In the second step of the work we examined how heparin commonly used for catheter flushing affects TEG-assessed...
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Nursing care of patient with coagulopathy.
RŮŽIČKOVÁ, Ivana
Abstract This thesis deals with the nursing care for patients with coagulopathy. Its aim is to monitor the issue and create a summary of information about the disease, its distribution, symptoms, possible treatments used in the diagnosis and subsequent treatment options for patients suffering from this disease. The main point of this work is of course the part about nursing care, where the emphasis is laid on the patient and the problems associated with the disease. After that, dealing with a deficit of needs is described where the nurse plays major role, in removing the deficit. Coagulopathy is a general name for diseases that are characterized by increased bleeding disorder or a lack of clotting factors or their inhibitors. The disease can be divided into two basic groups. The first group refers to the coagulopathy, which have originated based on heredity. Conversely, the second group is called up during the life of a patient and is due to the primary disease; that is most commonly impaired liver function. Congenital coagulopathy is often found in the literature under the name of hemophilia. This disease can be further subdivided according to which coagulation factor is violated. If the disorder relates to coagulation factor VIII, we're talking about the type of hemophilia A. Hemophilia B is then characterized by a lack of factor IX. Hemophilia C, which in our geographical conditions doesn't occur, is reported as a deficiency of coagulation factor number XI. Von Willebrand's disease, which is specific deficiency of von Willebrand factor in the coagulation cascade, can also be included among hemophilic disorders. Acquired coagulopathy arises as a secondary disease. Its cause is the liver diseases, which are mostly liver cirrhosis, hepatitis, obstructive jaundice. Coagulopathy, however, can be caused by poisoning by pharmacological drugs. Most are coumarin-type drugs, among which belong Paralen, Warfarin, Macumar. The difference in the treatment of patients with haemophilia and congenital coagulopathies lies in the realization that congenital coagulopathies are the subsequent diseases resulting from complications of the underlying disease. In this work we will also learn about investigative methods that lead to a subsequent diagnosis. Emphasis is placed on medical history, physical examination and subsequent laboratory methods that are most important for us in this disease. Among the basic laboratory tests there belong a blood count and coagulation tests. After that, imaging methods are important in patients with coagulopathy, because they are considered preventive care, preventing patients suffering from this disease from the occurrence of complications. The main point of this work is nursing, in which it is important for us to know how to manage care for patients with this disease and to deprive them of their current deficits of needs. Most often are these deficits associated with increased risk of bleeding and consequent violation of the integrity of the skin or soft tissues. A frequent problem is also the risk of infection. A major problem in the treatment of such patients are disturbances of mental state, where there is mostly disturbed body image due to hematoma forming on the patient's body or frequent bleeding. Patients with coagulopathy should also be aware of the possibilities of the refilling of vitamin K in the diet. Vitamin K is an integral part of the treatment of patients with acquired coagulopathy. A major problem for patients and for us as a medical staff is, after that, deficit of knowledge about the disease and its subsequent treatment by application of intravenous coagulation factor concentrates. In the Czech Republic there are two associations for this kind of patients. We're talking about Hemojunior association, which is intended for children suffering from hemophilia. Patient with this disease should bbe taken as an individual, and thus we should approach him.
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