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Vloga perfuzionista pri kardioplegiji med zunajtelesnim krvnim obtokom : diplomsko delo
ID Končan, Žiga (Author), ID Pajnič, Manca (Mentor) More about this mentor... This link opens in a new window, ID Marinšek, Mitja (Comentor), ID Pađen, Ljubiša (Reviewer)

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Abstract
Uvod: V Evropi so bolezni srca in ožilja najpogostejši vzrok smrti, za njihovimi posledicami letno umre prek 4 milijone ljudi. Bolezni srca in ožilja so najpogostejši vzrok smrti tudi v Sloveniji, v letu 2019 so predstavljale 38 % vseh smrti, v letu 2020 pa 32 %. Pri večini operativnih posegov na odprtem srcu mora biti prisoten tudi perfuzionist, ki med operacijo na odprtem srcu skrbi za zunajtelesni krvni obtok, in če je potrebno zagotavlja mirno srce, kar omogoča kirurgu brezkrvno operativno polje in nemoteno operiranje. To doseže z raztopinami kardioplegije. Namen: Predstaviti, kakšne so naloge perfuzionistov pri aplikaciji in nadzorovanju kardioplegije, kakšno opremo potrebujejo za izvedbo postopka in katere raztopine uporabljajo v Univerzitetnem kliničnem centru Ljubljana. Metode dela: Izvedli smo polstrukturirane intervjuje s tremi perfuzionisti, ki so zaposleni v Univerzitetnem kliničnem centru Ljubljana in imajo vsaj 9 let delovnih izkušenj. Intervju je vseboval 5 glavnih vprašanj in nekaj podvprašanj. Intervjuvanje smo izvedli v prostorih Univerzitetnega kliničnega centra Ljubljana in so bili glasovno snemani. Za analizo smo jih dobesedno prepisali in izvedli odprto kodiranje. Rezultati: Za zaposlitev na delovno mesto perfuzionista mora imeti diplomirana medicinska sestra/diplomirani zdravstvenik vsaj dve leti delovnih izkušenj v enoti intenzivne terapije III. Novo zaposleni perfuzionist gre najprej za dve leti na usposabljanje, sledi samostojno delo pod nadzorom. Za izvedbo kardioplegije potrebujejo črpalko, sistem cevi, izmenjevalec toplote s pripadajočimi cevmi in hiperkalemično raztopino. Vedno imajo v bližini tudi več peanov, s katerimi lahko v trenutku zmanjšajo pretok kjerkoli v sistemu ali pa pretok popolnoma zaustavijo. Za kardioplegijo uporabljajo tri različne raztopine, St. Thomas, del Nido in Custodiol. Na kakšen način bo aplicirana kardioplegija se vedno odloči kirurg, saj on v dani situaciji vidi in presodi, kaj bi bilo najbolj primerno. Cilj vsakega kirurga je zmanjšati čas trajanja zunajtelesnega krvnega obtoka. Razprava in zaključek: Delo perfuzionistov je zelo specifično in odgovorno. Zahteva ogromno znanja o biokemiji krvi ter poznavanje anatomije, fiziologije in patologije kardiovaskularnega sistema. Poleg strokovnega znanja pa potrebujejo tudi tehnično znanje za sestavljanje kompleksnega cevja in upravljanje črpalk. Za uspešno operacijo na odprtem srcu mora perfuzionist stalno komunicirati s kirurgom in anesteziologom.

Language:Slovenian
Keywords:diplomska dela, zdravstvena nega, operacija na srcu, perfuzija, raztopine
Work type:Bachelor thesis/paper
Typology:2.11 - Undergraduate Thesis
Organization:ZF - Faculty of Health Sciences
Place of publishing:Ljubljana
Publisher:[Ž. Končan]
Year:2023
Number of pages:42 str., [4] str. pril.
PID:20.500.12556/RUL-148734 This link opens in a new window
UDC:616-083
COBISS.SI-ID:162850563 This link opens in a new window
Publication date in RUL:31.08.2023
Views:1372
Downloads:145
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Secondary language

Language:English
Title:The role of the perfusionist in cardioplegia during cardiopulmonary bypass : diploma work
Abstract:
Introduction: In Europe, cardiovascular diseases are the most common cause of death, with over 4 million people dying from their consequences each year. Cardiovascular diseases are the leading cause of death in Slovenia as well, accounting for 38 % of all deaths in 2019 and 32 % in 2020. For most open-heart surgeries, a perfusionist must be present to maintain the extracorporeal blood circulation during the operation and provide a still heart if necessary, enabling the surgeon to operate bloodlessly and smoothly. This is achieved by using cardioplegia solutions. Purpose: To present the tasks of perfusionists in the application and monitoring of cardioplegia, what equipment they need to perform the procedure, and which solutions they use at the University Medical Centre Ljubljana. Methods: In the empirical part we conducted semi-structured interviews with three perfusionists employed at the University Medical Centre Ljubljana, each with at least 9 years of work experience. The interview consisted of 5 main questions and several sub-questions. They were conducted at the University Medical Centre Ljubljana and were voice recorded. We transcribed them verbatim and conducted open coding for analysis. Results: To be employed as a perfusionist, a registered nurse with a bachelor's degree must have at least two years of work experience in the intensive care unit III. The newly employed perfusionist undergoes a two-year training period, followed by supervised independent work. To perform cardioplegia they need a pump, tubing system, heat exchanger with corresponding tubing, and a hyperkalemic solution. They always have several forceps nearby, which can reduce or stop blood flow in the system instantly. They use three different solutions for cardioplegia: St. Thomas, del Nido, and Custodiol. The surgeon always decides how cardioplegia will be applied, as they can see and assess the most appropriate method in a given situation. The goal of every surgeon is to minimize the duration of extracorporeal blood circulation. Discussion and conclusion: The work of perfusionists is very specific and responsible. It requires a great deal of knowledge about blood biochemistry, as well as an understanding of the anatomy, physiology, and pathology of the cardiovascular system. In addition to professional knowledge, they also need technical skills to assemble complex tubing and operate pumps. For a successful open-heart surgery, a perfusionist must communicate constantly with the surgeon and anesthesiologist.

Keywords:diploma theses, nursing care, heart surgery, perfusion, solutions

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