Preprečevanje okužb likvorja pri bolnikih z vstavljeno zunanjo ventrikularno drenažo : diplomsko delo

Borišek, Darja (author), Djekić, Bernarda (mentor), Zidar-Zupan, Alenka (co-mentor)

Uvod: Zunanja ventrikularna drenaža je eden izmed najbolj pogostih nevrokirurških posegov. Njena naloga je začasno dreniranje likvorja iz možganskih prekatov. Vstavitev drenaže je rutinski poseg, ki lahko za seboj potegne številne zaplete. Najpogostejša med njimi je okužba, ki ima za posledico daljše bivanje v bolnišnici ali celo smrt. Namen: Namen diplomskega dela je z vidika zdravstvene nege predstaviti preprečevanje okužb likvorja pri bolnikih, ki imajo vstavljeno zunanjo ventrikularno drenažo. Ugotoviti smo želeli, kakšna je pojavnost okužb likvorja, kateri so najpogostejši vzroki za okužbo in kako odvzem vzorca likvorja vpliva na pojav okužb. Metode dela: Uporabljena je bila deskriptivna metoda dela s kritičnim pregledom slovenske in tuje strokovne in znanstvene literature. Iskanje literature je potekalo preko spletnega portala digitalne knjižnice Univerze v Ljubljani (DiKUL) v mednarodnih spletnih bazah CINAHL in Medline ter s pomočjo vzajemne kataloške baze podatkov COBIB.SI. Zbiranje in pregled literature je potekalo od maja do oktobra 2018. Upoštevala se je literatura, ki je bila napisana med leti 2008 in 2018. Iskanje literature je potekalo s pomočjo ključnih besed: zunanja ventrikularna drenaža/external ventricular drainage, infekcija ali okužba/infection, ventrikulitis/ventriculitis, meningitis; rokovanje/manipulation, odvzem vzorca likvorja/cerebrospinal fluid sampling Rezultati: Okužbe likvorja so se po navajanjih v literaturi pojavile v razponu od 6,1 do 32,2 %. Zaradi različnih pristopov pri ugotavljanju pojavnosti okužb, dobljenih vrednosti ni možno posplošiti. Na pojav okužbe vpliva čas trajanja vstavljene drenaže in sicer se pojavi okužba povprečno 6,5 dni po vstavitvi. Dejavniki tveganja za razvoj okužbe so tudi: hemoragični dogodek, predhodna sistemska okužba, vstavljenih več zaporednih drenov, lumbalna drenaža in puščanje ob mestu vstavitve drena. Nevarnost za razvoj okužbe se poveča z večanjem števila odvzetih vzorcev likvorja. Razprava in sklep: Medicinska sestra mora bolnika z vstavljeno zunanjo ventrikularno drenažo ves čas nadzorovati. Poznati mora znake, ki kažejo na pojav okužbe. Znati mora pravilno rokovati s sistemom. Smiselno bi bilo, da bi tudi v Sloveniji vpeljali enostavne protokole, ki bi zajemali tako vstavitev kot oskrbo katetra in bi bili namenjeni zdravnikom in medicinskim sestram. Smernice in protokoli, ki že obstajajo, bi morali biti pregledani in obnovljeni.

• Language: Slovenian
• Keywords: cerebrospinalna tekočina, hidrocefalus, intrakranialni pritisk, zdravstvena nega, odvzem vzorca likvorja, pojavnost okužbe
• Work type: Bachelor thesis/paper
• Organization: ZF - Faculty of Health Sciences
• Year: 2019
• PID: 20.500.12556/RUL-106816
• COBISS.SI-ID: 5596267
• Publication date in RUL: 18.03.2019

Secondary language

• Language: English
• Title: Prevention of likvor infections at patients with installed external ventricular drainage : diploma work

Abstract

Introduction: External ventricular drainage is common neurosurgical intervention which mission is to drain excessive cerebrospinal fluid. Insertion of drainage is a routine procedure, which nevertheless can cause many complications. The most common complication is the infection of the central nervous system. Purpose: Purpose of this diploma work from nursing care perspective is to present prevention of cerebral spinal fluid infection of patients with inserted external ventricular drainage. We wanted to find out what is the incidence of cerebral spinal fluid infection, which are the most common causes for infection and how sampling of cerebral spinal fluid influences at the occurrence of infections. Methods: A descriptive method was used with critical review of Slovenian and foreign science literature. The search of literature was throughout the digital library data from Ljubljana University library (DiKUL), worldwide online basis CINAHL, Medline and COBIB.SI. The search of literature was throughout with help of key words: external ventricular drainage, infection, ventriculitis, meningitis; manipulation, cerebrospinal fluid sampling. Results: Observed incidence values of cerebral spinal fluid infection are very different in viewed literature are in range from 6,1 to 32,2 %. Because of different approaches at determining the incidence of infections, the results cannot be generalized. It was discovered, that more factors influences the occurrence of infection. The time of duration of inserted drainage is important, the infection usually occurs on the 6.5 day after the insertion. Hemorrhagic event, preliminary system infection, more multiple drainage inserted, lumbar drainage, catheter leaking at insertion site and frequent cerebrospinal fluid sampling are factors that increase danger for the occurrence of cerebral spinal fluid infection. Discussion and conclusion: Nurse must always monitor the patient with inserted external ventricular drainage. She must correctly handle the system. She must know the signs, which show the occurrence of infection and in time take action. It would make sense, that simple protocols would be implemented in Slovenia, which would cover insertion and care of the catheter and would be intended for surgeons, doctors and nurses. Guidelines and protocols should be reviewed and restored.

• Keywords: cerebrospinal fluid, hydrocephalus, intracranial pressure, health care, cerebrospinal fluid sampling, incidence infections