diplomsko delo
Luka Gradišek (Author), Robert Sotler (Reviewer), Darja Thaler (Mentor), Anton Posavec (Co-mentor)

Abstract

Uvod: Med vaskularne pristope za aplikacijo medikamentov štejemo tudi intraosalni pristop, ki je v sodobnem času zdravstva nepogrešljiv pripomoček reševalcev in zdravnikov. Pri intraosalnem pristopu se s pomočjo debele igle predre kožo in pokostnico ter umesti debelejši kovinski kanal v mezgovno votlino. Zaradi dobre prekrvavitve mezgovne votline lahko po intraosalnem kanalu apliciramo medikamente, večje doze kristaloidov ali krvne preparate. Za vzpostavitev intraosalnega pristopa obstaja več vrst pripomočkov. Izvajalec mora biti pozoren na možne kontraindikacije in pravilno izbiro vbodnega mesta. Namen: Namen diplomskega dela je na podlagi domače in tuje znanstvene ter strokovne literature predstaviti intraosalni pristop kot metodo vzpostavitve žilnega pristopa v predbolnišnični nujni medicinski pomoči. Predstavili bomo tudi možne indikacije, kontraindikacije, zaplete in rezultate vprašalnika. Metode dela: Teoretični del diplomskega dela je zasnovan na pregledu domače in tuje strokovne literature ter različnih strokovnih člankov. Iskanje literature je potekalo s pomočjo podatkovnih baz COBISS, Pubmed, CINAHL in spletnega portala DiKUL. Pri iskanju virov smo se omejili na članke, ki imajo dostopno polno besedilo in niso starejši od 10 let z izjemo določenih, katerih vsebina ni omenjena v novejši literaturi. Podatke za empirični del diplomskega dela smo pridobili s pomočjo anketnega vprabalnika, ki so ga izpolnili reševalci na Reševalni postaji Univerzitetnega kliničnega centra Ljubljana. Vprašalnik je zaprtega tipa. Vprašanja so bila oblikovana po pregledu strokovne literature. Rezultati: Med raziskavo smo ugotovili, da večina reševalcev (47,6 %) uporabi intraosalni pristop enkrat letno, najpogosteje zaradi nezmožnosti vstavitve intravenozne kanile v primernem času. Večina reševalcev za primarno mesto vstavitve intraosalnega pristopa izbere proksimalni del tibie. Osebe, ki potrebujejo alternativni pristop za aplikacijo zdravil, so v veliki meri odrasli pacienti v stanju nezavesti, z znaki hipovolemičnega ali kardiogenega šoka. Anketiranci so za najpogostejši zaplet navedli napačno umestitev v mehko tkivo, sledita lokalno otekanje in predrtje kosti. Razprava in zaključek: študija med reševalci UKC Ljubljana kaže, da je intraosalni pristop pogosto uporabljen pri hipovolemičnem šoku in takrat, ko vstavitev intravenozne kanile ni možna ali zanjo porabimo preveč časa. Največkrat izberejo vbod v proksimalni del tibie, čeprav literatura opozarja na prednosti vstavitve v humerus zaradi boljšega pretoka tekočin. Najpogostejša zapleta sta napačna namestitev v mehko tkivo in ekstravazacija, medtem ko sta osteomielitis in okužba razmeroma redka. Kljub sorazmerno redki uporabi v praksi je intraosalni pristop v kritičnih situacijah nepogrešljiv, saj omogoča hiter in zanesljiv dovod zdravil ter tekočin, s čimer pomembno prispeva k boljšim izidom zdravljenja.

Keywords

diplomska dela;zdravstvena nega;vaskularni pristop;reševalec;nujna medicinska pomoč;stanje šoka;

Data

Language: Slovenian
Year of publishing:
Typology: 2.11 - Undergraduate Thesis
Organization: UL ZF - University College of Health Studies
Publisher: [L. Gradišek]
UDC: 616-083
COBISS: 234230019 Link will open in a new window
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Downloads: 22
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Other data

Secondary language: English
Secondary title: Establishing intraosseous access in prehospital environment
Secondary abstract: Introduction: Among the various vascular access methods for medication administration, the intraosseous approach is also recognized as an essential tool for rescuers and healthcare professionals in modern medicine. This method involves the use of a thick needle to penetrate the skin and periosteum, allowing a sturdy metal cannula to be inserted directly into the bone marrow cavity. Due to the rich vascularization of the marrow, the intraosseous route enables the rapid administration of medications, large volumes of crystalloids, or blood products. There are several types of devices available for establishing intraosseous access. However, providers must carefully consider potential contraindications and ensure the correct selection of the puncture site.Purpose: The purpose of this diploma thesis is to present the intraosseous approach as a method for establishing vascular access in pre-hospital emergency medical care, drawing primarily on foreign and domestic scientific and professional literature. Additionally, we will examine its indications, contraindications, potential complications, and the findings of the questionnaire.Methods: The theoretical part of this diploma thesis is based on a review of domestic and foreign professional literature, as well as various scholarly articles. The literature search was conducted using the COBISS, PubMed, and CINAHL databases, along with the DiKUL web portal. We limited our search to articles with full-text access that are no older than 10 years, except for certain ones whose content is not covered in more recent literature. Data for the empirical part of the thesis was collected through a closed-ended questionnaire, which we distributed to registered nurses and emergency medical technicians at the Ambulance Service of University Medical Centre Ljubljana. The questions were formulated based on a review of professional literature.Results: The research findings indicate that the majority of rescuers (47.6 %) use the intraosseous approach approximately once per year, primarily when intravenous cannulation cannot be established in a timely manner. The proximal tibia is the most commonly chosen site for intraosseous insertion. Patients requiring an alternative circulatory access method are predominantly unconscious adults exhibiting signs of hypovolemic or cardiogenic shock. Among complications, respondents most frequently reported incorrect placement into soft tissue, followed by local swelling and bone perforation.Discussion and Conclusion: The study among rescuers at the Ambulance Service of University Medical Centre Ljubljana shows that the intraosseous approach is often used in cases of hypovolemic shock and when it is not possible to insert an intravenous cannula or when it takes too long. They most frequently opt for the proximal tibia for the puncture, although the literature points out the advantages of insertion into the humerus because of better fluid flow. The most common complications are incorrect placement into soft tissue and extravasation, while osteomyelitis and infection are relatively rare. Despite relatively infrequent use in practice, the intraosseous approach is indispensable in critical situations, as it provides a quick and reliable route for administering medications and fluids, thus significantly contributing to better treatment outcomes.
Secondary keywords: diploma theses;nursing care;vascular approach;paramedics;emergency medical care;shock state;
Type (COBISS): Bachelor thesis/paper
Study programme: 0
Thesis comment: Univ. v Ljubljani, Zdravstvena fak., Oddelek za zdravstveno nego
Pages: 37 str., [4] str. pril.
ID: 26270509