Specifičnosti zbrinjavanja i njege bolesnika s vanjskom drenažom moždanih klijetki

master's thesis

• Title (english): Specificity of management and medical care of patients with external ventricular drainage
• Author: Nives Ćirić
• Mentor: Zdravka Poljaković-Skurić (mentor)
• Committee member: Fran Borovečki (predsjednik povjerenstva)
• Committee member: Mario Habek (član povjerenstva)
• Committee member: Zdravka Poljaković-Skurić (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; Zagreb
• Defense date and country: 2022-09-28, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences

Abstract

Vanjski ventrikularni odvod (EVD) je privremeni sustav, koji uz pomoć
gravitacije omogućava odvod cerebrospinalne tekućine (CSF) iz ventrikula, u vanjski
zatvoreni sustav. Postavljanje katetera (ventrikulostomija) izvodi se kroz trepanacijski
otvor, na mjestu Kocherove točke, najčešće u treći ventrikul. Kada je drenaža
privremena, nazivamo je vanjskom ventrikularnom drenažom (EVD), a ukoliko je trajna
govorimo o postavljanju šanta. Ventrikularni šantovi nazivaju se prema mjestu gdje
drenažni kateter završava, tako npr. šant može biti peritonealni, jer završava u
peritonealnoj šupljini. Primarna indikacija za postavljanje EVD-a je terapijska, odnosno
drenaža likvora ili krvi, s ciljem da se snizi intrakranijski tlak. Povišen intrakranijski tlak
često je udružen sa tri čimbenika: edemom mozga, intrakranijskom hipertenzijom i
hidrocefalusom. Akutni opstruktivni hidrocefalus je česta komplikacija nakon
aneurizme subarahnoidalnog krvarenja, gdje dolazi do naglog povećanja ICP-a, što
može dovesti do brzog gubitka svijesti, pa čak i do smrti bolesnika. Povišen ICP se
medicinski može kontrolirati analgosedacijom bolesnika i osmotskim diureticima,
međutim takvo liječenje često nije dovoljno, već je potrebno hitno pristupiti
neurokirurškom liječenju, tj. postavljanju EVD-a. Nakon što neurokirurg postavi EVD,
bolesnik se smješta u neurološku ili neurokiruršku jedinicu intenzivnog liječenja, gdje
održavanje i rješavanje problema EVD-a postaje odgovornost medicinske sestre. Cilj
ovog rada je napraviti cjelovit prikaz teme EVD-a, od osnovnih anatomskih i fizioloških
postulata o cerebrospinalnoj tekućini, njenoj patofiziologiji, opisati komplikacije koje
nastaju kao rezultat opstrukcije protoka likvora, te prikazati složenost i ozbiljnost
poslova koje provode medicinske sestre u neurološkoj jedinici intenzivne njege.
Ukazati na potrebe dodatne edukacije medicinskih sestara, kako bi se mogla osigurati
sigurna i kvalitetna zdravstvena skrb bolesnika sa EVD-om.

Abstract (english)

The external ventricular drain (EVD) is a temporary system, which with the
help of gravity enables the drainage of cerebrospinal fluid (CSF) from the ventricle to
the outside closed system. Catheter placement (ventriculostomy) is performed through
Trepanation opening, at the Kocher point, usually in the third ventricle. When the
drainage is temporary, we call it external ventricular drainage (EVD), and if it is
permanent, we are talking about placing a shunt. Ventricular shunts are called
according to the place where the drainage catheter ends, so for example the shunt
can be peritoneal, because it ends in the peritoneal cavity. The primary indication for
EVD placement is therapeutic, that is, drainage of cerebrospinal fluid or blood, with
the aim of lowering intracranial pressure. Raised intracranial pressure is often
associated with three factors: brain edema, intracranial hypertension and
hydrocephalus. Acute obstructive hydrocephalus is a frequent complication after
aneurysm of subarachnoid hemorrhage, where there is a sudden increase in ICP,
which can lead to rapid loss of consciousness and even death of the patient. Elevated
ICP can be medically controlled by analgosedation of the patient and osmotic diuretics,
however, such treatment is often not enough, and it is urgently needed to proceed to
neurosurgical treatment, i.e. placement of EVD. After the neurosurgeon place an EVD,
the patient is placed to the neurological or neurosurgical intensive care unit treatment,
where maintaining and solving the EVD problem becomes a responsibility of nurses.
The aim of this work is to make a complete presentation of the subject of EVD, from
basic anatomical and physiological postulates about cerebrospinal fluid, its
pathophysiology, to describe the complications that arise as a result of cerebrospinal
fluid flow obstruction, and show the complexity and seriousness of the work carried
out by nurses in neurological intensive care unit. Point out the need for additional
education of nurses, in order to be able to ensure safe and quality health care for
patients with EVD.

• Keywords: vanjska ventrikularna drenaža; cerebrospinalna tekućina; intrakranijski tlak; hidrocefalus.
• Keywords (english): external ventricular drainage; cerebrospinal fluid; intracranial pressure; hydrocephalus
• Language: croatian
• URN:NBN: urn:nbn:hr:105:672773
• Study programme: Title: Studies in Nursing; Study programme type: university; Study level: graduate; Academic / professional title: magistar/magistra sestrinstva (magistar/magistra sestrinstva)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2023-12-18 13:31:08