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Bakgrunn: Sentralvenøse katetre (SVK) er et tilbud til mange pasientgrupper når det foreligger indikasjoner. Dette medfører at SVK håndteres av helsepersonell på alle enheter i helsetjenesten. Samtidig som SVK er livgivende, kan anvendelse av katetre i blodbanen resultere i alvorlige blodbaneinfeksjoner (SVK-BBI). Blodbaneinfeksjoner assosiert med innleggelse og håndtering av SVK, er en av de alvorligste komplikasjonene som kan oppstå. Fokus på forebygging av SVK-BBI har spredd seg fra å gjelde intensivavdelinger tilå gjelde hele helsetjenesten. Hensikten med denne studien erå se på etterlevelse av infeksjonsforebyggende retningslinjer for å forebygge SVK-BBI utenom intensivavdelinger. Fokuseropplæring, aseptisk teknikk, håndhygiene ogdesinfeksjon av koblingene. Metode: Studien er en tverrsnittsstudie hvor det gjennomføres observasjoner av etterlevelse av håndtering og stell av SVK,samten spørreundersøkelse som kartlegger opplæringav helsepersonelli forhold tildette. 40 sykepleiere deltar i observasjonsstudien og 112 helsepersonelldeltar i spørreundersøkelsen. Hovedresultat: Etterlevelse av aseptisk teknikk under prosedyre var 72,5 %.Etterlevelse av håndhygiene før SVK-prosedyre var 42%. Etterlevelse av desinfeksjon før tilgang/ skifte av koblinger var 89,6 %. 96 % av desom håndterte SVK,har fått opplæring. 68 % er opplært med multimodale metoder. Konklusjon: Studien viser at defleste som håndterteSVK har hatt opplæring. Kommentarene til spørreundersøkelsen viser likevel at det etterlyses bedre opplæring hvor praktisk trening og oppdatering av kunnskap er vektlagt. Til tross for stort fokus på opplæring viser observasjonene av etterlevelse av SVK-prosedyren at vesentlige infekjsonsforebyggende tiltak svikter.
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Catheters. --- Catheters. --- Cathéters.
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Intravenous therapy --- Catheters --- Nursing
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This dissertation by Fredrik Hammarskjöld focuses on preventing infections related to the use of central venous catheters (CVCs) and arterial catheters (ACs) in medical settings. It examines the incidence and risk factors for catheter-related infections (CRI) and catheter-related bloodstream infections (CRBSI), particularly in intensive care units (ICUs). The study also explores the effectiveness of evidence-based hygiene routines in reducing these infections and investigates the transmission of Candida species between patients. The research includes both short-term and long-term studies conducted in Scandinavian hospitals, highlighting the importance of adherence to strict hygiene practices for catheter insertion and care.
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CATHETERS, INDWELLING --- SKIN --- HEMODIALYSIS --- CATHETERS, INDWELLING --- SKIN --- HEMODIALYSIS
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Catheters, Indwelling --- Catheterization, Central Venous --- instrumentation
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Catheters --- Nuclear medicine --- Defects. --- Accidents --- United States.
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Catheters --- Catheters --- Medical personnel --- Industrial safety --- Safety measures. --- Safety regulations --- Safety measures.
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Central venous stenosis is a common complication arising from the use of tunneled central venous catheters. However, superior vena cava stenosis is a rare event, at least according to current litterature. Indeed, a thorough review brought up thirty-nine articles and among them thirty-five were case reports and case series. Only one study was able to corne up with an incidence (30%) after perforrning a transesophageal echography on twenty patients with a tunneled central venous catheter placed in the internat jugular vein.Superior vena cava stenosis can present with the typical « superior vena cava syndrome », through a catheter malfunction or be asymptomatic. This retrospective study was designed to study superior vena cava stenosis incidence during the year 2010 in four hemodialysis units. A hundred-and-fifty patients carrying a tunneled central venous catheter were recruited during this year and five of them suffered from a superior vena cava stenosis that was diagnosed after perforrning a phlebography, the current gold standard exam in central venous diseases. Unfortunately, the cases were found in only one unit and the number was too small to conduct a statistical analysis on the entirety of the data so only those from the unit containing the cases were used. The study downgrading from a multicentric to monocentric type is partly explained by several bias (detection, selection and survival). Nevertheless, this study shows that superior vena cava stenosis is not as uncommon as it seems since its incidence for a year and in only one unit was of 10,4%. Moreover, it's the first study giving an incidence value based on clinicat and dialysis events and not on systematic imaging (transesophageal echography, phlebography) , which is currently hard to perforrn on a broad population. Two risk factors, specific of superior vena cava stenosis, were detected : diabetes and young age (less than 60 year-old). However, the typical central venous stenosis risk factors such as the number of catheters carried or the duration of catheter carriage didn't statistically put patients at risk for superior vena cava stenosis in this study. A larger scale, preferably prospective study, with a special care to the bias found here, would be necessary to confirm these results. Les sténoses des veines centrales font partie des complications secondaires à l'utilisation des cathéters veineux centraux tunnelisés (CVCT) fréquemment rencontrées dans la pratique actuelle. Par contre, la sténose de la veine cave supérieure (VCS), reste un événement rare, tout au moins selon la littérature actuelle. En effet, Wle revue de celle-ci aboutit à 39 articles dont 35 case-reports ou case-series. Une seule étude rapporte Wle incidence (30%), après la réalisation d'une échographie transoesophagienne chez vingt patients porteur d'un CVCT jugulaire. Une sténose de la VCS peut se présenter avec une symptomatologie de « syndrome de la veine cave supérieure » ou par une dysfonction du CVCT ou même rester asymptomatique .Notre étude a eu pour but d'étudier rétrospectivement l'incidence des sténoses de la VCS durant l'année 2010 dans quatre centres d'hémodialyse hospitalière. Elle a permis de recruter 150 patients porteurs d'un CVCT durant l'année 2010. Chez cinq d'entre eux, une sténose de la VCS avait été diagnostiquée suite à l'apparition d'un syndrome clinique de la VCS ou suite à une dysfonction de CVCT et confirmée par phlébographie, le gold standard actuel. Malheureusement, le petit nombre de cas détectés et le fait que ceux-ci soient concentrés dans un seul centre n'a pas permis de réaliser une analyse statistique sur l'ensemble des centres. Le passage d'une étude multicentrique à monocentrique s'explique probablement par plusieurs biais (de détection, sélection et survie). Néanmoins, notre étude montre que la sténose de la VCS n'est pas aussi rare que la littérature ne le laissait penser puisque elle conclu à une incidence de 10,4% pour un an et cela dans un seul centre. De plus, elle est la première à montrer Wle incidence de sténose basée sur des évènements cliniques et/ou dialytiques et non pas sur la réalisation d'Wle imagerie systématique (échographie transoesophagienne, phlébographie), difficilement réalisable à grande échelle dans la pratique actuelle. Deux facteurs de risque, spécifiques des lésions de la VCS, ont pu être mis en évidence, ils'agit du diabète et du jeune âge (moins de 60 ans). Par contre, on ne retrouve pas les facteurs de risque classiques de sténose des veines centrales tels que le nombre de CVCT portés ou encore la durée de portage. Une étude de plus grande ampleur, idéalement prospective avec une attention particulière aux biais rencontrés dans notre étude serait nécessaire pour préciser ces résultats.
Central Venous Catheters --- Vena Cava, Superior --- Venous Thrombosis
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