Application of NPWT in patients after cardiac surgery—а literature review and own experience

Postoperative chest wound infection and associated mediastinitis is one of the most dangerous complications in patients after cardiac surgery. In this context, accurate knowledge of the prevalence of surgical wound infection and the risk factors for its occurrence is imperative. This knowledge also concerns the creation and implementation of modern measures, which could contribute to the improvement of the treatment and care provided, as well as the prevention of this serious postoperative complication after cardiac surgery

Implantation of a hemodialysis catheter directly in the right atrium due to exhaustion of vascular access

Introduction: Patients on permanent hemodialysis need constant and secure vascular access with optimal flow to perform the procedure. Failure to provide such access can lead to life-threatening deterioration of the patient's condition.Case Presentation: We report a case of implantation of a hemodialysis catheter directly in the right atrium (RA) in an emergency in a 46 year-old woman, placed on permanent hemodialysis (HD) for nine years due to end-stage renal disease with exhausted opportunities for vascular access over the years and unsuitable for peritoneal dialysis.After a consultation between a cardiac surgeon, a vascular surgeon and an interventional radiologist, a decision was made to directly implant a permanent catheter for HD in the superior vena cava (SVC).The operation was performed as a matter of urgency, operative access was through ministerotomy and the catheter was implanted directly in the right atrium (RA) due to thrombosis and fibrosis of the SVC. No cardiac complications associated with the procedure were observed in the postoperative period. On the first postoperative day, HD was performed, followed by others according to the therapeutic plan. The patient was discharged from the Cardiac Surgery Department on the 7th postoperative day.Conclusion: The use of open surgical access and the implantation of a permanent HD catheter directly into the RA can be considered a life-saving procedure in HD patients with acute uremic syndrome and exhausted vascular access

Epidemiology, Risk Factors, and Clinical Presentation of Wound Infections after Sternotomy. Prevention and Treatment Trends at a Cardiac Surgery Clinic // Епидемиология, рискови фактори и клинична проява на раневите инфекции след стернотомия. Тенденции за превенция и лечение в Клиника по кардиохирургия

The thesis presents a study of the epidemiology, risk factors and clinical manifestation of wound infections after sternotomy, as well as modern trends in prevention and treatment. Our research aims to implement evidence-based practices and strategies to minimise the risk of sternal wound infections after cardiac surgery and to optimise the management of this serious complication. The risk factors for the development of wound infection in the Cardiac Surgery Clinic – Varna have been identified and analysed. A protocol for the prevention of wound infections is presented, and its effectiveness is statistically evaluated. Definitive data on the financial burden of this complication in cardiac surgery are presented, proving the need for preventive measures. Data on the epidemiology of wound infections in the clinic, as well as the trend in decreasing incidence over nine years, is presented. Initial data on the use of CiNPWT as a preventive measure are reported.Тема на дисертацията е изследването на епидемиологията, рисковите фактори и клиничната проява на раневите инфекции след стернотомия, както и съвременните тенденции за профилактика и лечение. Целта на дисертационния труд е чрез прилагане на основани на доказателства практики и стратегии да се минимизира рискът от раневи инфекции на гръдната рана след сърдечна операция и да се оптимизира управлението на това сериозно усложнение. Идентифицирани и анализирани са рисковите фактори за развитие на ранева инфекция в Клиника по кардиохирургия, Варна. Представен е Протокол за превенция на раневите инфекции, оценена е статистически неговата ефективност. Посочени са категорични данни за финансовата тежест на това усложнение в сърдечната хирургия, доказващи нуждата от превантивни мерки. Представени са данни за епидемиологията на раневите инфекции в клиниката, както и тенденцията за намаляването на честотата им за деветгодишен период. Отчетени са първоначални данни за приложението на ciNPWT като превантивна мярка

Risk factors for surgical site infection in cardiac surgery - A short literary survey, risk patterns

It has been established that worldwide surgical site infections (SSI) account for over 10 billion US dollars in medical treatment expenses per year. Compared to patients that do not develop such a complication, the ones with SSI have their hospital stay prolonged by an average of 7 days, have a 60% higher chance to be treated in an ICU, have a 5 times higher rate of rehospitalization in the first 30 days after their discharge and twice as high mortality rate (12, 14, 16).Admittedly, regardless of expenses and efforts, patient condition, successful treatment and quality of life are of utmost importance