20 research outputs found

    Infections Related to the Use of Medical Devices and Changes in the Oropharyngeal Flora

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    Background: Humans exist in mutualistic balance with a large range of microbiota. Illness and hospitalization can disturb this balance and contribute to hospital-acquired infections (HAIs), which occur most often in critically ill patients. The use of medical devices such as central venous catheters (CVCs) and endotracheal tubes (ETTs) is essential in the care of critically ill patients. At the same time, they increase the risk of HAI by forcing or disrupting the normal barriers in the human body. All such devices eventually become colonized with microbes (usually normal flora), that form biofilms on the surface of the foreign material and subsequently lead to infection. The three types of devices related to the majority of HAIs in the intensive care unit are ETTs, urinary catheters, and CVCs.Aim: The present research was conducted to study: (i) changes in oropharyngeal microbial flora during hospitalization; (ii) compare biofilm formation on widely used ETTs with different surface properties and to explore factors potentially predictive of biofilm formation; (iii) the incidence of catheter-related infections and the impact of implementing a simple hygiene insertion bundle; (iiii) compare the blood compatibility of widely used CVCs.Paper I: In a clinical observational study, oropharyngeal cultures were collected from 487 individuals: 77 controls, 193 ward patients, and 217 critically ill patients. The results indicated that occurrence of an abnormal oropharyngeal flora is an early and frequent event in hospitalized patients, particularly the critically ill. Also, colonization with gut flora in the oropharynx was common in critically ill patients. Treatment with proton pump inhibitors was associated with colonization of gut flora in the oropharynx. The result of paper I reinforces the hypothesis that proton pump inhibitor use increases the risk of pneumonia by changing the oral flora, harboring gut bacteria which then may be micro aspirated into the lungs.Paper II: In a clinical observational study, biofilm formation on three widely used ETTs was compared in critically ill patients. Biofilm formation on the tubes was found to be an early and frequent event, and high-grade biofilm formation on the ETTs was associated with development of VAP. Compared to uncoated polyvinyl chloride (PVC) ETTs, silicone-coated and noble-metal-coated PVC ETTs were independently associated with reduced high-grade biofilm formation. Methods aimed at the continuous monitoring of biofilm formation are warranted. Routines for biofilm removal need further study.Paper III: This retrospective study compared the incidence of catheter-related infections and catheter-related bloodstream infections during a 2-year period starting 1 year before and ending 1 year after the implementation of a simple hygiene insertion bundle. A total of 1,722 catheter insertions were included. The incidence of catheter-related infections and catheter-related bloodstream infections in this Scandinavian cohort was low. Thus, it seems that the implementation of a simple hygiene insertion bundle was effective in reducing catheter-related infections. The use of multiple-lumen catheters was associated with increased risk of catheter-related infections.Paper IV: In an experimental study, the blood compatibility of three coated and three uncoated CVC materials was evaluated in a modified Chandler loop model imitating the flow of blood in a vein. When in contact with blood, all the tested catheters had some impact on blood cells, contact coagulation, the complement system, or inflammatory markers, although the effects varied significantly. A polyurethane catheter coated with chlorohexidine and silver sulfadiazine showed the most unfavorable blood compatibility profile. A silicone dialysis catheter exhibited the greatest variation in the blood compatibility tests. Poor blood compatibility could cause inflammation and facilitate the development of catheter-related thrombosis in patients receiving these central venous catheters, but clinical significance has to be studied further

    Kartläggning av röntgensjuksköterskors användning av subkutana venportar inom Region Skåne

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    Röntgensjuksköterskan möter i sitt yrke ett flertal patienter med subkutana venportar, som dessutom ökar i takt med att fler patienter blir erbjudna långtidsbehandling. Trots att subkutana venportar kan vara det bästa alternativet för kontrastinjicering hos en del patienter, finns en försummande användning av dessa portar på kliniker med radiologisk verksamhet. Syftet med studien var att kartlägga röntgensjuksköterskors användning av subkutana venportar inom Region Skåne. Vidare hade även studien som målsättning att undersöka bakomliggande faktorer till varför legitimerade röntgensjuksköterskor väljer att ej använda subkutana venportar vid kontrastadministrering samt vad som behövs för att uppnå en mer frekvent användning. En enkätstudie genomfördes där 146 röntgensjuksköterskor från samtliga sjukhus inom Region Skåne deltog. Resultaten visade att subkutana venportar till största del används sällan eller aldrig (61 %), med flertal bakomliggande faktorer som orsak som var osäkerhet med handhavande, otillräcklig kunskap och tekniska faktorer.Sammanfattningsvis finner studiedeltagarna en osäkerhet när det kommer till subkutana venportar i samband med kontrastinjicering. Ytterligare utbildning anses behövas som i sin tur kan förstärka röntgensjuksköterskors kompetens och självsäkerhet samt gynna patienter med subkutana venportar i samband med kontrastadministering via en subkutan venport

    Central Venous Catheterization. Aspects of Catheter-Related Infections and Thrombosis.

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    Nursing aspects of fluid therapy in dogs and cats

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    V√§tsketerapi √§r en viktig och vanligt f√∂rekommande del i behandlingen av hundar och katter inom djursjukv√•rden. Det √§r ett kraftfullt redskap i behandlingen av flera sjukdomstillst√•nd och b√∂r utv√§rderas kontinuerligt f√∂r att komplikationer ska undvikas i samband med v√§tskeadministrationen. Som djursjuksk√∂tare √§r det viktigt att ha k√§nnedom om olika former av v√§tskeadministrering, liksom k√§nnedom om symtom kopplade till komplikationer som kan uppst√• i samband med behandlingen. Syftet med uppsatsen √§r att sammanst√§lla information kring v√§tsketerapi hos hundar och katter med fokus p√• omv√•rdnad. Omv√•rdnad i det h√§r fallet innefattar administreringsteknik, hygien och √∂vervakning av patienter. Studien √§r en litteraturgenomg√•ng d√§r veterin√§rmedicinsk- och humanmedicinsk litteratur sammanst√§lls f√∂r att skapa en √∂versikt √∂ver l√§mpliga omv√•rdnads√•tg√§rder i samband med v√§tskeadministrering subkutant, intraven√∂st, peroralt och intraosse√∂st med s√• f√• komplikationer som m√∂jligt till f√∂ljd av behandlingen. Subkutana v√§tskeinfusioner kan vara l√§mpligt p√• lindrigt-m√•ttligt dehydrerade hundar och katter och anv√§nds fr√§mst p√• dagpatienter utan m√∂jlighet till kontinuerlig √∂vervakning. Inte mer √§n 10-12 ml v√§tska/kg b√∂r administreras per injektionsplats och inte fler √§n tre injektioner per tillf√§lle och patient rekommenderas. Intraven√∂sa v√§tskeinfusioner l√§mpar sig v√§l f√∂r kraftigt dehydrerade eller hypovolemiska patienter. Central- eller perifer venkateter kan v√§ljas d√§r den f√∂rra √§r f√∂rknippad med fler komplikationer, men kan vara l√§mpligt om st√∂rre v√§tskem√§ngder ordinerats eller om k√§rlretande infusioner ska administreras. Noggrann aseptik i samband med placering och hantering √§r viktigt f√∂r att undvika kateterrelaterade komplikationer vid intraven√∂s administrering. Perorala v√§tskeinfusioner kan vara l√§mpligt om patienten inte √§r hypovolemisk och dessutom √§r i behov av n√§ring. Om inte matning av patienten tolereras kan olika typer av stomisonder placeras via vilka administration av b√•de v√§tska och n√§ring kan ske. Intraosse√∂s v√§tskeadministrering anv√§nds om ingen intraven√∂s kateter kan placeras. F√• komplikationer kopplas till metoden om katetern placeras aseptiskt och korrekt. Sm√§rta i samband med kateterplaceringen och v√§tskeinfusionen kan minskas med hj√§lp av lokalbed√∂vning. Hypotermi √§r en vanlig komplikation hos hundar och katter, i synnerhet under narkos. Betydelsen av v√§tskans temperatur f√∂r utvecklingen av hypotermi √§r omdiskuterad. √Ėver- eller underv√§tskning kan f√• stora konsekvenser f√∂r patienten och en regelbunden √∂vervakning av olika parametrar √§r en viktig del i omv√•rdnaden. Puls, andning, allm√§ntillst√•nd, hudturgor, slemhinnor och centralven√∂st tryck √§r olika parametrar som gemensamt kan ge en uppfattning om patientens hydreringsstatus. F√• studier finns som behandlar omv√•rdnaden kring v√§tsketerapi hos hundar och katter. Den litteratur som finns bygger oftast p√• humanmedicinsk forskning och djurh√§lsopersonalens bepr√∂vade kunskap. Mer forskning kr√§vs inom omr√•det f√∂r att hitta metoder som kan minska risken f√∂r komplikationer och f√∂r att √∂ka v√§lf√§rden f√∂r djurh√§lsov√•rdens patienter. Eftersom allt allvarligare sjukdomstillst√•nd behandlas √∂kar sannolikt √§ven mottagligheten f√∂r komplikationer i samband med v√§tskeinfusioner.Fluid therapy is often an important part of the treatment of dogs and cats at the animal hospital. Fluid therapy is a powerful tool in the treatment of several medical conditions and should be evaluated continuously to avoid complications. As a veterinary nurse, it is important to have knowledge of the methods associated with various forms of fluid administration, as well as the symptoms linked to complications that may arise from the treatment. The purpose of this paper is to compile information about fluid therapy in dogs and cats with focus on the nursing aspects. Nursing in this case includes administration technique, hygiene and monitoring of patients. The study is a literature review where veterinary and human medical literature is compiled to create an overview of the appropriate approach to administer fluid subcutaneously, intravenously, orally and intraosseously with as few complications as a possible. Subcutaneous fluid infusions can be useful in mild-moderately dehydrated dogs and cats and are most often used in outpatients. No more than 10-12 ml fluid /kg should be administered per injection site and no more than three injection sites per session are recommended. Intravenous infusions are suitable for highly dehydrated or hypovolemic patients. Central or peripheral venous line can be selected, where the former is associated with more complications, but may be appropriate when larger amounts of fluid are required or if vessel excitatory infusions are administrated. Careful asepsis during handling and placement of the catheters is important to prevent catheter-related complications. Oral administration of fluids may be appropriate if the patient is not hypovolemic and is also in need of nutrients. Different types of tubes can be placed if handfeeding is not well tolerated. Intraosseous infusion may be used if no intravenous catheter can be placed. Few complications are associated with the method if the catheter is placed aseptically and in an accurate way. Pain associated with catheter placement and fluid infusion can be reduced by use of local anesthetic. Hypothermia is a common complication in dogs and cats, especially during anesthesia. The importance of the fluid temperature for the development of hypothermia is controversial. Dehydration or fluid overload can have major consequences for the patient and a regular monitoring of various parameters is an important part of the nursing care. Pulse, respiration, mentation, skin turgor, mucous membranes, and central venous pressure are different parameters that combined could give an idea of the patient's hydration status. Few studies discuss the nursing aspects of fluid therapy in dogs and cats. Literature is usually based on research in human medicine and the common knowledge of veterinary personnel. Research is needed to find methods to reduce complications and improve the patient welfare. More advanced medical conditions are treated nowadays which may increase the susceptibility to complications associated with fluid infusions

    Adrenal crisis in dogs : monitoring and nursing the intensive care patient

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    Addisonkris hos hund är en livshotande komplikation av den endokrina sjukdomen hypoadrenokorticism och kan leda till att hunden hamnar i en hypovolemisk och kardiovaskulär chock. En patient i Addisonkris är i behov av omfattande omvårdnad och noga monitorering. För att ge patienten de bästa förutsättningarna för att överleva är det av yttersta vikt att förhindra, upptäcka och åtgärda eventuella komplikationer som kan tillstöta i sjukdomsförloppet. Djursjukskötaren har således en betydelsefull roll i vården av dessa patienter. Syftet med detta examensarbete i djuromvårdnad var att undersöka vilken omvårdnad och monitorering som ges till hundar i Addisonkris under vistelsen på en intensivvårdsavdelning på tre stora svenska djursjukhus. Detta med syftet att undersöka vilka parametrar inom respektive område som en djursjukskötare behöver vara särskilt observant på vid sjukdomstillståndet. En intervjustudie utfördes med tre erfarna djursjukskötare som är verksamma på olika intensivvårdsavdelningar. En litteraturstudie där vetenskapliga artiklar samt facklitteratur söktes inom ämnet användes som ett komplement till studien. Det sammanställda resultatet från intervjustudien och litteraturstudien visade att monitorering av cirkulation, blodtryck och vätskestatus var av särskild vikt vid tillståndet. Resultatet av intervjuerna visade att djursjukskötarna inte upplevde att en patient i Addisonkris har några specifika, utmärkande omvårdnadsbehov, utan att ett holistiskt perspektiv för individuell omvårdnad används. Det holistiska synsättet omfattade generella omvårdnadsbehov som patientkomfort, hygien, nutrition, smärtlindring samt vätsketerapi och skötsel av infartskatetrar. Konklusionen av denna studie är att det föreligger en brist på forskning inom ämnet omvårdnad av hundar i Addisonkris. Majoriteten av de studier som finns behandlar patofysiologi, diagnostisering samt den medicinska behandlingen av sjukdomstillståndet. För att kunna möta utvecklingen inom veterinärmedicin och djurägares ökande krav och efterfrågan av specialiserad vård idag bedöms det finnas ett behov av ytterligare forskning gällande djuromvårdnad. Detta skulle även bidra till en ökad djurvälfärd.Addisonian crisis in dogs is a life-threatening complication due to the endocrine disorder hypoadrenocorticism and can lead to hypovolemic and cardiovascular shock. A patient in an Addisonian crisis is in need of extensive nursing and careful monitoring. In order to provide the patient with the best conditions for survival, it is of the utmost importance to prevent, detect and countermeasure any complications that may occur in the course of the disease. The veterinary nurse therefore has a significant role in the care of these patients. The purpose of this bachelor’s thesis in veterinary nursing was to investigate the nursing and monitoring of dogs in Addisonian crisis during their stay in an intensive care unit at three large animal hospitals in Sweden. This with the purpose of examining which parameters that a veterinary nurse must be particularly observant of with this condition. An interview study was conducted with three experienced veterinary nurses that work in different intensive care units. A literature study of scientific articles and literature within the subject was conducted as a complement to the interview study. The compiled results from the interviews and literature highlighted the importance of monitoring circulation, blood pressure and hydration during this condition. The results from the interviews showed that the veterinary nurses did not experience that a patient in an Addisonian crisis had any specific, distinctive nursing needs, but that a holistic approach to individual nursing was used. The holistic approach included general nursing needs such as patient comfort, hygiene, nutrition, pain relief as well as fluid therapy and the maintenance of catheters. In conclusion, this study has shown that there is a need of more research in the field of nursing in dogs in Addisonian crisis. The majority of the studies available cover the pathophysiology, diagnosis and the medical treatment of this condition. In order to meet the development in veterinary medicine and the increasing demands from the animal owners and demands for specialized care there is a need for further research in the field of animal nursing. It could also contribute to an increased animal welfare

    Effect of atropine on intestinal motility in the horse

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    Atropin √§r en viktig del i behandlingen av √∂gonsjukdomar hos h√§st. Genom att minska spasmen i ciliarmuskeln och dilatera pupillen minskar risken f√∂r synekier i √∂gat. Atropin blockerar acetylkolins effekt p√• muskarinreceptorer och d√§rmed parasympatikus. F√∂rutom effekt p√• √∂gat har atropin √§ven effekt p√• flera organsystem i kroppen. Det √§r v√§l k√§nt sedan tidigare att atropin vid frekvent topikal administrering och h√∂ga doser intraven√∂st kan vara en bidragande faktor till ileus och kolik, ett potentiellt livshotande tillst√•nd hos h√§st. F√∂r att utveckla s√§kra behandlingsrekommendationer beh√∂ver dos-effekt sambandet studeras. Effekterna efter en intraven√∂s infusion av atropin i dosen 0,009 mg/kg har utv√§rderats genom att √∂vervaka h√§starnas tarmmotilitet genom auskultation och transkutant ultraljud. Auskultation av bukens fyra kvadranter √§r en v√§l anv√§nd diagnostisk metod d√§r observat√∂ren graderar tarmljuden, minskade tarmljud tyder p√• en funktionsneds√§ttning av tarmen. Vid dosen 0,009 mg/kg observeras en funktionsminskning i tarm hos n√•gra av h√§starna. Den skattade sannolikhetsf√∂rdelningen indikerar att 4,5 % av alla h√§star p√• populationsniv√• skulle drabbas av funktionsneds√§ttning vid given dos (0,009 mg/kg). Det indikerar att effekten p√• tarm √§r liten vid denna dos. √Ėkad stickprovstorlek i studien skulle ge ett b√§ttre underlag f√∂r s√§krare skattningar. F√∂rutom auskultation monitorerades tarmen √§ven genom transkutant ultraljud. Tekniken upplevdes som sv√•r att anv√§nda d√• det kr√§vs en subjektiv bed√∂mning av kontraktionerna och tarmsegment kan f√∂rflyttas ur bild under m√§tperioderna och auskultation visades vara en k√§nsligare metod f√∂r att utv√§rdera tarmmotilitet p√• h√§st.Atropine is an important part of the treatment of uveitis in horses. It reduces the spasm in the ciliary muscle and dilate pupils, thereby the risk of synechia in the eye is reduced. Besides local effects on the eye, atropine has systemic effects on multiple organs in the body. It is well known that atropine at frequent topical administrations and high doses intravenously may be a contributing factor to ileus and colic, a potentially life-threatening condition in horses. To increase the scientific base for dose recommendations with lowest possible risk for unwanted effects, the dose-effect relationship needs to be studied. The effects of an intravenous infusion of atropine at the dose of 0,009 mg/kg have been evaluated by monitoring the intestinal motility of the horses, by means of auscultation and transcutaneous ultrasound. At this dose, the observed values of bowel motility from the placebo group and the treatment group largely overlap. The fraction of the atropine-treated horses with significant decrease in bowel motility, was estimated to approximately 4,5% of the population level. This indicates that the effect of atropine on bowel motility is low at this dose (0,009 mg/kg). Increasing the sample size would provide safer estimates. Transcutaneous ultrasound as a method to monitor the intestinal motility was proved difficult to use in this study, due to the subjectivity in assessment of contractions. Auscultation showed to be the most sensitive method to evaluate intestinal motility in the horse

    Klinisk hantering av dystoki och kejsarsnitt hos tik

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    F√∂r cirka 2‚Äď16 % av dr√§ktiga tikar uppst√•r dystoki, hos 60 % av dessa kr√§vs kirurgiska √•tg√§rder i form av kejsarsnitt. I den h√§r studien beskrivs systematiskt hanteringen av dystokier som leder till kejsarsnitt vid Universitetsdjursjukhusets (UDS) Sm√•djursklinik. Under perioden sept-nov 2018 utf√∂rdes sex akuta kejsarsnitt vid UDS. Sex tikar f√∂dde totalt 33 valpar, varav 28 valpar f√∂dda via kejsarsnitt. H√§lften av tikarna i studien var av rasen fransk bulldogg. √Ėvriga raser i studien inkluderar pomeranian, welsh corgi cardigan samt lagotto romagnolo. V√§rksvaghet var bakomliggande orsak till dystoki hos fyra av sex tikar i studien. Hos √∂vriga tikar hade dystokin troligen obstruktiva orsaker. Indikationer f√∂r kejsarsnitt i studien inkluderade prim√§r och sekund√§r v√§rksvaghet, allm√§np√•verkan hos tiken, misstanke om obstruktiv dystoki, fetal stress m.m. Blodprov togs p√• samtliga tikar, hypokalcemi s√•gs hos h√§lften av tikarna. Fem av sex tikar r√∂ntgades, i samtliga fall kunde dr√§ktigheten bekr√§ftas, alla foster var v√§lmineraliserade och inga tecken p√• fosterd√∂d s√•gs. Hos fyra tikar s√•gs heller inga fell√§gen. Endast tv√• av sex tikar ultraljudades, trots att ultraljud √§r ett utm√§rkt verktyg f√∂r att utv√§rdera fostrens viabilitet och uppt√§cka fetal stress, vilket √§r en tydlig indikation f√∂r omedelbart kejsarsnitt. Fyra tikar fick initialt medicinsk behandling med kalcium intraven√∂st. Ingen av tikarna i studien behandlades med oxytocin f√∂r att stimulera v√§rkarbetet. Inf√∂r kejsarsnittet preoxygenerades samtliga tikar. Tv√• tikar premedicinerades med fentanyl. F√∂r samtliga tikar inducerades narkosen med alfaxalon. Tv√• tikar fick lokalbed√∂vning med lidokain. Sevofluran anv√§ndes f√∂r underh√•ll av narkosen hos fyra av tikarna, f√∂r tv√• av tikarna anv√§ndes ist√§llet isofluran. Med god planering kan valparna f√∂rl√∂sas 5‚Äď15 min efter induktion av narkosen, f√∂r tre av tikarna i den aktuella studien var samtliga valpar f√∂rl√∂sta inom 16 minuter. 28 valpar f√∂ddes via kejsarsnitt. Vid √•terupplivning/aktivering av valparna efter kejsarsnitt gnuggades alla valpar torra med handdukar och luftv√§garna s√∂gs rutinm√§ssigt rena med valpsug. N√•gon form av v√§rmek√§lla anv√§ndes f√∂r alla valpar. Endast en valp gavs syrgas i samband med √•terupplivningen. Tre kullar placerades i syrgasbur d√• √•terupplivningen var avslutad. Fyra valpar gavs hj√§rtmassage. Tre valpar gavs glukos oralt. Inga andra l√§kemedel anv√§ndes i samband med √•terupplivning av valpar f√∂dda via kejsarsnitt. Totalt 28 valpar unders√∂ktes enligt Apgar-skalan. De allra flesta valparna (64 %) tillh√∂rde den h√∂gsta po√§ngkategorin, 7‚Äď10 Apgar-po√§ng. Totalt 18 % av valparna tillh√∂rde kategorin med 4‚Äď 6 Apgar-po√§ng, lika stor del, 18 %, tillh√∂rde den l√§gsta po√§ngkategorin (0‚Äď3), endast en av totalt fem valpar i denna kategori levde efter tv√• timmar. H√∂gst mortalitet s√•gs d√§rmed i den l√§gsta Apgar-kategorin. Samtliga valpar i h√∂gsta och mellersta kategorin levde efter tv√• timmar. Den neonatala mortaliteten omedelbart efter f√∂delsen samt efter tv√• timmar f√∂r valpar f√∂dda via kejsarsnitt var i studien 14 %. Detta resultat √§r j√§mf√∂rbart med valp√∂verlevanden i flertalet andra studier. Samtliga tikar √∂verlevde till utskrivning fr√•n djursjukhuset. Resultatet i studien visar att hanteringen av dystoki och kejsarsnitt hos tik generellt √§r god vid UDS Sm√•djursklinik. Med rutinm√§ssig anv√§ndning av ultraljud skulle fetal stress kunna uppt√§ckas tidigare och i st√∂rre utstr√§ckning √§n i dagsl√§get, vilket m√∂jligg√∂r f√∂r tidigare insatta √•tg√§rder/tidigare beslut om kejsarsnitt. Genom att f√∂rb√§ttra den neonatala omv√•rdnaden efter kejsarsnitt och i st√∂rre utstr√§ckning ge valparna syrgas samt ventilera/intubera valpar med apn√© torde den neonatala √∂verlevnaden kunna f√∂rb√§ttras ytterligare. Oavsett hur bra behandling tiken och valparna ges p√• djursjukhus √§r det dock avg√∂rande att djur√§garen s√∂ker hj√§lp i tid.Dystocia develops in about 2‚Äď16 % of pregnant bitches. Sixty percent of bitches with dystocia will require a cesarean section. In this study the management of dystocia leading to cesarean section (CS) at the small animal clinic at the university animal hospital in Uppsala during the autumn of 2018 is systematically described. In the period from September to November a total of six CS were performed at the hospital. Six bitches delivered 33 puppies. French bulldog was the most common breed in the current study. Other breeds in the study includes pomeranian, welsh corgi cardigan and lagotto romagnolo. The most common cause for dystocia in the study was uterine inertia. In all bitches blood samples was taken, hypocalcemia was seen in 50 % of the cases. Four bitches received initial medical treatment with calcium intravenously. None of the bitches were treated with oxytocin to stimulate labour. Radiographs were taken in five of six cases, in all bitches pregnancy could be confirmed, all fetuses were well mineralized with no signs of fetal death. In four bitches no fetal malpositions or malpresentations were seen. Ultrasound was only performed in two bitches, even though it‚Äôs an excellent method for evaluation of fetal viability and fetal stress, which in turn is a clear indication for immediate CS. All bitches were preoxygenated before induction of anesthesia. Two bitches were premedicated with fentanyl. For all bitches, anesthesia was induced with alfaxalone. Two bitches received local anesthesia with lidocaine. For maintenance of anesthesia sevoflurane was used in four bitches, in two bitches isoflurane was used. With good planning/coordination puppies can be delivered in 5-15 minutes after induction of anesthesia, in three of the litters all of the puppies were delivered in 16 minutes. 28 puppies were delivered through CS. During resuscitation of the puppies, all puppies were vigorously rubbed with dry towels and the airways were routinely cleared through gentle suction. Some kind of heat source was used for all the puppies. Only one puppy was administered oxygen during resuscitation. Three of the litters were placed in an oxygen chamber after completion of resuscitation. Four of the puppies received external cardiac compressions. Oral glucose was given to three puppies. No other medications were used during resuscitation of neonates delivered through CS. 28 puppies were evaluated through the Apgar scoring system. Sixty four percent of the puppies were scored as the highest Apgar category, 7-10 points. Eighteen percent of puppies were placed in the Apgar category with 4-6 points. All of the puppies in the highest and middle Apgar category were alive two hours after delivery. Eighteen percent of the puppies showed severe distress and were scored in the category of 0-3 Apgar points. Only one out of five puppies in the lowest category survived. The highest mortality rate was seen in the lowest Apgar category. For puppies delivered through CS the neonatal mortality was 14.2 % immediately after birth and two hours after birth. This result is comparable to the neonatal survival rate in several other studies. All of the bitches survived to discharge from the animal hospital. The result of the study show that the management of dystocia and cesarean sections in bitches at the university animal hospital in Uppsala is generally good. With routine use of ultrasound, fetal stress could be detected earlier and to a larger extent than currently, enabling earlier decision on surgery. By improving the neonatal care after CS and to a larger extent provide oxygen for newborn puppies and ventilate/intubate puppies with apnea, the neonatal survival rate could be further improved. However, even with optimal clinical management and treatment of dystocia, it is crucial that the animal owner seeks help on time

    √Ąr det inte dokumenterat √§r det inte gjort!

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    SAMMANFATTNING Detta examensarbete syftar till att kvalitetssäkra omvårdnaden av hästar med medicinsk kolik på djursjukhusens stationärvårdsavdelning. Genom att bidra med ett förslag till standardvårdplan för hästar med medicinsk kolik vill vi optimera hästens vård och omvårdnad under sjukhusvistelsen. Syftet med att arbeta med standardvårdplaner (SVP) är att skapa högkvalitativ omvårdnad, underlätta dokumentationsarbetet och i förlängningen kunna få mer tid till att se och vårda den enskilde patienten. Kolik är en åkomma med många olika samverkande faktorer, både miljöbetingade och eventuellt ärftliga Kolik i matsmältningskanalen delas ofta in i medicinsk- och kirurgisk kolik och i detta arbete läggs vikten på medicinsk kolik. Huvuddelen (~90 %) av all kolik kräver ingen kirurgi och tillhör därmed gruppen medicinsk kolik. Kolikavsnittet i arbetet är tänkt som en kunskapsöversikt över sjukdomstillståndet och ska användas som ett styrdokument för att trygga en kvalitativ basnivå på omvårdnaden. I standardvårdplanen har ett antal riskområden identifierats och därefter har riskdiagnoser, mål och åtgärder för att uppnå huvudmålet - en kolikfri patient, utarbetats. Därpå utvecklades kryssprotokoll för parametrar vid observation av kolikhäst och för smärtbedömning vid medicinsk kolik. Nyckelord: dokumentation, medicinsk kolik, omvårdnad, standardvårdplan SUMMARY This diploma work aims to assure the quality care of horses with medical colic on the veterinary hospital's stationary ward. By contributing this proposal of a standard care plan for horses with medical colic we intend to optimize the horse's medical and nursing care during the hospital stay. The aim of working with standard care plans is to create high-quality nursing care, facilitate documentation and in the extension have more time to tend to the individual patient. Colic is a disease with many different interacting factors, both environmental and possibly hereditary. Colic in the gastrointestinal canal is often divided into medical - and surgical colic and in this essay the main emphasis is on medical colic. The main part (~90%) of all colic cases are non surgical and therefore belong to the medical colic cases. The colic chapter in this essay is intended as a knowledge overview over the illness and should be used as a governing document to pursue a safe and high quality-based level of nursing care. In the standard care plan a number of risk areas have been identified. Following this, risk diagnoses, objectives and measures were compiled in order to achieve the main objective - a colic free patient. Subsequently, diagrams for observing the symptoms of colic and pain in horses were developed. Key words: care, documentation, medical colic, standard care planSAMMANFATTNING Detta examensarbete syftar till att kvalitetssäkra omvårdnaden av hästar med medicinsk kolik på djursjukhusens stationärvårdsavdelning. Genom att bidra med ett förslag till standardvårdplan för hästar med medicinsk kolik vill vi optimera hästens vård och omvårdnad under sjukhusvistelsen. Syftet med att arbeta med standardvårdplaner (SVP) är att skapa högkvalitativ omvårdnad, underlätta dokumentationsarbetet och i förlängningen kunna få mer tid till att se och vårda den enskilde patienten. Kolik är en åkomma med många olika samverkande faktorer, både miljöbetingade och eventuellt ärftliga Kolik i matsmältningskanalen delas ofta in i medicinsk- och kirurgisk kolik och i detta arbete läggs vikten på medicinsk kolik. Huvuddelen (~90 %) av all kolik kräver ingen kirurgi och tillhör därmed gruppen medicinsk kolik. Kolikavsnittet i arbetet är tänkt som en kunskapsöversikt över sjukdomstillståndet och ska användas som ett styrdokument för att trygga en kvalitativ basnivå på omvårdnaden. I standardvårdplanen har ett antal riskområden identifierats och därefter har riskdiagnoser, mål och åtgärder för att uppnå huvudmålet - en kolikfri patient, utarbetats. Därpå utvecklades kryssprotokoll för parametrar vid observation av kolikhäst och för smärtbedömning vid medicinsk kolik. Nyckelord: dokumentation, medicinsk kolik, omvårdnad, standardvårdplan SUMMARY This diploma work aims to assure the quality care of horses with medical colic on the veterinary hospital's stationary ward. By contributing this proposal of a standard care plan for horses with medical colic we intend to optimize the horse's medical and nursing care during the hospital stay. The aim of working with standard care plans is to create high-quality nursing care, facilitate documentation and in the extension have more time to tend to the individual patient. Colic is a disease with many different interacting factors, both environmental and possibly hereditary. Colic in the gastrointestinal canal is often divided into medical - and surgical colic and in this essay the main emphasis is on medical colic. The main part (~90%) of all colic cases are non surgical and therefore belong to the medical colic cases. The colic chapter in this essay is intended as a knowledge overview over the illness and should be used as a governing document to pursue a safe and high quality-based level of nursing care. In the standard care plan a number of risk areas have been identified. Following this, risk diagnoses, objectives and measures were compiled in order to achieve the main objective - a colic free patient. Subsequently, diagrams for observing the symptoms of colic and pain in horses were developed. Key words: care, documentation, medical colic, standard care pla

    Central venous catheterisation - clinical studies on mechanical complications in the ultrasound-guided era

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    Central venous catheterisation is one of the most common invasive procedures performed on patients in secondary care. Unfortunately the catheterisation procedure is associated with mechanical complications that both can be life-threatening and may force postponement of life-saving treatments such as surgery and chemotherapy. The use of real-time ultrasound guidance increases success rates and reduces the numbers of mechanical complications - but major mechanical complications still occur. The general aim of this thesis was to explore various aspects of ultrasound-guided central venous catheterisation and associated mechanical complications in order to enable future quality improvements of the procedure.Papers I and II investigate the incidence of mechanical complications within 24 hours after central venous catheterisation and analyse possible associated risk factors. In total, 12 667 central venous catheter insertions in 8 586 patients were included. We found that in hospitals where real-time ultrasound guidance is standard of care for central venous access, the incidence of major mechanical complications was only 0.4%. We also identified patient BMI <20 kg/m2, male operator gender, limited operator experience and more than one skin puncture as independent risk factors for major mechanical complications. In addition, subclavian vein catheterisation was an independent risk factor for pneumothorax compared to internal jugular vein catheterisation. Paper III evaluates the use of a micro-convex probe and the right supraclavicular fossa ultrasound view for aiding guidewire positioning to avoid catheter misplacements in right infraclavicular subclavian vein catheterisation. We prospectively included 103 patients and showed that with the ultrasound method described, 14 of the 15 initially misplaced guidewires were detected and 12 of them were successfully adjusted to a correct position, which in turn helped avoid 12 catheter misplacements at the time of insertion. Paper IV estimates the minimal guidewire length required to avoid guidewire retraction, thereby maintaining a guidewire tip position in the lower segment of the superior vena cava throughout an ultrasound-guided infraclavicular catheter placement in the right subclavian vein. Based on vessel measurements in 100 patients, we concluded that the majority of the assessed 15‚Äď16 cm central venous catheter kits contain guidewires that are too short for right subclavian vein catheterisation, i.e., guidewire retraction is needed prior to catheter insertion. Paper V examines the effect of an implementation package on the documentation of central venous catheter insertions. We found that introduction of an updated central venous catheter insertion form, delegated information responsibility of the new local directions for central venous catheter placement, and follow-up of all registered insertion forms during a limited period of time reduced the porportion of missing data with 55%.The general conclusion of this thesis is that there are possibilities for further quality improvements of central venous catheterisation also in the ultrasound-guided era and that the combination of appropriate recording of central venous catheter insertions, possibilities to track patient outcomes, and clinical research contribute to advanced understanding and delivering of patient-safe healthcare

    The inappetent cat

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    Detta arbete √§r en litteraturstudie som syftar till att √∂ka f√∂rst√•elsen kring inappetenta katter. F√∂r att kunna optimera kattens nutrition kr√§vs kunskap kring kattens energi- och n√§ringsbehov samt om katters generella f√∂dopreferenser. F√∂r att belysa vikten av att katten f√•r i sig n√§rings√§mnen i tillr√§cklig m√§ngd tar arbetet upp hur sv√§lt p√•verkar katten, dels den friska katten som av n√•gon anledning inte √§ter och dels katten som √§ven lider av n√•gon underliggande skada eller sjukdom. Nutritionen spelar √§ven en viktig roll f√∂r kattens sammantagna prognos. D√• anledningarna till inappetens hos katter kan vara m√•nga n√§mns h√§r endast n√•gra av de vanligare orsakerna √∂versiktligt. F√∂r att de nutritionella √•tg√§rderna som s√§tts in ska ge s√• bra resultat som m√∂jligt √§r det viktigt att det finns kunskap kring m√•len med √•tg√§rderna, att en nutritionell plan l√§ggs upp och att katten noggrant unders√∂ks f√∂r att r√§tt √•tg√§rder ska s√§ttas in. N√§ring kan tillf√∂ras enteralt (via mag-tarmkanalen) eller parenteralt (utanf√∂r mag-tarmkanalen). Enteral nutrition √§r att f√∂redra framf√∂r parenteral nutrition i de flesta fall. F√∂r√§ndringar i utfodringen, fodertypen eller klinikmilj√∂n kan ibland vara tillr√§ckliga f√∂r att den inappetenta katten ska b√∂rja √§ta igen, men ofta kr√§vs mer invasiva √•tg√§rder s√• som sondmatning eller parenteral nutrition f√∂r att tillgodose kattens n√§ringsbehov. Ofta anv√§nds tv√•ngsmatning eller aptitstimulerande l√§kemedel f√∂r att f√• katten att √§ta, men dessa √•tg√§rder √§r s√§llan tillr√§ckligt effektiva f√∂r att m√∂ta kattens n√§ringsbehov. De vanligaste sondtyperna √§r nasoesofagealsond, esofagostomisond, gastrostomisond och jejunostomisond, vilka presenteras i arbetet. √Ąven f√∂rdelar och nackdelar med de olika nutritionella √•tg√§rderna och komplikationer som kan uppst√• beskrivs
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