PREOPERATIV FASTA VID VAKUUM-ASSISTERAD SÅRLÄKNING - Anestesisjuksköterskors upplevelse av den preoperativa fastans påverkan på den anestesiologiska omvårdnaden

Nilsson, Anna; Karlsson Möller, Stina

dc.contributor.author	Nilsson, Anna
dc.contributor.author	Karlsson Möller, Stina
dc.date.accessioned	2018-07-10T10:19:03Z
dc.date.available	2018-07-10T10:19:03Z
dc.date.issued	2018-07-10
dc.identifier.uri	http://hdl.handle.net/2077/57075
dc.description	Background: Vacuum-assisted closure (VAC) is used in treatment of mediastinitis, an infection after open-heart surgery. VAC-treatment requires general anesthesia to allow adequate surgical revision, which is performed 2-3 times a week. The patient is fasting prior to anesthesia, and previous research shows that the fasting episode often is significantly longer than required. Longer fasting times can lead to negative consequences for the patient's well- being. Aim: The purpose is to identify how long and how often patients undergoing VAC-treatment for mediastinitis fasten prior to surgical revision in general anesthesia, and to explore if the nurse anesthetist experiences preoperative fasting to affect the anesthesiological care for this group of patients. Method: A multimethod approach combining examination of patient records (n=14) and semi- structured focusgroups with nurse anesthetist. Results: 14 patient records were examined and showed fasting times ranging from 3-24.5 hours with a median of 10.3 hours. The median for the fastingperiods was 4.5 per patient, and 3 per patient for completed surgical revisions. The median was 1,7 for the numer of days without fasting between the fastingepisodes. Two focus groups including three nurse anesthetist in each group were conducted. The analysis of the focus groups resulted in three categories; "compliance to fasting routines", "consequences of frequent and prolonged fasting" and "preconditions for preoperative optimization." Conclusion: VAC patients fasted frequently and the fasting episodes were in the majority of cases longer than recommended by the European Society of Anaesthesiologys (ESA), and 28% exceeded 12 hours. The anesthesiological care were many times affected by the fact that the patients were hypovolemic, and had a reduced well-being due to the length and frequency of the fasting episodes.	sv
dc.description.abstract	Bakgrund: Vakuum-assisterad sårläkning (VAC) används vid behandling av mediastinit, en infektion efter öppen hjärtkirurgi. Sårrevidering och omläggning vid VAC-behandling för mediastinit sker 2-3 gånger per vecka på operationssal i generell anestesi för att möjliggöra adekvat revidering. Inför anestesi krävs att patienten är fastande och tidigare forskning har visat att fastetiderna ofta är betydligt längre än vad som rekommenderas. Längre fastetider kan leda till negativa konsekvenser för patientens välbefinnande. Syfte: Syftet är att kartlägga hur länge och hur ofta patienter som genomgår VAC-behandling för mediastinit fastar preoperativt inför generell anestesi. Dessutom är syftet att belysa om anestesisjuksköterskan upplever att den preoperativa fastan påverkar den anestesiologiska omvårdnaden för denna patientgrupp. Metod: En multimetod med en kombination av journalgranskning (n = 14) och semistrukturerade fokusgrupper med anestesisjuksköterskor användes. Resultat: 14 patientjournaler granskades och visade fastetider mellan 3-24,5 timmar med en median på 10,3 timmar. Medianen för antalet fasteperioder var 4,5 gånger per patient och för genomförda omläggningar 3 gånger per patient. Medelvärdet för antal dagar utan fasta mellan genomförda fasteperioder var 1,7. Två fokusgrupper med tre anestesisjuksköterskor i varje genomfördes. Analysen av fokusgrupperna utmynnade i tre kategorier; "följsamhet till fasterutiner", "följder av frekvent och långvarig fasta” och "förutsättningar för preoperativ optimering". Slutsats: Patienter som behandlades med VAC fastade frekvent och fastetiderna var i majoriteten av fallen längre än det som rekommenderas av European Society of Anaesthesiologys (ESA) och 28% överskred 12 timmar. Den anestesiologiska omvårdnaden påverkades genom att patienterna många gånger upplevdes hypovolema och hade ett nedsatt välbefinnande på grund av fastans längd och frekvens.	sv
dc.language.iso	swe	sv
dc.subject	Anestesiologisk omvårdnad	sv
dc.subject	Preoperativ fasta	sv
dc.subject	Vakuum- assisterad sårläkning (VAC)	sv
dc.subject	Mediastinit	sv
dc.subject	Patient advocacy	sv
dc.subject	Patientsäkerhet	sv
dc.title	PREOPERATIV FASTA VID VAKUUM-ASSISTERAD SÅRLÄKNING - Anestesisjuksköterskors upplevelse av den preoperativa fastans påverkan på den anestesiologiska omvårdnaden	sv
dc.title.alternative	PREOPERATIVE FASTING IN VACUUM-ASSISTED CLOSURE - Nurse anaesthetist experience of the preoperative fasting episodes influence on the anesthesiological care	sv
dc.type	Text
dc.setspec.uppsok	Medicine
dc.type.uppsok	H1
dc.contributor.department	University of Gothenburg/Institute of Health and Care Sciences
dc.contributor.department	Göteborgs universitet/Institutionen för vårdvetenskap och hälsa
dc.type.degree	Student essay

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