Simulacija vpliva zračne embolije na delovanje izven-telesne membranske oksigenacije

Krašna, Nejc

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Title:	Simulacija vpliva zračne embolije na delovanje izven-telesne membranske oksigenacije
Authors:	ID Krašna, Nejc (Author) ID Goslar, Tomaž (Mentor) More about this mentor...
Files:	MAG_Krasna_Nejc_2022.pdf (2,70 MB) MD5: 4B46B2DD4538E551F87040F688126295 PID: 20.500.12556/dkum/81463fd3-37ae-47db-a0c2-92ea02d2fd69
Language:	Slovenian
Work type:	Master's thesis/paper
Typology:	2.09 - Master's Thesis
Organization:	FZV - Faculty of Health Sciences
Abstract:	Uvod: Zračna embolija (ZE) je možen zaplet pri zdravljenju z izven-telesno membransko oksigenacijo (ECMO). ECMO ustvarja negativen tlak v venskem delu sistema in poleg krvi lahko vsrka tudi zrak. Zrak v črpalki izpodrine kri in zaustavi njeno delovanje, če preide prek membrane oksigenatorja v pacienta lahko povzroči ZE in nepopravljivo okvaro. Metode: V teoretičnem delu smo opravili pregled literature. V empiričnem delu smo opravili 460 simulacij, raziskovali smo vplive različnih količin zraka ob različnih obratih črpalke na delovanje ECMO ter preverili možnost vstopa zraka prek centralnega venskega kanala (CVK). Rezultati: Že ob najmanjši količini zraka, 1 ml, zaslišimo šumenje. Alarm za zaznavo zraka se pojavi šele, ko zrak preide prek membrane oksigenatorja v arterijski del sistema. Ob 4500 obratih v minuti že 1 ml zraka preide v arterijski del sistema, pri večji količini zraka je za prehod zraka prek membrane oksigenatorja potrebno nižje število obratov. Že 25 ml zraka popolnoma zaustavi delovanje ECMO. Nezaščiten lumen CVK predstavlja potencialno vstopno mesto zraka v pacienta in ECMO sistem. Zaprt tripotni petelinček (TP) ali odprt TP z nameščenim enosmernim ventilom sta varna zaščita pred vstopom zraka prek CVK. Sklep: Dokazali smo, da zrak v ECMO sistemu predstavlja neposredno nevarnost za pacienta, ki od medicinske sestre (MS) zahteva takojšnje ukrepanje. Šumenje je prvi in najpomembnejši zgodnji opozorilni znak. Nezaščiten lumen CVK predstavlja potencialno vstopno mesto zraka v pacienta in ECMO. Varno zaščito lumna lahko zagotovimo s TP ali nepovratnim ventilom.
Keywords:	izven-telesna membranska oksigenacija, zračna embolija, urgentna komplikacija, simulacija.
Place of publishing:	Maribor
Publisher:	[N. Krašna]
Year of publishing:	2022
PID:	20.500.12556/DKUM-81488
UDC:	004.94:615.471(043.2)
COBISS.SI-ID:	110046211
Publication date in DKUM:	17.06.2022
Views:	823
Downloads:	91
Metadata:
Categories:	FZV
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Licences

License:	CC BY-NC-ND 4.0, Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International

Link:	http://creativecommons.org/licenses/by-nc-nd/4.0/
Description:	The most restrictive Creative Commons license. This only allows people to download and share the work for no commercial gain and for no other purposes.
Licensing start date:	01.04.2022

Secondary language

Language:	English
Title:	Simulation of air embolism effects on extracorporeal membrane oxygenation operation
Abstract:	Introduction: Air embolism is a possible complication of extracorporeal membrane oxygenation (ECMO) treatment. ECMO creates a negative pressure in the venous portion of the system and can draw in both air and blood. The air in the pump displaces the blood and stops its action. If it enters the patient through the oxygenator, it causes air embolism. Methods: In the theoretical part, we conducted a literature review. In the empirical part, 460 simulations were performed to investigate the effect of different air volumes at different pump speeds on ECMO performance and to test the possibility of air entry via the central venous catheter (CVC). Results: Even the smallest amount of air, 1 ml, produces a hissing sound. The air detection alarm occurs only when air passes through the oxygenator into the arterial part. At 4500 rpm, as little as 1 ml of air enters the arterial part, with larger amounts of air requiring a smaller number of rpm to pass through the oxygenator. As little as 25 ml of air stops ECMO completely. The unprotected lumen of the CVC is a potential entry point for air into the patient and the ECMO. A closed three-way stopcock or a three-way stopcock with a one-way valve is a safe protection against air entry via the CVC. Conclusion: We have shown that air in an ECMO system is a hazard to the patient requiering immediate action. A hissing sound is the first and most important early warning sign. An unprotected lumen of a CVC is a potential entry point for air into the patient and the ECMO. Safe protection of the lumen can be provided by a three-way stopcock or a one-way valve.
Keywords:	extracorporeal membrane oxygenation, air embolism, urgent complication, simulation.

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