Role and function of a nurse in patients undergoing endovasculare procedures of intracranial artery embolisation

Intrakranijalne aneurizme (IA) su vaskularne malformacije krvnih žila mozga. Dva su osnovna načina liječenja: neurokirurški zahvat (postavljanje kopče na vrat aneurizme kojom se aneurizma isključuje iz cirkulacije) i endovaskularni zahvat (isključivanje aneurizme iz cirkulacije, ubaci-vanjem različitog materijala u aneurizmu). Cilj liječenja IA je sprječavanje rupture. Dijagnoza se postavlja uzimanjem anamneze i neurološkog statusa uz pomoć radioloških pretraga: CT, CTA, DSA. Digitalna substrakcijska angiografija (DSA) je „zlatni standard“, jer se na taj način mogu otkriti i jako male aneurizme i mala krvarenja. Takav način liječenja je manje invazivan u odnosu na neurokirurški, s boljom prognozom i manjim morbiditetom i mortalitetom, stoga je zadnjih dvadesetak godina embolizacija postala dominantan način liječenja IA. Medicinska sestra ima važnu ulogu u samoj pripremi bolesnika za embolizaciju (psihička i fizička priprema), kao i zbrinjavanju bolesnika nakon zahvata. S obzirom da se radi o vitalno ugroženim pacijentima i složenosti poslova koje medicinska sestra izvršava od velike je važnosti da medicinska sestra ima odgovarajuće iskustvo, znanje i manualne vještine. U ovom radu opisani su zadaci koje medicinska sestra provodi prije i nakon endovaskularnog zahvata u KBC-u Zagreb, na Zavodu za intenzivnu neurologiju i cerebrovaskularne bolesti. Glavana ideja rada je razmjena iskustva sa ostalim medicinskim sestrama koje zbrinjavaju takve bolesnike, sa ciljem poboljšanja zdravstvene njege bolesnika misleći pritom prvenstveno na bolesnike sa rupturom aneurizme tj. subarahnoidalnim krvarenjem (SAH) i njihovo hitno zbrinjavanje. U radu je dan i kritički osvrt u poglavlju koje opisuje edukaciju medicinskih sestara, s ciljem da se ukaže koliko se zapravo ne pridaje ozbiljnosti poslova koje obavlja medicinska sestra kada je u pitanju uvođenje nekih novih metoda liječenja. Trenutno, sestre uče „u hodu“ dobivajući upute od liječnika.Intracranial aneurysms (IA) are vascular malformations of the blood vessels in the brain. There are two basic manners of treatment: a neurosurgical intervention (setting a clip on the neck of the aneurysm, thus excluding the aneurysm from the circulation) and endovascular intervention (excluding the aneurysm from the circulation by setting different material into the aneurysm). The goal of IA treatment is to prevent ruptures. Diagnosis is set by taking medical history and neurological status through radiological tests: CT, CTA, DSA. The DSA test is the “golden standard” because it can detect even very small aneurysms and bleeding. This manner of treatment is less invasive than neurosurgery, with better prognoses and lower morbidity and mortality, this is why, in the last two decades, embolisation has become the dominant way of treating IA. A nurse has an important role in the preparation of the patient for embolisation (psychological and physical preparation), as well as in the care for the patient after the intervention. Given that these are high-risk patients, with high complexity of the nurse's tasks, it is of great importance for the nurse to have appropriate experience, knowledge, and manual skills. This paper describes the nurse's task before and after endovascular intervention at Clinical Hospital Zagreb, at the Intensive Neurology and Cerebrovascular Diseases Institute. The main idea of the paper is to exchange experiences with other nurses who care for such patients, with the goal to improve the nursing of patients, primarily meaning patients with a rupture of aneurysm and their urgent care. The paper also provides a critical view in the issue describing the education of nurses, with the goal to point out how little attention is paid to the seriousness of the nurses' work when it comes to the introduction of new methods of treatment. At present, the nurses have to learn “in the way”, following the doctor's instructions