APPLICATION OF ANTICOAGULANT THERAPY IN SURGICAL PATIENTS

Teoretična izhodišča: Globoka venska tromboza (GVT) je resen zaplet, ki je posledica nastanka krvnega strdka, ki povzroči zaporo žilnega lumna. Z izvajanjem antikoagulantega zdravljenja lahko učinkovito preprečujemo VT pri bolnikih, ki ležijo na kirurških oddelkih. Preprečevanje izvajamo z mehanskimi in farmakološkimi metodami, vendar so zadnje dokazano bolj učinkovite. V zadnjih letih se v veliki meri poslužujemo heparina, katerega namen je redčenje krvi, prednost pa ta, da ima malo stranskih učinkov. Bolnikom ga s pomočjo injekcij apliciramo v podkožje v nizkih odmerkih ob upoštevanju standarda zdravstvene nege. Medicinska sestra je kompetentna za dajanje medikamentozne terapije in ukrepanje ob morebitnih zapletih. Biti mora strokovno podkovana in odgovorna, njena dolžnost pa je, da bolnika pouči o samoaplikaciji heparinskih pripravkov in preveri ustreznost njegovega znanja. Metodologija: V diplomskem delu je bila uporabljena deskriptivna metoda dela. Pregledali smo domačo in tujo literaturo, avtorske prispevke v strokovnih revijah, strokovne članke ter zbornike. S študijem literature smo povzemali in primerjali različna dejstva o določeni tematiki. Rezultati: Ugotovili smo, da je najuspešnejša preventiva pred nastankom krvnih strdkov uporaba nizkomolekularnih heparinov (NMH), ki so enostavni za uporabo. Pomembna je njihova pravilna aplikacija, saj lahko ob nestrokovnem ravnanju pride do zapletov za bolnika. Ključnega pomena je poznavanje mesta aplikacije in pravilnega postopka vbrizgavanja. Diskusija in zaključek: Kirurški bolniki so ogroženi za nastanek VT predvsem zaradi operativnega posega, prav tako pa tudi osebnih značilnosti in življenjskega sloga. Začetek in trajanje profilakse je odvisen od vrste operacije, vendar se je izkazalo, da je najbolj učinkovit način ta, da prvi odmerek zdravila bolnik dobi po operaciji in ga nato prejema redno enkrat dnevno. Strokovni in varni način aplikacije je v področju abdomna, saj je na tem mestu veliko podkožnega tkiva in s tem manjša možnost komplikacij. Medicinska sestra je pacienta dolžna izobraziti za samoaplikacijo po odhodu v domače okolje.Theoretical framework: Deep vein thrombosis (DVT) is a serious complication that occurs as a result of a blood clot causing an obstruction of the vascular lumen. With the introduction of anticoagulation therapy, DTV can be effectively prevented in inpatients in surgical wards. Prevention is performed by mechanical and pharmacological methods, however the latter have proven to be more effective. In recent years we have extensively made use of a blood thinner heparin which has the least adverse effects. It is injected to the patients subcutaneously in low doses, taking into account the healthcare standards. A nurse is competent in administrating the medical therapy and responding to potential incidents. He or she has to be professionally educated and responsible, and has to teach the patients to self-administer the heparin preparations and verify their knowledge. Methodology: The descriptive method of research was used in this diploma thesis. We reviewed the domestic and foreign literature, articles in scientific journals, expert articles and collections of scientific papers. By studying the literature we have summarised and compared different facts on a specific topic. Results: We have concluded that the most effective prevention before the occurrence of blood clots is the use of low molecular weight heparins (LMWH) which are convenient to use. Correct application is important, as unprofessional handling leads to complications. It is crucial to recognise the injection site and to follow the correct injection process. Discussion and conclusion: Surgical patients are at risk of developing DVT mainly due to surgery, as well as personal characteristics and lifestyle. The onset and duration of prophylaxis depends on the type of surgery, however it was shown that the treatment is the most effective if the patient receives the first dose of medicine after the surgery and then continues to receive daily doses. Professional and safe method of application is in the abdominal area, because the high amount of subcutaneous tissue in this area reduces the risk of complications. A nurse is required to educate the patient to self-administer the medicine in their home environment