Show document

A+ | A- | | SLO | ENG

Title: Intraosalni pristop pri vitalno ogroženemu bolniku Authors: ID Grandovec, Urša (Author) ID Kren, Aljaž (Mentor) More about this mentor... Files: DIP_Grandovec_Ursa_2026.pdf (1,09 MB) MD5: 6105050E06FCEB18C9245512F411DC7A   Language: Slovenian Work type: Bachelor thesis/paper Organization: UNM FZV - University of Novo mesto - Faculty of Health Sciences Abstract: Teoretična izhodišča: Intraosalni pristop je hitra in učinkovita metoda zagotavljanja »žilnega« pristopa pri kritično bolnih, ko je vzpostavitev intravenoznega pristopa otežena ali nemogoča. Uporablja se predvsem v nujnih situacijah, kot so srčni zastoj, huda oblika šoka ali poškodba, ker omogoča hitro dajanje tekočin in zdravil. Namen raziskave je preučiti poznavanje intraosalnega pristopa pri vitalno ogroženem bolniku med zaposlenimi v nujni medicinski pomoči, raziskati pogostost tega pristopa v nujni medicinski pomoči, ugotoviti najpogosteje izbrana mesta in pripomočke za intraosalni pristop, prepoznati zaplete in izzive intraosalnega pristopa na terenu in definirati vlogo zaposlenih pri njem. Metode: Izvedli smo kvalitativno raziskavo s pomočjo polstrukturiranega intervjuja. Glede na cilje smo sestavili predlogo za intervju, ki je bila sestavljena iz dveh delov in je vsebovala 20 vprašanj. Prvi del se je nanašal na sociodemografske podatke intervjuvancev (spol, starost, delovna doba, izobrazba), drugi del pa na vprašanja, povezana s poznavanjem in uporabo intraosalnega pristopa, poznavanjem rokovanja z intraosalnimi pripomočki in najpogosteje izbranih mest, izzivov in zapletov ter vlogo zaposlenih pri uporabi intraosalnega pristopa v nujni medicinski pomoči. V raziskavo smo zajeli namenski vzorec 6 diplomiranih zdravstvenikov, ki imajo več kot eno leto delovnih izkušenj v nujni medicinski pomoči in izkušnje z uporabo intraosalnega pristopa. Rezultati: V raziskavi smo ugotovili, da zaposleni v nujni medicinski pomoči intraosalni pristop najpogosteje uporabijo pri reanimaciji in kadar ni mogoče vzpostaviti intravenskega pristopa. Potrebno znanje pridobivajo iz dela, izobraževanj, simulacij in samostojnega učenja. Kot glavni pripomoček uporabljajo EZ-IO, ki ga opisujejo kot hitrega, enostavnega in zanesljivega. Pri odraslih najpogosteje izberejo proksimalni humerus, pri otrocih pa proksimalno tibijo. Niso se še srečali z zapleti ali situacijami, ko intraosalni pristop ne bi bil primeren zaradi bolnika ali okoliščin, opozarjajo pa na nevarnost neustreznega poznavanja anatomije, postopkov, zapletov, nastanek kompartment sindroma in ekstravazacije. Odločitev za intraosalni pristop je samostojna; intravenski pristop ostaja prva izbira, medtem ko je intraosalni alternativa pri smrtno nevarnih stanjih. Udeleženci raziskave poudarjajo, da morajo biti zaposleni v nujni medicinski pomoči glede tega dobro usposobljeni in pripravljeni, ker je lahko intraosalni pristop v nujnih primerih, kjer šteje vsaka minuta, edina možnost. Razprava: Pri prvem raziskovalnem vprašanju ugotavljamo, da zaposleni v nujni medicinski pomoči dobro do zelo dobro poznajo intraosalni pristop; znanje pridobivajo z izobraževanjem, simulacijami, študijem, prakso in dodatnim samostojnim učenjem. Redno vadijo tudi manj pogoste postopke, kar jim omogoča hitrejše in varnejše ukrepanje v nujnih situacijah. Pri drugem raziskovalnem vprašanju se je pokazalo, da je uporaba intraosalnega pristopa v praksi redka, vendar ga udeleženci raziskave izvajajo v trenutkih, ko je ogroženo bolnikovo življenje in vzpostavitev intravenskega pristopa ni mogoča. Kot najpogostejše primere uporabe udeleženci navajajo reanimacijo, hude oblike šoka in politravmo. V okviru tretjega raziskovalnega vprašanja so udeleženci navedli, da se pri odraslih za pristop najpogosteje uporabi proksimalni humerus, pri otrocih pa proksimalna tibija, saj sta mesti dobro dostopni in varni. Kot pripomoček za izvedbo intraosalnega pristopa enotno navajajo pripomoček EZ-IO, ki omogoča natančno in hitro namestitev, medtem ko en udeleženec raziskave pripomoček BIG navaja kot manj natančnega zaradi »izstrelitvenega« mehanizma. Pri četrtem raziskovalnem vprašanju udeleženci ne poročajo o zapletih, kot največje nevarnosti pa navajajo neustrezno poznavanje anatomije, nepravilno izbira mesta, nepoznavanje postopka in sestave intraosalnega pripomočka, kompartment sindrom, namestitev na poškodovanem delu telesa in ekstravazacijo. Pri petem raziskovalnem vprašanju se je izkazalo, da je osebje nujne medicinske pomoči pri odločitvi za intraosalni pristop avtonomno. Znanje in usposobljenost sta nujno potrebna, saj lahko ostane ta pristop v primerih, ko ni mogoče vzpostaviti intravenskega pristopa, edina možnost. Intraosalni pristop tako ostaja druga izbira. Keywords: intraosalni pristop, intravenozni pristop, nujna medicinska pomoč, kritično bolni Year of publishing: 2026 PID: 20.500.12556/ReVIS-13158  Publication date in ReVIS: 06.02.2026 Views: 41 Downloads: 1 Metadata:    Cite this work Plain text BibTeX EndNote XML EndNote/Refer RIS ABNT ACM Ref AMA APA Chicago 17th Author-Date Harvard IEEE ISO 690 MLA Vancouver : Copy citation

Share: Hover the mouse pointer over a document title to show the abstract or click on the title to get all document metadata.

Secondary language

Language:	English
Title:	Intraosseous approach in the critically ill patient
Abstract:	Theoretical background: The intraosseous approach is a quick and effective method of ensuring "vascular" access in critically ill patients in whom establishing intravenous access is difficult or impossible. It is mainly used in emergency situations such as cardiac arrest, severe shock, or trauma, as it allows for rapid administration of fluids and medications.mThe purpose of the study is to determine the knowledge of emergency medical personnel about the intraosseous approach in critically ill patients, to determine the frequency of use of the intraosseous approach among emergency medical personnel, to determine the most frequently selected sites and devices for the intraosseous approach, to identify complications and challenges of the intraosseous approach in the field, and to determine the role of employees in the intraosseous approach. Methods: We conducted a qualitative study using semi-structured interviews. Based on our objectives, we developed an interview template consisting of two parts and containing 20 questions. The first part concerned the socio-demographic data of the interviewees (gender, age, length of service, education), while the second part concerned questions related to knowledge and use of the intraosseous approach, knowledge of handling intraosseous devices and the most frequently selected sites, challenges and complications in implementation, and the role of employees in the use of the intraosseous approach in emergency medical care. We included a purposive sample in the study, which included six registered nurses/health technicians who had more than one year of work experience in emergency medical services and who had experience with the intraosseous approach. Results: The study found that emergency medical service personnel most often use the intraosseous approach during resuscitation and when intravenous access cannot be established, drawing on knowledge gained from work, training, simulations, and independent learning. They use EZ-IO as their main tool, describing it as fast, easy, and reliable. In adults, they most often choose the proximal humerus, while in children they choose the proximal tibia. They have not yet encountered any complications or situations where the intraosseous approach would not be appropriate due to the patient or circumstances, but they warn of the danger of inadequate knowledge of anatomy, procedures, complications, compartment syndrome, and extravasation. The decision to use the intraosseous approach is made independently, with the intravenous approach remaining the first choice. while the intraosseous approach is an alternative in life-threatening situations. The study participants emphasize that emergency medical personnel must be well trained and prepared, as this approach may be the only option in emergency situations where every minute counts. Discussion: In the first research question, we find that emergency medical service employees have good to very good knowledge of the intraosseous approach, which they have acquired through training, simulations, study, practice, and additional independent learning. They also regularly practice less common procedures, which enables them to respond more quickly and safely in emergency situations. The second research question showed that the use of the intraosseous approach is rare in practice, but that the study participants use it in situations where the patient's life is at risk and it is not possible to establish an intravenous approach. The most common cases cited by participants are resuscitation, severe shock, and multiple trauma. In the third research question, participants stated that they most often use the proximal humerus in adults and the proximal tibia in children, as these sites are easily accessible and safe. As an aid for performing the intraosseous approach, they unanimously mention the EZ-IO device, which enables accurate and quick placement, while one participant in the study mentions the BIG device as less accurate due to its "ejection" mechanism. In the fourth research question, participants did not report any complications, but cited inadequate knowledge of anatomy, incorrect site selection, lack of knowledge of the procedure and composition of the intraosseous device, compartment syndrome, placement on an injured part of the body, and extravasation as the greatest risks. The fifth research question highlighted that employees play an important role in deciding on and performing the intraosseous approach, which they perform independently. Knowledge and training are essential, as this approach may be the only option in cases where intravenous access cannot be established. The intraosseous approach thus remains the second choice.
Keywords:	intraosseous approach, intravenous approach, emergency medical care, critically ill patients

Back